Prescription Advantage is the Massachusetts State Pharmaceutical Assistance Program (SPAP), which is overseen by the Commonwealth of Massachusetts Executive Office of Elder Affairs. It is one of the most comprehensive SPAPs in that the program provides financial assistance to both Medicare and non-Medicare qualified individuals.
Individuals who are eligible for Medicare must enroll or be enrolled in a Medicare Part D plan or a Medicare Advantage plan that has prescription coverage. When filling a prescription, Medicare is the first payer, and costs not covered by Medicare are then eligible to be paid for by the Prescription Advantage program.
For persons ineligible for Medicare, the program serves as the individual’s primary coverage for prescription drugs. It helps with prescription costs directly, requiring only small deductibles or co-payments from the program participant.
There is also an annual maximum out-of-pocket spending amount set for individuals enrolled in this program, regardless of whether they are Medicare eligible or not.
To be eligible for this program, the state of Massachusetts considers the following factors. Note that there are interdependencies between some of these requirements.
Residency – applicants must be Massachusetts state residents.
Age – applicants must be 65 years of age or if they are under 65, they must be blind or disabled as certified by the state.
Income – applicants who are a minimum of 65 years old and receive Medicare are permitted an annual income of up to 500% of the federal poverty limit. As of 2020, single applicants can have an annual income up to $63,800 and married applicants up to $86,200. Note that this is the maximum income limit and benefits increase for persons of lower annual incomes. For applicants who are at least 65 years old and do not receive Medicare, there is no income limit.
Medicaid Dependency – to be eligible, one cannot also be eligible and receiving assistance from Massachusetts Medicaid (MassHealth). However, there is one exception. Persons who may be eligible for MassHealth’s Buy-In Program (Medicare Savings Program) must apply.
Worth mentioning is that assets are not an eligibility factor, nor is the applicant’s health or veteran status.
The Prescription Advantage program provides different benefits depending on if the enrolled individual is or is not on Medicare. For those individuals on Medicare, Prescription Advantage will help them with the cost of their Part D drug coverage. For those individuals who are not enrolled in Medicare, the program, which has no monthly premium, will pay for their prescription medications. This is provided they have reached their individual out-of-pocket spending limit. The out-of-pocket limits vary depending on their income level.
The Prescription Advantage program does not have application or enrollment fees.
To gather more information about this program or to receive an application, one can visit the Prescription Advantage website, go to their local Mass Area Agency on Aging, or call the toll free number at (800) 243-4636 and press option #3. Persons can also apply online here.