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Get ready for changes in EPIC

The Seniors Page

Just a reminder that as of July 1,2011, EPIC will pay your prescription plan monthly premiums if your income is less than $23,000 (singles) and $29,000 (couples) per year. However, EPIC will only pay up to $38.69 per month (this amount is for 2011) for your plan. If your monthly premium is higher than $38.69 per month, you will be responsible for paying the balance. Members with higher annual incomes are still eligible for EPIC but are responsible for paying their monthly prescription plan premium.

Also, effective July 1, 2011, an additional deductible of $464 will be applied to all current members in the “Deductible” program. The $464 credit towards a member’s deductible was intended to cover the cost of the member’s prescription plan premium, but this credit is eliminated. This means you will be responsible for meeting an additional $464 towards your deductible, even if you have already met your EPIC deductible this year.

BEGINNING JANUARY 1, 2012:

  1. FREE MEMBERSHIP. The new EPIC program will be free to all members. There will be no EPIC fees or deductibles.

  2. DRUG COVERAGE: EPIC will only offer prescription coverage when a member reaches the Medicare Part D coverage gap (Donut Hole). This is, your EPIC co-pays will not be in effect until you reach the Donut Hole.

  3. PRESCRIPTION PLAN ENROLLMENT: All EPIC members must be enrolled in a prescription plan in order to maintain EPIC coverage. Members in a Medicare Advantage plan that does not have prescription coverage will have to join a plan that includes prescription coverage or join a separate prescription plan.

EFFECTIVE JANUARY 1, 2012, EPIC WILL NO LONGER BE CONSIDERED CREDITABLE COVERAGE. EPIC WILL ONLY SUPPLEMENT YOUR PRESCRIPTION COVERAGE, NOT REPLACE IT.

HIPPA (The Privacy Rule) DICTIONARY

PHI - Protected health information - Information contained within a health record, such as personal identifiers; health care provider’s medical notes and billing records, health plan enrollment, payment or claims; other information that can or is used to make decisions about the individual.

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