Yes. If you are in the PACE program, your co-payments at the pharmacy will be no more than $6 for generic medications and $9 for brand names for a 30-day supply. PACENET co-payments are no more than $8 for generics and $15 for brand names for a 30-day supply. Both PACE and PACENET cover deductible and "donut hole" drug costs.
Once your application is received, it takes three business days to process.
PACE
Single: $14,500 or less
Married: $17,700 or less
PACENET
Single: $14, 501 to $33,500
Married: $17,701 to $41,500
PACE looks at your previous calendar year gross income, including your Social Security income. Examples of income include but are not limited to pensions, taxable amounts of annuity/401K/IRA distributions (not account balances), interest/dividends/capital gains, prizes, wages, commissions, self-employment, net rental, net business, royalties, unemployment, workers’ comp, alimony, gambling, gifts and inheritance (if over $300), death benefits (over $10,000).
According to the PACE Act 1983-63, income eligibility is determined by the previous year income.
Yes, if eligible for benefits, you will receive a PACE identification card. You should show your PACE card at the pharmacy along with your Medicare Part D plan card, if you are enrolled in a Part D plan
No. PACE has an auto-renewal process to determine eligibility. If your income remains within the income requirements, you will be re-enrolled.
To check on your claims or to ask about costs, contact PACE Provider Services at 1-800-835-4080.
Call Cardholder Services at 1-800-225-7223 for a new card.
Call Cardholder Services at 1-800-225-7223 with any address, name, or phone number changes.
You may submit a PACE application up to 30 calendar days prior to your birthday
Yes, we encourage you to apply for Extra Help if enrolled in a Medicare Part D plan.
No. If you are receiving Medicaid benefits and you are eligible for Medicare, you must be enrolled in a Medicare Part D prescription plan. You must get most of your prescription drugs through the Medicare Part D plan.
For information on how to enroll in a Part D plan if you are not already enrolled, contact PA MEDI, Pennsylvania’s health insurance counseling and assistance program, at (800) 783-7067 or call the PA MEDI Program at your local Area Agency on Aging. Trained counselors offer free assistance to help guide Medicare beneficiaries through the many health insurance options.
Many PACE or PACENET cardholders will save money by being enrolled in both Medicare Part D and PACE or PACENET at the same time. Having both a Medicare Part D plan and PACE or PACENET also helps the Program save money that can be used to help more Pennsylvanians.
No. We will not enroll the following cardholders into a Medicare Part D plan: those who are not Medicare Part D eligible, those in Medicare Advantage Plans, and those in employee retirement plans with creditable drug coverage. The PACE and PACENET programs will not enroll anyone who notifies us that they do not want to be enrolled in a Medicare Part D plan for 2023.
If PACE or PACENET enrolls you in a Medicare Part D plan, you will receive a letter from the program telling you the Medicare Part D plan and the effective date of enrollment. To select the best Medicare Part D plan on your behalf, the program reviews your information and selects a plan that will cover your medications at the lowest cost while also allowing you to go to the pharmacy that you prefer.
If you have not received information from the program, we may not be enrolling you in Medicare Part D as mentioned in Question 2; or we may not know that you have a Medicare Part D plan.
All PACE and PACENET cardholders get help with their Medicare Part D deductibles, co-pays and costs during the coverage gap. If you have any questions about how PACE or PACENET can work with your Medicare Part D plan, you should call the program at 1-800-225-7223.
Yes. You will receive an identification card from the Medicare Part D plan. You will use your Medicare Part D plan’s identification card along with your PACE or PACENET identification card at the pharmacy.
If you do not have a Medicare Part D plan when you enroll in PACE or PACENET, we will not assign you to one immediately, but we may provide recommendations to you within a few months.
PACE :
The PACE Program will pay the Medicare Part D premiums for PACE cardholders enrolled in a plan that has a premium payment agreement with PACE. A list of these plans can be found here.
For 2023, PACE will pay up to the regional benchmark, which is $41.08. If you enroll in a plan with a Medicare Part D premium higher than $41.08 you must pay the difference.
The PACE Program will not be able to help pay the monthly Medicare Part D premium for individuals enrolled in a Medicare Part D plan not on the premium assistance list.
PACENET:
PACENET cardholders enrolled in one of the program’s Partner Medicare Part D plans (SilverScript Choice or Wellcare Classic) will have to pay the Medicare Part D plan’s premium at the pharmacy through the cost of your medications.
