Plan Discontinued + Missed Deadline in NY: How She Still Got Coverage Starting July 1 (EPIC SEP)
REVIEWED & VERIFIED BY
Nolan Popel
- Licensed Medicare Advisor
- 17+ Years Experience
- Independent Medicare Specialist
This content has been reviewed by a licensed, independent Medicare specialist for accuracy and compliance. We work for you, not the insurance companies
Direct Answer:
CTА:
A real case study from The Popel Insurance Group. Names and identifying details omitted for privacy.
- The Problem
- What We Found
Once we walked through her income during the free consultation, it became clear she qualified for
CTА:
EPIC (Elderly Pharmaceutical Insurance Coverage) – a New York State assistance program that
helps seniors pay for prescription drugs. The previous agent had never asked the right income
questions to catch it.
- What That Unlocked
Enrollment in a state pharmaceutical assistance program like EPIC triggers a Special Election
Period (SEP) under Medicare rules. That meant she could enroll in a new Medicare Advantage or
Part D plan outside of AEP.
• Enrolled her in EPIC
• Used the SEP to select a new Medicare plan that fit her doctors and medications
• Locked in a July 1 effective date -no waiting until 2027
- The Outcome
- Avoided being uninsured for months during active medical treatment
- Coverage started July 1 instead of January 2027
- Added prescription cost help through EPIC on top of her Part D coverage
- Peace of mind- and a clear next step
Why This Case Matters
Most seniors – and even many agents – don’t know that qualifying for a state pharmaceutical assistance program like EPIC creates a Special Election Period. If you’re told “you have to wait until annual enrollment,” that may not be true. It’s worth a second opinion from an independent, licensed advisor who is willing to dig into every possible special election period before giving up.
Common Situations That May Still Have Options
• Your Medicare Advantage or Part D plan was discontinued for the new year
• You missed the Annual Enrollment Period (Oct 15- Dec 7)
• Your prescription costs jumped and your current plan no longer fits
• You qualify (or might qualify) for EPIC, Extra Help / LIS, or Medicaid
• You moved, lost employer coverage, or your income changed
- Think you may still have options?
If your plan ended, you misseda deadline, or your prescriptions got expensive, requesta free
review. A licensed agent from The Popel Insurance Group will look at every SEP you may qualify
for- including EPIC and Extra Help.
- Frequently Asked Questions
Medicare is a federal health insurance program for people aged 65 and older. You may also qualify if you're under 65 and have a qualifying disability or End-Stage Renal Disease (ESRD). Eligibility typically starts three months before your 65th birthday and continues for a total of seven months.
- Part A: Hospital insurance (inpatient care, skilled nursing, hospice)
- Part B: Medical insurance (doctor visits, outpatient care, preventive services)
- Part C (Medicare Advantage): All-in-one alternative to Original Medicare, often includes dental, vision, and wellness programs
- Part D: Prescription drug coverage
Original Medicare includes Part A and Part B and allows you to see any provider that accepts Medicare. Medicare Advantage plans are offered by private insurance companies and may offer additional benefits like dental, vision, hearing, and gym memberships. They often have network restrictions.
Prescription drug coverage is not included in Original Medicare. You can get coverage through a standalone Part D plan or through a Medicare Advantage plan that includes drug coverage.
Part A is usually premium-free if you or your spouse paid Medicare taxes while working. Part B requires a monthly premium. Part C and Part D costs vary depending on the plan. You may also have deductibles, copays, or coinsurance.
