Two PACE Programs in Pennsylvania: Know the Difference
When exploring the PACE program in PA, it is important to understand there are two separate programs using the same acronym. One is a state-funded program focused on prescription drug costs, while the other is a federal program offering comprehensive healthcare and support services.
The Pennsylvania PACE/PACENET Program: Prescription Assistance
Pennsylvania's PACE and PACENET are state programs funded by the Pennsylvania Lottery and managed by the Department of Aging. These programs help eligible individuals aged 65 and older afford their prescription medications by reducing out-of-pocket costs, particularly those with ongoing medical conditions.
Who is eligible for PA's PACE and PACENET?
Eligibility depends on age and income. Income limits are reviewed periodically and were expanded in 2022. The primary distinction between PACE and PACENET lies in the income thresholds:
- PACE: For a single person, income must be \$14,500 or less. For a married couple, combined income must be \$17,700 or less.
- PACENET: For a single person, income can be between \$14,501 and \$33,500. For a married couple, combined income can be between \$17,701 and \$41,500.
These limits include net Social Security income and gross income from all other sources.
How do PACE/PACENET and Medicare Part D work together?
The PA PACE and PACENET programs can supplement a senior's federal Medicare Part D plan. They can act as a secondary payer, helping to cover costs not paid by Part D and assisting with the coverage gap, often called the "doughnut hole".
The Federal Program of All-inclusive Care for the Elderly (PACE)
Distinct from the state program, the federal PACE program is a comprehensive care model for frail seniors. It integrates medical and long-term care through a coordinated team approach with the goal of enabling participants to remain in their homes rather than require nursing facility care.
Services covered by Federal PACE
The federal PACE program covers a broad range of services based on individual needs as determined by an interdisciplinary team. These can include:
- Primary and specialty medical care
- Adult day care
- Nutritional counseling
- Therapies (physical, occupational, etc.)
- Prescription drugs
- Home care
- Hospital and emergency care
- Dentistry and eye care
- Transportation
How does eligibility and cost work for Federal PACE?
To be eligible for the federal PACE program, individuals must be 55 or older, certified by their state as needing nursing-home level care, live in a PACE organization's service area, and be able to live safely in the community with support. Costs can be covered fully for those with Medicare and Medicaid. Individuals with only Medicare will have a monthly premium, and those without either can pay privately.
Comparison: PA's PACE/PACENET vs. Federal PACE
To highlight the key differences between the two programs, refer to the table below:
| Feature | PA's PACE/PACENET Program | Federal PACE Program |
|---|---|---|
| Primary Purpose | Lower prescription drug costs for eligible seniors (65+). | Provide comprehensive medical and social services to frail seniors (55+) to support living in the community. |
| Funding Source | Pennsylvania Lottery | Medicare, Medicaid, or private payment |
| Coverage | Prescriptions, insulin, and diabetes supplies. | Extensive medical and long-term care, including prescriptions. |
| Key Eligibility | Age 65+ and specific income limits. | Age 55+, need for nursing-home level care, live in service area, can live safely in community. |
| Administration | Pennsylvania Department of Aging. | Federally-regulated program administered by state-contracted organizations. |
Which program is right for me?
The choice of program depends on your specific needs. If your primary concern is managing prescription costs, the state's PACE or PACENET program is likely the one to consider, especially if you have Medicare Part D. If you require a broader range of coordinated health and social services to remain independent at home, the federal PACE program is more appropriate. It's possible to qualify for both, potentially using the state program for prescription coverage alongside the comprehensive services of the federal program.
For additional information about the state program, please visit the official Pennsylvania Department of Aging website.
Conclusion
Understanding the distinction between the two PACE programs in PA is crucial for seniors and caregivers seeking assistance. Whether the need is for help with prescription expenses through the state program or comprehensive, coordinated healthcare via the federal program, resources are available. Reviewing the eligibility criteria and services for each program is the first step toward making informed decisions about senior care. Contacting the relevant program administrators or a senior care advisor is recommended for personalized guidance.
