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  • Nys Doh-5080 Epic Application - Ee Brokers

Get Nys Doh-5080 Epic Application - Ee Brokers

AndMedicareWorking Together What is EPIC?Medicare Part D EnrollmentThe Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State program administered by the Department of Health.

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How to fill out the NYS DOH-5080 EPIC Application - EE Brokers online

Filling out the NYS DOH-5080 EPIC Application is crucial for seniors seeking assistance with Medicare prescription drug costs. This guide provides a step-by-step approach to complete the application accurately and efficiently online.

Follow the steps to complete your application successfully.

  1. Press the ‘Get Form’ button to access the application form. The form will open in your preferred online editor where you can start filling it out.
  2. Enter your personal details in the sections provided, including your full name, date of birth, social security number, and address. Ensure that the information matches your Medicare information.
  3. Indicate if you are applying for yourself only, or if it is a joint application with your spouse. Fill out your spouse's details if applicable.
  4. Report your yearly income from the previous calendar year, and if married and living together, report combined income.
  5. Review the certification section carefully. This is where you acknowledge that the information provided is correct and complete. You and your spouse (if applicable) need to sign and date the form.
  6. Once you have filled out the entire form, save your changes. You can choose to download, print, or share the application for final review before submission.

Complete your NYS DOH-5080 EPIC Application online today and ensure you receive the benefits you deserve.

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If your income is between $20,001-$23,000 and you are single, or $26,001-$29,000 and you are married: You will not have to pay an annual fee to have EPIC. EPIC will pay your Part D premium up to the state benchmark ($38.90/month in New York in 2023).

EPIC operates a toll-free Helpline which is available from 8:00AM 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.

Members pay an annual fee to EPIC ranging from $8 to $300 based on their prior year's income (see Fee Plan schedule). This fee is billed in quarterly installments or can be paid annually. After any Part D deductible is met, if the member has one, Fee Plan members only pay the EPIC co-payment for drugs.

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. EPIC also covers many Medicare Part D excluded drugs.

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.

It provides seniors with co-payment assistance for Medicare Part D covered prescription drugs after any Part D deductible is met. EPIC also covers many Medicare Part D excluded drugs. Fee Plan members pay an annual fee to EPIC based on their income. The EPIC co-payments range from $3-$20 based on the cost of the drug.

You must meet the eligibility requirements for the EPIC program: be 65 years old or older, be a New York State Resident, and. have income up to $75,000 for a single person or up to $100,000 for a married couple living together.

How Much Does Epic Unlimited Cost? The answer to how much Epic cost is that the price of an Epic EMR system starts from $1200 and goes over $500,000, depending on the features you choose.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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