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C/o Name (if di?erent from above) Female Address Where You Live (not P.O. Box) City Last Name Your Date of Birth Month Day State DOH-5080 (Page 1 of 2) 1/14 ZIP Address Where You Get Your Mail (if.

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be a New York State resident age 65 or older. have an annual income below $75,000 if single or $100,000 if married. be enrolled or eligible to be enrolled in a Medicare Part D plan (no exceptions), and. not be receiving full Medicaid benefits.

EPIC helps pay the Medicare Part D drug plan premiums for members with income up to $23,000 if single or $29,000 if married. Higher income members are required to pay their own Part D premiums but EPIC provides premium assistance by lowering their EPIC deductible. EPIC has two plans based on income.

The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State Program administered by the Department of Health. It provides seniors with co-payment assistance for Medicare Part D covered prescription drugs after any Part D deductible is met.

The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State program for seniors administered by the Department of Health. It helps more than 337,000 income-eligible seniors aged 65 and older to supplement their out-of-pocket Medicare Part D drug plan costs.

EPIC operates a toll-free Helpline which is available from 8:30AM to 5:00PM, Monday through Friday. Call 1-800-332-3742 (TTY 1-800-290-9138) for more information or to request an application. Or email us at: nysdohepic@magellanhealth.com.

EPIC is available to New York State residents who: Are 65 years or older. Have annual incomes below $75,000 if single or $100,000 if married. Do not receive full Medicaid benefits.

EPIC operates a toll-free Helpline which is available from 8:30AM to 5:00PM, Monday through Friday. Call 1-800-332-3742 (TTY 1-800-290-9138) for more information or to request an application. Or email us at: nysdohepic@magellanhealth.com.

The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State program for seniors administered by the Department of Health. It helps more than 337,000 income-eligible seniors aged 65 and older to supplement their out-of-pocket Medicare Part D drug plan costs.

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Get The EPIC Application - New York State Department Of Health - Health Ny
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
The EPIC Application - New York State Department Of Health - Health Ny
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2022 NY DOH-5080
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  • Online Application For Epic For Elderly Form
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