PACE and PACENET Prescription Rules Relaxed
A very recent change in the law for qualifying for PACE and PACENET prescription drug assistance from the Commonwealth of Pennsylvania can make many thousands more Pennsylvanians eligible for help.
PACE and PACENET are well-known programs administered by the State that help seniors faced with high prescription drug costs. One of the main qualifying factors is income.
Applicants must be at least 65 years old. They cannot be on Medical Assistance that covers prescription drugs and they must meet the income eligibility requirements.
Until now, income has included the Medicare Part B premium that comes from Social Security checks every month. In other words, income was not the actual amount received but, instead, the amount received plus the amount that the government deducts each month for Medicare Part B. This has changed.
Under Act 12 of 2014 which was passed unanimously by the Pennsylvania Senate and House (Republicans and Democrats) and signed into law by the Governor on February 7, the Medicare Part B premium will no longer be counted as income. Also, Social Security cost-of-living adjustments that in the past could disqualify recipients are removed from consideration at least until December 31, 2015.
What does the change mean? PACE and PACENET, while model prescription drug programs that have helped thousands, have had a very unforgiving feature when it comes to income. If you are even slightly too high in income, you can be disqualified. In the past, some could lose benefits if their Social Security cost-of-living (COLA) increase pushed them over the eligibility limit. This was changed temporarily by a policy that continued until December 31, 2013. Now, this change disregarding increases in COLAs will continue at least through December 31, 2015. Also, the Medicare Part B premium that comes from Social Security checks and is, for most people $104.90, will no longer be counted as income. Income calculations are based on prior year’s income so that eligibility for 2014 is decided based on 2013 income.
The law takes effect immediately. One feature of this law that makes it unusual is that it takes effect immediately. You do not have to wait for the change. In other words, if you calculated whether you were eligible for PACE or PACENET previously and your numbers were fairly close, you should go back to calculate and see whether you might qualify now. Under the new calculation, you might.
What are the numbers? PACE provides the greatest benefit and is available to applicants with lower incomes. For PACE, a single person cannot have countable income of more than $14,500. Married couples are permitted combined income up to $17,700.
For PACENET, total income for a single person can be between $14,500 and $23,500. For a married couple, total combined income can be between $17,700 and $31,500.
What is the difference now? When calculating PACE or PACENET, you should consider the amount actually received last year not the amount plus the Medicare Part B premiums with the one exception that you do not count the cost-of-living adjustment received last year.
This effectively increases the PACE and PACENET income limits by $1,259 per person for most applicants.
There are no asset limitations for either program.
What is the benefit? For PACE, qualified individuals pay copayments of $6 for each generic medication and $9 for each brand name medication with no insurance premium. For PACENET, qualified individuals pay a monthly premium and prescription co-payments of $8 for each generic drug and $15 for each brand name medication.
How does this relate to Medicare Part “D” benefits? The administrators of PACE coordinate with Medicare “D” benefits in a wraparound program called PACE Plus Medicare.
How Can I Apply? Applications can be submitted online. Go to www.aging.state.pa.us. Click “PACE and Affordable Medications.” Follow the text to PaceCare Website and click on the link. Also, there is a toll free number, 1-800-225-7223. Alternatively, check with the County Department of Aging Services.
Do I need documentation? Documentation is generally not required. PACE/PACENET can check with other available state and federal sources to verify age, income and residence.
For further information, you can also check out the website of elder law attorney, Jeffrey Marshall, Esq. of Marshall, Parker & Weber, LLC at www.paelderlaw.com, “Easier income limits for PACE and PACENET drug programs.”
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.