You will never be charged more than the cost of your medication at one time. Therefore, if the cost of your medication is less than the amount of premium you owe, you only pay the cost of the medication.
You only pay towards the monthly premium for each month you use the card. Any remaining premium does not roll over to the next month and does not accumulate.
If you have not used your PACENET card and you do not currently take medications, you will not have to pay a monthly premium until you activate your card at the pharmacy.
Example:
You are enrolled in PACENET as of January 2023, but do not use your card until March 2023. There will be no premium collected for the months of January or February.
In March, you have 2 medications to fill. You will pay the March premium of $41.08 through the cost of your medications. After you have met your March premium cost, you will be charged $8 for a 30-day supply of generic medication and $15 for a 30-day supply of name brand medication.
The first medication is filled on 3/12/23 for $10. You pay $10 which is applied to your March premium. The second medication is a brand medication, is filled on 3/20/23 and should cost $80. However, you only pay $31.08 which is the remaining premium owed, plus a $15 brand name copay for a total of $46.08. If you would have received additional medications in that month, you would have paid only the copay for brand or the generic, depending on the medication, since you paid the full monthly March premium at the pharmacy.
In April, you do not go to the pharmacy so no premium will be collected.
In May you have one medication to fill. Again, the premium of $41.08 will be collected, but no premium will be collected for April (the month you did not go to the pharmacy). The cost of the May premium will be collected out of your medication costs as was done in March.
The medication is $20, which is applied toward your May premium ($21.08 remaining). If no other medications are picked up that month, the remaining premium for May will not roll over to the next month.
You will have to pay a premium that is equal to the regional benchmark premium for Medicare Part D, which is $41.08 for 2023. After you pay the premium at the pharmacy, you will pay the PACENET copays for your medications ($8 for generics and $15 for name brand medications). You only pay towards this monthly premium for each month you use the card. Any remaining premium does not roll over to the next month and does not accumulate. See the example in Question #7 as this applies to those without a Medicare Part D.
No, there are many instances in which the program will send payment to your Medicare Part D plan on your behalf. By signing up for automatic deductions from Social Security, you may be overpaying for your Medicare Part D services. Please check with the program prior to making this decision.
No, you should not send any money to the Medicare Part D plan without checking with PACE or PACENET first. Please call the program's toll-free number at 1-800-225-7223 to review any coupon booklets or invoices you may have received.
Yes, show both cards at the pharmacy. This will let your pharmacist know to bill your Medicare Part D plan first and bill PACE or PACENET second. It will also let your pharmacist know that you are entitled to all of the drugs that are available under PACE and PACENET.
No, not for medications that are covered by PACE or PACENET. If your Medicare Part D plan charges higher copayments than you were paying under PACE or PACENET, the program will pay the difference if the pharmacy has the capability to bill more than one payer for a prescription claim. If you are taking medications that are not covered by PACE or PACENET, you will pay your Medicare Part D plan’s copay for those drugs.
If you run into any confusion at your pharmacy, call the program's toll-free number at 1-800-225-7223.
You will pay the lower copayments when the Medicare Part D plan pays for the medication.
You will not experience a “donut hole” or period of time when you have no prescription drug coverage. Instead, the PACE or PACENET program will fill in the gaps for covered medications, so that you can continue to get your prescriptions by only paying the PACE or PACENET copays.
If your Medicare Part D plan has a restrictive drug formulary, PACE or PACENET will cover your prescription medications or work directly with the plan to process a prior authorization on your behalf so the drugs will be covered by your Medicare Part D plan.
No. You must use the pharmacies that are in your Medicare Part D plan's network and participate with PACE or PACENET. If you decide to change pharmacies, check with your new pharmacy to make sure they participate with both your Medicare Part D plan and the PACE Program.
Yes. However, the mail-order pharmacy must participate with the PACE Program for the program to help pay for your extra co-payments. Please have your doctor‘s office verify if the mail-order pharmacy is in the PACE network prior to submitting prescriptions for processing. Also, when you receive a three-month supply of your drug(s) by mail, you will pay up to three PACE or PACENET co-payments at once. For example, a PACE cardholder would pay up to $18 for a 90-day supply of generic medications.
