PACE, PACENET and PACE Plus Medicare: PA's Pharmaceutical Assistance Contract for the Elderly

Page Reviewed / Updated - Apr. 2017

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 2017, considers the applicant's 2016 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 approximately $40 in monthly premiums. All programs offer assistance in the form of very low co-payment amounts for prescription medications.

These program 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 2017, 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 2017, the PACENET annual income limit from the previous year is $23,500, but must be more than $14,500 for an individual. The annual income limit is $31,500 for couples, but must be more than $17,700.

Assets 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 $39.45 / 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.

 

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.