For Pennsylvania residents, managing prescription drug costs can be easier thanks to two important assistance programs: PACE (Pharmaceutical Assistance Contract for the Elderly) and Extra Help (also known as the Low-Income Subsidy or LIS). While both aim to reduce out-of-pocket expenses for prescription medications, they have different eligibility requirements and benefits.
What is PACE/PACENET?
PACE is a state-run program specifically for Pennsylvania residents aged 65 and older to help lower prescription drug costs. It works alongside Medicare Part D and other prescription drug plans to provide additional savings.
Here’s how PACE works if you have Medicare Part D but your plan is not partnered with PACE/PACENET:
- Premium Payments: You pay your Medicare Part D premiums directly to your plan provider; PACE does not cover these premiums.
- Prescription Costs: When you fill a prescription, your Medicare Part D plan is billed first, then PACE/PACENET covers any remaining costs to ensure you pay the lowest amount possible.
- Deductibles: Qualifying individuals may have their Medicare Part D deductibles reduced or eliminated by PACE/PACENET.
- Formulary Differences: If your Medicare Part D plan doesn’t cover certain medications that PACE/PACENET does, PACENET will either cover those medications or coordinate with your plan.
- No Late Enrollment Penalty: Enrolling in Medicare Part D late won’t result in a penalty if you qualify for PACE/PACENET.
What is Extra Help (Low-Income Subsidy)?
Extra Help is a federal program that assists people with limited income and resources nationwide by helping to pay for Medicare prescription drug costs. Here’s what Extra Help provides when you have a Medicare Part D plan:
- Premium Assistance: Extra Help may cover all or part of your monthly Medicare Part D premiums.
- Deductible Assistance: You may not have to pay the annual deductible.
- Reduced Co-payments: In 2024, co-pays are capped at $4.50 for generic drugs and $11.20 for brand-name drugs.
- Coverage Gap Protection: Extra Help eliminates the Medicare Part D “donut hole,” giving continuous coverage.
- No Late Enrollment Penalty: Qualifying individuals won’t pay a penalty if they join a Medicare drug plan after their initial enrollment period.
Key Differences Between PACE and Extra Help
- Geographic Scope: PACE is exclusive to Pennsylvania residents aged 65 and older, while Extra Help is available to eligible individuals nationwide.
- Eligibility Rules: PACE eligibility follows Pennsylvania’s state-specific guidelines, whereas Extra Help uses federal income and resource limits.
How to Apply
- PACE: Apply here
- Extra Help: Apply here
Both programs aim to make prescription medications more affordable, and depending on your eligibility and location, you might qualify for one or even both to lower your medication costs.
Helping clients understand these programs can make a big difference in their health and finances.
Contact National Insurance Markets for more information.
