Older adults on Medicare still pay part of their prescription costs out of pocket. Caregivers see the result at the pharmacy counter, when a parent skips a refill or splits pills to make a bottle last longer. New York State runs a program that covers part of what Medicare does not pay.
How EPIC Works With Medicare
Medicare Part D is the prescription drug coverage that older adults buy as part of Medicare. It pays for most prescriptions, but it does not pay all of the cost, and the older adult pays whatever Part D does not.
EPIC is the program that covers part of that remaining amount. It is not insurance, and it does not replace Part D. It works alongside Part D, which is why the older adult must have a Part D plan before EPIC will pay anything.
At the pharmacy, the older adult shows both cards and tells the pharmacist that Medicare Part D is the primary coverage. The pharmacist sends the claim to Part D first and to EPIC second. The older adult then pays a small amount, either $3, $7, $15, or $20, depending on the price of the drug.
Who Qualifies
EPIC is open to New York residents who are 65 or older. A single person qualifies if their income last year was $75,000 or less. A married couple qualifies if their combined income last year was $100,000 or less.
Three groups cannot join the program. Older adults who receive full Medicaid are not eligible. Older adults who cannot enroll in a Medicare Part D plan are not eligible either, and this includes anyone whose drug coverage comes from a union or a retiree plan rather than from Part D. Finally, an older adult with a Medicare Advantage plan can only join EPIC if that plan includes Part D drug coverage.
The Two Plans
EPIC has two versions, and an older adult’s income determines which one they receive. The difference between them is how soon their prescription costs go down.
An older adult on the Fee Plan pays a yearly fee, and their prescription costs go down immediately. An older adult on the Deductible Plan pays nothing to join, but they continue paying full price for their prescriptions until their spending reaches the deductible amount. EPIC keeps track of that spending for them.
Married couples should read the schedule carefully, because the income figure is combined but the costs are not. Each spouse pays their own yearly fee, and on the Deductible Plan, each spouse meets their own deductible.
One detail catches families by surprise. Some Part D plans have their own deductible that must be met before the plan begins paying. Money the older adult spends during that period does not count toward the EPIC deductible.
Help With the Monthly Premium
A Medicare Part D plan charges a monthly premium, and the older adult normally pays it.
EPIC pays that premium for older adults whose income was $23,000 or less if single, or $29,000 or less if married. In 2026, EPIC covers up to $58.82 a month.
Older adults who earn more than those amounts pay their own premium. To help with that cost, EPIC lowers their yearly deductible by about $706, which is roughly what a basic Part D plan costs over a year.
An older adult who receives full Extra Help from Medicare pays no EPIC fee at all.
What EPIC Covers and What It Does Not
EPIC covers new prescriptions and refills, both brand name and generic drugs, and insulin along with syringes and needles. It also covers a few kinds of drugs that Part D refuses to cover, including prescription vitamins and prescription cough and cold preparations.
EPIC does not cover medicines sold without a prescription, such as aspirin or over-the-counter vitamins. It does not cover medical devices or supplies, which means test strips, glucometers, walkers, wheelchairs, eyeglasses, and oxygen fall outside the program. Medicare itself may cover some of those items, so it is worth asking.
EPIC also will not pay for a prescription filled outside New York State, or filled at a pharmacy that does not participate in the program. The older adult should use a pharmacy that participates in both EPIC and their Part D plan, and should confirm this before filling a prescription there.
How to Apply
Applications are accepted on any day of the year, and a caregiver can complete one on a parent’s behalf.
The EPIC application form can be printed and filled out by hand, completed online, or requested by telephone. It comes in fourteen languages, including Spanish, Chinese, Bengali, Haitian Creole, Korean, Russian, and Urdu.
Coverage always ends on December 31, no matter when the older adult enrolls. Every two years, EPIC asks for updated information and may request proof of income.
If EPIC denies an application, the older adult can ask the program to reconsider. EPIC responds in writing, and anyone who still disagrees has the right to a hearing before an independent judge.
Where to Get Help
The EPIC Helpline answers questions at 1-800-332-3742, or 1-800-290-9138 for TTY, from 8:00 AM to 5:00 PM Monday through Friday. The same number handles lost cards and cancellations.
Free Medicare counseling is available in New York City through the HIICAP program. Call Aging Connect at 212-244-6469 and ask for HIICAP.
Sources: New York State Department of Health, EPIC Program eligibility, drug coverage, and application pages; 2026 EPIC Program Highlights including the Fee Plan and Deductible Plan schedules.