PACE and PACENET cardholders enrolled in Medicare Part D will have to use the pharmacies within the Medicare Part D plan’s pharmacy network and also participate with PACE and PACENET. If your Medicare Part D plan offers mail-order services, the plan will provide information regarding these pharmacies in their Welcome Kit and enrollment documents that will be sent to you.
If you want to find out whether a mail-order pharmacy participates with PACE and PACENET, contact the PACE program at 1-800-835-4080.
We reviewed the drugs that you take and the pharmacy you use most often. Then, we matched you with a partner plan that covers your medications at the lowest possible costs and is accepted at the pharmacy you use.
During 2023 the PACE and PACENET programs will be partnering with the SilverScript Choice (S5601-012) and WellCare Classic (S4802-080) plans.
The program has premium payment agreements with many Medicare Part D plans. Enrolling in one of these plans guarantees that you get the most help with your medication costs. A list of plans can be found here .
Information about premiums, participating pharmacies and covered drugs for these companies, and any other Medicare Part D plan operating in Pennsylvania, is available by calling 1-800-Medicare (1-800-633-4227 or 1-877-486-2048 (TTY)) or at www.medicare.gov.
The Medicare & You Handbook mailed to all Medicare beneficiaries during open enrollment has a list of all the available plans in Pennsylvania.
For additional information about Medicare Part D plans, call PA MEDI at 1-800-783-7067. PA MEDI Counselors are specially trained to answer your questions and provide you with objective, easy-to-understand information about Medicare, Medicare Supplemental Insurance, Medicaid, and Long-Term Care Insurance.
Yes. During the Annual Enrollment Period from October 15 through December 7, anyone on Medicare can change their Medicare Part D plan. The PACE and PACENET programs send its members a notification regarding their personal plan selection before the start of this period.
PACE and PACENET cardholders are also eligible for one Special Enrollment Period (SEP) per year. This means you can change the Medicare Part D plan in which you are enrolled or were assigned to one time outside the Annual Enrollment Period.
If you want to enroll in a Medicare Part D plan that is not one of our Medicare Part D Partner plans, let us know and call the Medicare Part D plan directly or Medicare at 1-800-MEDICARE or 1-800-633-4227.
If you are in a Medicare Advantage Plan (HMO/ PPO) without prescription drug coverage and you would like to enroll in Part D, you need to contact your Medicare Advantage Plan to see if they offer a Part D benefit. If they do, you should enroll through your Medicare Advantage Plan in order to keep your doctor and other health care providers. If you are in PACE (as opposed to PAGENET), the program will pay the Part D premium portion for you (up to $41.08) if the plan has signed a premium payment agreement with the program.
If your Medicare Advantage Plan does not offer a Part D benefit, then you may need to join a different Medicare Advantage Plan to get Part D. Keep in mind that changing Medicare Advantage Plans may affect your choice of doctors.
The Program encourages cardholders to enroll in Medicare Part D because there are several added benefits to being enrolled in PACE or PACENET and Medicare Part D at the same time. At this time, enrollment in a Medicare Part D plan is voluntary.
However, if you are enrolled in PACENET but not enrolled in Medicare Part D, you will pay a monthly premium at the pharmacy that is equal to the regional benchmark premium for Medicare Part D. For plan year 2023, the premium is $41.08. After paying the premium at the pharmacy, you will pay the PACENET copays for your medications of $8 for generics and $15 for name brand medications for a 30-day supply. You only pay towards the monthly premium for each month you use the card. Any remaining premium does not roll over to the next month and does not accumulate. The regional benchmark premium does not apply to PACE cardholders.
No. The VA is considered creditable coverage (as good as or better than Medicare Part D) and so are PACE and PACENET. PACENET cardholders that have VA prescription drug coverage but are not enrolled in Medicare Part D, do not have to pay a monthly premium at the pharmacy.
PACE and PACENET cardholders that have VA prescription drug benefits can enroll in Medicare Part D and keep your other benefits, but it is not required.
If you are enrolled in PEBTF/REHP and PACE or PACENET, the PACE Program will not enroll you into a Medicare Part D plan. The PEBTF/REHP will offer Medicare Part D coverage in 2023 through a retiree SilverScript Part D plan. For more information, you should contact PEBTF at 1-800-522-7279 or REHP/SilverScript at 1-866-329-2088.
PACE and PACENET may help pay your full Late Enrollment Penalty (LEP). Call us at 1-800-225-7223 for more information.