THE SHORT ANSWER

EPIC (Elderly Pharmaceutical Insurance Coverage) is a New York State program that helps residents 65 and older pay what their Medicare Part D drug plan doesn't. You qualify with prior-year income up to $75,000 if single or $100,000 if married, as long as you're enrolled (or eligible to enroll) in Part D and don't get full Medicaid. Once you're in, most prescriptions cost $3, $7, $15 or $20. You can apply any time of year, online or by mail, with no documents required in most cases. [1][2][3]

Who qualifies[3]

  • New York State resident (your permanent home, not a seasonal one) age 65 or older

  • Annual income below $75,000 single or $100,000 married (based on the previous year)

  • Enrolled, or eligible to enroll, in a Medicare Part D plan. No exceptions: people without Part A or B, or with a union/retiree drug plan that isn't Part D, can't join

  • Not receiving full Medicaid benefits

  • Medicare Advantage members can join only if their plan includes Part D drug coverage

Under 65 on Medicare disability? EPIC says you don't qualify yet and suggests your local Office for the Aging for other help [6].

The two EPIC plans (2026)[2]

Fee Plan Deductible Plan
Income (single) Up to $20,000 $20,001 to $75,000
Income (married, joint) Up to $26,000 $26,001 to $100,000
What you pay EPIC Annual fee of $8 to $300, billed quarterly or paid at once No fee to join
Before copays start Nothing beyond any Part D deductible You pay full Part D price until you meet an annual EPIC deductible of $530 to $3,215 (married amounts are per person)
Part D premium EPIC pays it up to $58.82/month in 2026 EPIC pays it up to the basic-plan average if income is up to $23,000 single / $29,000 married; above that you pay the premium and EPIC lowers your deductible by about $706

People with full Extra Help from Medicare have their EPIC fees waived [2].

Drug costs during your Part D deductible phase don't count toward the EPIC deductible [2].

What you pay at the pharmacy[4]

Show both your Part D card and your EPIC card. EPIC's copay depends on what's left after Part D pays:

Cost left after Part D EPIC copay
Up to $15 $3
$15.01 to $35 $7
$35.01 to $55 $15
Over $55 $20

EPIC also covers approved drugs that Part D excludes, such as prescription vitamins and prescription cough and cold medicines, once you're enrolled in Part D [5].

What counts as income[3]

EPIC uses the previous year's household gross income. It includes federal adjusted gross income, Social Security (minus Medicare premiums), the taxable part of IRA and annuity distributions, SSI, tax-exempt interest, veterans' disability pensions and lottery winnings, among others. It does not include SNAP (food stamps), Medicare premiums, Medicaid, scholarships or grants.

Tip for families: it's withdrawals that count, not account balances [6]. EPIC has no asset test on its eligibility page [3].

How to apply[1][7][8]

  1. Online: the EPIC portal (register with an email and password; you can save a draft).

  2. Paper: download the application (English, Spanish and 14 other languages) and mail it to EPIC, P.O. Box 15018, Albany, NY 12212-5018, or fax (518) 452-3576 [6].

  3. Phone: EPIC Helpline 1-800-332-3742 (TTY 1-800-290-9138), weekdays 8 AM to 5 PM.

Good to know:

  • No documentation is needed in most cases; EPIC checks with Social Security and NYS Tax [1]. If you already get Extra Help or a Medicare Savings Program, upload your determination letter [7].

  • EPIC uses your answers to apply for federal Extra Help on your behalf; that's required by law [7].

  • A family member acting as authorized representative must upload the Power of Attorney [7].

  • Married couples don't have to apply at the same time [7].

  • EPIC doesn't tell you online which plan you landed in; call the Helpline [7].

EPIC and Medicare open enrollment

Medicare's annual open enrollment runs October 15 to December 7 [9]. If you're comparing Part D plans, keep EPIC: it's secondary coverage that works with any Part D plan. If you join EPIC mid-year, you get a Special Enrollment Period to join a Part D plan, and you don't get EPIC benefits until you're in one [3].

Questions families ask

What are the EPIC income limits for 2026?

Up to $75,000 for a single person or $100,000 for a married couple, based on the previous year's income [2].

Does EPIC replace Medicare Part D?

No. Part D stays your primary drug coverage and you must stay enrolled; EPIC pays secondary [5].

How much are EPIC copays?

$3, $7, $15 or $20, depending on the drug's cost after Part D [4].

Can I get EPIC if I have Medicaid?

Not if you receive full Medicaid benefits [3].

Can I apply for EPIC any time?

Yes, applications are accepted year-round [1].

Does EPIC count my savings?

EPIC's eligibility rules are based on income; retirement account withdrawals count, not balances [3][6].

Keep exploring

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Sources & dates

  1. NYS DOH, EPIC program overview: www.health.ny.gov
  2. NYS DOH, EPIC 2026 Program Highlights (fee and deductible schedules): www.health.ny.gov
  3. NYS DOH, EPIC Eligibility Requirements: www.health.ny.gov
  4. NYS DOH, EPIC Co-payments: health.ny.gov
  5. NYS DOH, EPIC Fee Plan (how EPIC works with Part D): www.health.ny.gov
  6. NYS DOH, EPIC general FAQ: health.ny.gov
  7. NYS DOH, EPIC Online Enrollment FAQ: www.health.state.ny.us
  8. NYS DOH, EPIC Application and Contact Information: www.health.ny.gov
  9. Medicare.gov, Joining a plan (open enrollment dates): www.medicare.gov

Sources checked 2026-10; page published 2026-10-31. General education only, not legal or financial advice.