Prescription costs have a way of sneaking up on people. A refill here, a new medication there, and suddenly the pharmacy counter becomes the least fun part of the week.
New Yorkers 65 and older may have a state benefit worth checking before they resign themselves to paying every Medicare drug bill alone.
The Elderly Pharmaceutical Insurance Coverage program, better known as EPIC, helps more than 325,000 income-eligible seniors across the state supplement their out-of-pocket Medicare Part D prescription costs, according to the New York State Department of Health.
EPIC is not a replacement for Medicare. It works alongside a Medicare Part D drug plan, potentially helping with prescription costs after the Part D deductible is met, and it can also cover certain approved drugs excluded from Part D.
Unlike plenty of benefits that seem to vanish the second you hear about them, New Yorkers can apply for EPIC at any point during the year.
We break it down here on how to take advantage.
What is EPIC?
EPIC is a New York State prescription-assistance program administered by the Department of Health. It acts as secondary coverage for eligible older adults who have, or can enroll in, Medicare Part D prescription-drug coverage.
That means Medicare Part D pays first. Once the member has met their Part D deductible, EPIC can help cover costs for Part D-covered medicines and certain approved drugs excluded from Part D, including some prescription vitamins and cough-and-cold preparations. New York State’s EPIC drug-coverage guidance explains the program’s wraparound coverage.ny
For 2026, EPIC also provides Medicare Part D premium support for some lower-income members.
The state says it will pay Part D premiums up to $58.82 per month, the average cost of a basic Part D plan in New York, for eligible members with annual income up to $23,000 for an individual or $29,000 for a married couple.
Who can qualify for EPIC?
- You may qualify for EPIC if you meet all of these requirements:
- You are 65 or older
- You are a New York State resident
- Your annual income is below $75,000 if single or $100,000 if married
- You are enrolled in, or eligible to enroll in, a Medicare Part D prescription-drug plan
- You are not receiving full Medicaid benefits
The income calculation is based on the previous calendar year’s household gross income. It can include adjusted gross income, Social Security payments after Medicare premiums, retirement income, tax-exempt interest, workers’ compensation, and other sources listed in the state’s eligibility guidance.
Medicare Advantage members can participate only when their plan includes Part D drug coverage. Seniors who are accepted into EPIC but do not have a Part D plan can receive a Special Enrollment Period to choose one, though EPIC benefits do not begin until the person is enrolled in Part D.
How the two EPIC plans work
EPIC has two plans, based on income. The basic idea is straightforward: lower-income members use the Fee Plan, while higher-income eligible members use the Deductible Plan.
The EPIC Fee Plan
The Fee Plan is for single New Yorkers with annual incomes up to $20,000, or married couples with annual incomes up to $26,000.
Members pay an annual fee based on income, billed in quarterly installments. For 2026, annual fees range from $8 to $300. After meeting their Medicare Part D deductible, Fee Plan members pay EPIC copays for covered prescriptions, generally ranging from $3 to $20, depending on the medication’s cost.
Lower-income Fee Plan members may also qualify for help with their Medicare Part D monthly premium. For 2026, EPIC can pay premiums up to $58.82 per month for eligible individuals earning up to $23,000 or married couples earning up to $29,000.
The EPIC Deductible Plan
The Deductible Plan is for single New Yorkers earning between $20,001 and $75,000 per year, or married couples earning between $26,001 and $100,000.
There is no fee to join the Deductible Plan. Instead, members pay the amount charged by their Medicare Part D plan for prescriptions until they reach an annual EPIC deductible based on their income. For 2026, that deductible ranges from $530 to $2,430 for individuals and can reach $3,215 for married couples.
Once the deductible is met, members pay EPIC copays for covered medications, generally from $3 to $20 per prescription.
The important distinction
EPIC is not a flat, instant discount that automatically covers every prescription. What a member pays depends on their income, which EPIC plan they are assigned to, their Medicare Part D coverage, the specific medication, and whether applicable deductibles have been met.
How to apply
There is no seasonal application window to chase. Seniors can apply for EPIC at any time of year, either online or with a paper form.
The Department of Health says applicants do not need to send supporting documentation with their application. EPIC verifies information through the Social Security Administration and the New York State Department of Taxation and Finance, meanign you can start an EPIC application or find the printable form anytime through the New York State Department of Health.
You can also request an application or get enrollment help by calling the EPIC Helpline at 1-800-332-3742, Monday through Friday from 8 am to 5 pm. TTY users can call 1-800-290-9138. New York State’s EPIC FAQ has application instructions, including the mailing address and fax number for paper applications.
A good time to check eligibility
EPIC is worth exploring now, particularly before Medicare’s annual fall enrollment season becomes another tab-opened, deadline-filled undertaking.
Being accepted into EPIC can give a qualifying senior a Special Enrollment Period to enroll in a Medicare Part D plan, though the person must actually enroll in Part D before EPIC benefits begin.
The program will not be the right fit for everyone. But for an eligible New Yorker 65 or older, it can add a meaningful layer of help between Medicare coverage and the cost of keeping prescriptions filled.
For personalized, free help understanding Medicare options, New Yorkers can contact the state’s Health Insurance Information, Counseling and Assistance Program, or HIICAP. It is particularly useful for comparing Part D plans, reviewing EPIC eligibility, and avoiding the accidental fine-print chaos that comes with trying to decode prescription coverage alone.