Program Description
The state of Pennsylvania offers two prescription assistance programs for its residents; the Pharmaceutical Assistance Contract for the Elderly (PACE) and the companion program PACE Needs Enhancement Tier (PACENET). Placement into one of these programs is determined by one’s annual income from the previous year and whether the applicant has Medicare Part D. Therefore, eligibility for the calendar year 2022 considers the applicant’s 2021 income for eligibility purposes.
Unlike many state pharmaceutical assistance programs, enrollment in a Medicare Part D plan is not a requirement for PACE or PACENET participants. However, PACE members are encouraged to enroll in a Part D plan. PACENET members who do not enroll are charged $40.74 in monthly premiums each month they use their PACENET benefit. All programs offer assistance in the form of very low co-payment amounts for prescription medications.
These programs have a similar name but should not be confused with Medicare PACE (Program of All Inclusive Care for the Elderly), which is a comprehensive care program, not prescription only assistance. Furthering the confusion, Medicare PACE in Pennsylvania is sometimes called LIFE (Living Independence for the Elderly) Programs.
Eligibility Guidelines
To be eligible, seniors must meet the following criteria:
- Be a Pennsylvania resident for a minimum of 90 days.
- Be age 65 or older.
- Cannot be receiving Medicaid prescription benefits.
- In 2022, the PACE annual income limit is $14,500 for an individual and $17,700 for couples.
- In 2022, the PACENET annual income limit is $14,501-$33,500 for singles and $17,701-$41,500 for couples.
When calculating one’s income, Medicare Part B (medical) premiums should be excluded. This allows single participants with income approximately $1,600 higher than the number above to be eligible. Assets, such as the value of one’s home, vehicle and savings are not considered when determining eligibility.
Benefits and Services
PACE will pay for a senior’s complete cost of medications except for the monthly co-payments of $6 for generic drugs and $9 for brand name drugs. PACENET has similar benefits but has co-payments of $8 for generics and $15 for brand name drugs. The above co-payments are for a supply of 30 days.
There are no costs to enroll in the PACE program. PACENET participants have an enrollment fee of $40.74 a month. However, if they enroll in a Medicare Part D plan, that fee is waived.
How to Apply / Learn More
To apply, candidates have three options. They can apply online, download an application and mail it in, or they can visit their local Area Agency on Aging to receive assistance with the application. One can learn more about these programs by visiting the PACE homepage or by calling their toll free number at (800) 225-7223.
Did You Know? Pennsylvania offers a program called Dom Care, which works as an alternative to more expensive assisted living programs.
The state of Illinois has two programs designed to provide financial assistance to the elderly to help them purchase their prescription drugs. Rx Basic is for individuals without Medicare insurance and the Rx Plus is designed for those on Medicare.
Rx Plus is known as a Medicare wraparound program which means the benefits wrap around those benefits provided by a Medicare Part D plan. When making a prescription purchase, Medicare Part D is the first payer and then this program contributes towards those costs the Part D plan does not cover.
