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Elderly Pharmaceutical Insurance Coverage (EPIC) [1] [2] [3] ("New York State's Senior Prescription Plan") [4] was designed so that personal/out-of-pocket costs for medicines are reduced or largely paid for program participants by the state. [1] Members are also given assistance with Medicare Part D. [5]
By the end of the century, less than one-third of drug spending was paid out-of-pocket. Despite the absence of a Medicare drug benefit, about 70% of Medicare enrollees obtained drug coverage through other means, often through an employer or Medicaid. [36] Medicare began offering subsidized outpatient drug coverage in the mid-2000s.
The benefit is funded in a complex way, reflecting diverse priorities of lobbyists and constituencies. It provides a subsidy for large employers to discourage them from eliminating private prescription coverage to retired workers (a key AARP goal); It prohibits the federal government from negotiating discounts with drug companies;
In these states, only one payment is made to include both the SSI and the SSP, combining federal and state benefits. In some states, SSP is dually administrated. Social Security administers some categories of State supplement payments, while the State administers other categories of supplemental payments.
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Enrollees reaching the coverage gap stayed in the gap for just over four months on average. [13] According to a study done in 2007, premiums for plans offering gap coverage are roughly double those of defined standard plans. The average monthly premium for stand-alone Part D plans (PDPs) with basic benefits that do not offer gap coverage is $30.14.