Pennsylvania PACE and PACENET Programs – 2020: Help with Medicare Part D in PA

Pennsylvania PACE and PACENET Programs: Help with Medicare Part D in PA

UPDATED Nov. 28, 2020.   There are two State Pharmaceutical Assistance Programs (SPAPs) in Pennsylvania: Pennsylvania PACE and Pennsylvania PACENET.  They provide low-cost prescription drugs to qualified Pennsylvania residents age 65 and older.

Enrollment in Medicare Part D  is not a requirement for PACE or PACENET participants. However, both may be coupled with Medicare Part D – a recommended course of action.

Pennsylvania PACE (Pharmaceutical Assistance Contract for the Elderly)

  • Eligibility

– Age 65 and older; and

– A Pennsylvania resident for at least 90 days; and

– Cannot be enrolled in Medicaid; and

Annual income must be less than $14,500 for individuals and less than $17,700 for married couples. Income qualification is based on the prior year’s salary and includes taxable and non-taxable sources. Assets, such as the value of the home, vehicle, and savings are not considered as factors determining eligibility. Medicare Part B premiums are also excluded.

  • Benefits

– Drug cost will be no more than $6.00 for a generic drug; $9.00 for brand name drug

– With Part D and PACE enrollments, cardholders receive help with:

a). Part D premium (up to the regional benchmark)

b). If your Part D plan has a restrictive drug formulary, the PACE will cover your prescription medications, or work directly with the Part D plan to process a prior authorization on your behalf

c). Coverage during the coverage gap

d). Part D cardholder cost sharing is reduced to the PACE copays and premiums

  • Cost

– There are no costs to enroll in the Pennsylvania PACE program

Pennsylvania PACENET (PACE Needs Enhancement Tier)

  • Eligibility

– Age 65 years and older; and

– A Pennsylvania resident for at least 90 days; and

– Must not be enrolled in Medicaid; and

An annual income between $14,500 and $27,500 for individuals, and between $17,700 and $35,500 for married couples. Income qualification is based on the prior year’s income and includes taxable and non-taxable sources. Assets, such as the value of the home, vehicle, and savings are not considered as factors determining eligibility. Medicare Part B premiums are also excluded.

  • Benefits

– Drug cost will be no more than $8.00 for a generic drug; $15.00 for brand name drug

– With Part D and PACENET enrollments, cardholders will receive help with:

a). The PACENET deductible, however, you will have to pay the Part D plan premium

b). If your Part D plan has a restrictive drug formulary, PACENET will cover your prescription medications, or work directly with the Part D plan to process a prior authorization on your behalf.

c). Coverage during the coverage gap

d ). Part D cardholder cost sharing is reduced to the PACENET copays and premiums.

  • Cost

– PACENET participants have an enrollment fee of $37.45 / month. However, if they enroll in a Medicare Part D plan, that fee is waived.

Do not confuse the above programs with Medicare PACE (Program of All Inclusive Care for the Elderly) which is a comprehensive care program not limited with the prescription-only assistance.

For more details of the available Pennsylvania PACE programs, please visit PACE, PACENET, and PACE Plus Medicare, or call 1-800-225-7223. If you want to apply, click here.

Pennsylvania Patient Assistance Program Clearinghouse (PA PAP)

If you do not currently have Medicaid or PACE coverage, PA PAP will help you to apply for prescription assistance through various programs. Click here for the brochure. For more information, call 1-800-955-0989.

How Can Liberty Medicare Help with Drug Costs?

Liberty Medicare is a leading insurance agency that specializes in Medicare insurance in Pennsylvania. All our services are entirely free to you. An essential part of our job is working with low-income senior citizens and providing suggestions on available Medicare Extra Help Programs and State Pharmaceutical Assistance Programs (such as PACE and PACENET) that will help with your Prescription Drug Costs.

You should be aware that Medicare Extra Help Programs and State Pharmaceutical Assistance Programs (SPAPs) qualify for the Special Enrollment Period (SEP). It allows you to change your Medicare Advantage or Prescription Drug Plan once per calendar quarter during the first nine months of the year.

Learn more about all the benefits of working with Liberty Medicare.

Receive our Medicare Quotes, or give us a call at 877-657-7477, and you will be connected to a licensed agent/broker.