Understanding the Pennsylvania PACE Program
The Pharmaceutical Assistance Contract for the Elderly (PACE) is a prescription drug assistance program for older Pennsylvanians with limited incomes. Funded by the Pennsylvania Lottery, it helps eligible residents aged 65 and older cover the cost of their prescription medications. The program works with Medicare Part D and other insurance plans to reduce your out-of-pocket expenses. The companion program, PACENET, serves those with slightly higher incomes.
Eligibility requirements for PACE
To be eligible for the PACE program, you must meet several criteria based on age, residency, and income from the previous calendar year.
- Age: You must be 65 years of age or older. You can apply up to 30 days before your 65th birthday.
- Residency: You must be a Pennsylvania resident for at least 90 days before applying.
- Income limits: For the 2024 eligibility year, a single person's total annual income must be $14,500 or less. For a married couple, the combined total annual income must be $17,700 or less. Notably, Pennsylvania law excludes annual Medicare Part B premiums when calculating income for PACE eligibility.
- Other coverage: You cannot be enrolled in the Pennsylvania Department of Human Services' Medical Assistance prescription benefit.
Required documentation for your application
When preparing your application, you will need to gather specific documents to verify your eligibility. While you do not need to send proof of income with your initial application, the program may request it for verification.
- Personal information: Your Social Security Number, date of birth, and contact information.
- Spouse's information: If married, your spouse's information is required, even if they are not applying.
- Income information: Total income from the previous calendar year for both you and your spouse (if applicable). This includes gross Social Security and other income sources.
- Health coverage: Information on any other prescription drug coverage, including Medicare Part D, retiree plans, or employer coverage.
- Signature: A signed and dated application form is mandatory.
How to apply for PACE in PA: Step-by-step process
Applying for the PACE program is straightforward, with multiple options available to suit your preference.
- Choose your application method. You can apply online, by phone, or by mail.
- Gather required information. Collect all the necessary personal, income, and insurance information before you begin the application.
- Complete the application. Whether online or on paper, fill out all sections completely. Pay close attention to the income details and signature requirements.
- Submit your application.
- Online: Visit the PACE website and follow the instructions for the online application.
- Mail/Fax: If using a paper application, send it to the address provided on the form. The mail address is typically PACE/PACENET, PO Box 8806, Harrisburg, PA 17105-8806.
- Phone: Call the Cardholder Services number to apply by phone.
- Await confirmation. The PACE program will verify your information with other agencies. You will receive a new card if you remain eligible upon annual renewal.
PACE vs. PACENET: A comparison
The table below outlines the key differences between the PACE and PACENET programs in Pennsylvania. Both programs share age and residency requirements but differ primarily based on income and cost-sharing.
| Feature | PACE | PACENET |
|---|---|---|
| Annual Income (Single) | $14,500 or less | $14,501 to $33,500 |
| Annual Income (Married Couple) | $17,700 or less | $17,701 to $41,500 |
| Monthly Premium | $0 | Variable, based on Medicare Part D plan |
| Generic Drug Co-pay | $6 | $8 |
| Brand-Name Drug Co-pay | $9 | $15 |
| Medicare Part D Requirement | No requirement, but enrollment is encouraged | No requirement, but required for lower premium and deductible |
| Deductible | $0 | Enrollees pay a deductible before PACENET coverage begins |
Additional program considerations
Where to get an application
In addition to applying online, you can obtain a paper application from several locations:
- Your local pharmacy
- Pennsylvania state legislator's office
- Your local Senior Center
- Your local Area Agency on Aging (AAA)
How PACE works with Medicare Part D
PACE and PACENET coordinate with Medicare Part D plans to provide a comprehensive benefit. The PACE Plus Medicare initiative works to enroll eligible cardholders into Medicare Part D plans that best match their prescription needs. For those with Medicare, this coordination can help cover costs during the deductible phase and in the coverage gap (the 'donut hole'). PACE may also help pay your Part D premium directly to your plan.
Annual renewal process
Eligibility for the PACE and PACENET programs is subject to annual renewal. Approximately two months before your card expires, you will receive a renewal application in the mail. You must complete and return this form to the program to continue receiving benefits.
What happens if you are ineligible?
If your income exceeds the PACE limits but falls within the PACENET range, you will likely be enrolled in the PACENET program. If you do not meet the criteria for either program, you can call the Cardholder Services number to discuss your options.
Conclusion
Applying for PACE in PA is an accessible process designed to help older residents afford necessary prescription drugs. By meeting the age, residency, and income requirements, eligible seniors can significantly reduce their out-of-pocket medication costs. The state provides various application methods—online, phone, or mail—to make the process convenient. The distinction between PACE and PACENET is crucial for understanding your potential costs and benefits, as PACENET applies to a higher income bracket with different cost-sharing rules. Ultimately, for eligible Pennsylvanians, these programs are a vital resource for managing healthcare expenses and maintaining well-being. For more information, you can visit the official Pennsylvania Department of Aging website.
