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PACE, PACENET and PACE Plus Medicare: PA's Pharmaceutical Assistance Contract for the Elderly
Page Reviewed / Updated - May 06, 2019
Program Description
The state of Pennsylvania offers three prescription assistance programs for its residents; the Pharmaceutical Assistance Contract for the Elderly or PACE for short, the companion program PACE Needs Enhancement Tier or PACENET, and the third option is a Medicare Part D companion program called PACE Plus Medicare. Placement into one of these programs is determined by one's annual income from the previous year and whether or not the applicant has Medicare Part D. Therefore, eligibility for the calendar year 2019 considers the applicant's 2018 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, PACENET members are encouraged to enroll in a Part D plan. Those that do not enroll are charged $37.03 in monthly premiums. 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 PA is sometimes called LIFE Programs.
Eligibility Guidelines
To be eligible, seniors must meet the following criteria:
- Be a Pennsylvania resident for a minimum of 90 days
- Be aged 65 or older
- Cannot be receiving Medicaid prescription benefits
- In 2019, the PACE annual income limit from the previous year is $14,500 for an individual and $17,700 for couples. There is no annual income limit on the lower end.
- In 2019, the PACENET annual income limit from the previous year is $27,500, but must be more than $14,500 for an individual. The annual income limit is $35,500 for couples, but must be more than $17,700.
When calculating one’s income, Medicare Part B (medical) premiums should be excluded. This allows participants with income approximately $1,600 higher than the number above to be eligible. Veterans receiving the Aid and Attendance Pension benefit can also exclude that income in their annual income calculation. 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 $37.03 / month. However, if they enroll in a Medicare Part D plan, that fee is waived.
How to Apply / Learn More
To apply, candidates have 3 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 webpage or call their toll free number at (800) 225-7223.
Did You Know? PA offers a program called Dom Care, which works as an alternative to more expensive assisted living programs. Learn more.