Two programs help eligible Pennsylvania residents age 65 or older pay for their prescription drugs.
These are the Pharmaceutical Assistance Contract for the Elderly (PACE) and the PACE Needs Enhancement Tier (PACENET). Both programs are funded by the proceeds from the sale of Pennsylvania Lottery tickets and administered by the Pennsylvania Department of Aging.
About 300,000 Pennsylvanians are receiving prescription drug assistance through PACE / PACENET, and thousands more seniors will now be eligible for assistance programs in 2022.
Last December, Governor Tom Wolf enacted two bipartisan bills that adjust income limits for the PACE and PACENET programs. One of the new laws ensures that older Pennsylvanians who were enrolled in these programs as of December 30, 2020 will remain eligible regardless of the 5.9% increase in the cost of living of their Social Security benefits until the end of 2023. The other law increases the income limits for PACENET for the first time since 2018. Now singles with incomes up to $ 33,500 and married couples with incomes up to $ 41,500 will be eligible for PACENET. These limits were $ 27,500 for singles and $ 35,500 for married couples.
Increases in the income limit mean an additional 100,000 seniors are now eligible to participate in PACE / PACENET, according to the Pennsylvania Department of Aging. An additional 20,000 seniors are expected to enroll in 2022.
PACE / PACENET EXPLAINED
You are eligible for PACE if you have resided in Pennsylvania for at least 90 consecutive days prior to application; you are 65 years of age or older; and you had a total income for the previous calendar year of less than $ 14,500 for a single person, or less than $ 17,700 combined for a married couple living together.
You are eligible for PACENET if you have resided in Pennsylvania for at least 90 consecutive days prior to application; you are at least 65 years of age or older; and you had a total income for the previous calendar year of up to $ 33,500 for a single person and up to $ 41,500 for a married couple. PACE and PACENET work with and complement the coverage you may already have, including Medicare Part D prescription drug coverage, retiree and union coverage, employer plans, and veterans benefits.
Assets, such as the value of the home, vehicle, and savings, are not considered factors in determining eligibility, and Medicare Part B premiums are also excluded. You are not eligible for any of these programs if your prescription drug costs are covered by Medicaid.
The benefits for both of these programs are significant. PACE members pay a co-payment of $ 6 for each generic prescription filled by the pharmacist, or $ 9 for brand name drugs. Once PACENET members reach the deductible amount of $ 40 per month (cumulative to $ 480 per year), they are responsible for a co-payment of $ 8 for generic prescription drugs and $ 15 for brand name prescription drugs.
For those with other prescription drug coverage, PACE pays only the portion of your drug costs that is not covered by your current plan. PACE is the payer of last resort. For those with PACENET, the amount your insurance company pays for your prescriptions does not count towards your deductible, but any co-pay you make under your other plan does.
Do not confuse the above programs with Medicare PACE (Program of All Inclusive Care for the Elderly) which is a comprehensive care program that is not limited to prescription-only assistance.
If you receive PACE or PACENET, you will have a unique “Special Enrollment Opportunity” to change your Medicare Part D plan within the first 9 months of the calendar year.
Eligible PACE / PACENET members with Medicare Part D have “donut hole” coverage.
You will no longer be covered by PACE / PACENET if you move to another state.
Only drugs that require a medical prescription to be dispensed are covered. Insulin, insulin syringes, and insulin needles are the only exceptions. Over-the-counter drugs such as aspirin, antacids, vitamins, etc., and investigational drugs are not covered, even if prescribed.
Enrollment in the PACE program is free. PACENET participants may have to pay a monthly premium at the pharmacy.
If your application is denied or your PACE benefits are terminated by the Department of Aging, you have the right to appeal to the Department for a review of your case.
USE A PACE AND PACENET CARD
You must present your card and prescriptions at all pharmacies participating in the PACE and PACENET programs. Virtually all pharmacies located in Pennsylvania participate. Out-of-state pharmacies cannot participate. Medicines cannot be shipped outside of Pennsylvania.
PACE AND PACENET REQUEST
You can obtain a request from your local aging agency, pharmacy, or legislature’s office, or call Cardholder Services at (800) 225-7223.
Fill out the form and send it along with proof of age, income and residency to the PACE program.
You can apply 30 days before your 65th birthday. You can also get an application from the Department of Aging website. Click on this link www.aging.state.pa.us.
Your card is only valid for the period indicated on the face of the card. You will automatically receive your renewal request in the mail approximately two months before your card expires.
It will not be necessary to provide proof of age or residency documents with your renewal application. If you remain eligible, you will receive your new card before your current card expires.
(Joel Mekler is a Certified Senior Advisor. Email your Medicare questions to firstname.lastname@example.org)