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 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.
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.
- Until the premium is met in a month, a medication, in either of these scenarios could cost the cardholder up to the cost of the premium remaining plus the copay, if the cost of the medication is high enough.
- After premium (and/or copay) is fulfilled, PACE pays any additional cost of the medication.