Elder Law Guys: Are you eligible for Pennsylvania's prescription drug programs? That might have changed - Pittsburgh Post-Gazette
Since 1984, the Pennsylvania Department of Aging has offered two very helpful programs to assist eligible seniors age 65 and older with their prescription drug costs.
The Pharmaceutical Assistance Contract for the Elderly and Pharmaceutical Assistance Contract for the Elderly Needs Enhancement Tier programs cover most medications that require prescriptions, including insulin and diabetes supplies.
Some recent changes could impact recipients trying to figure out if they are eligible for the programs.
Both programs have income eligibility thresholds. At present, about 300,000 Pennsylvanians are enrolled in the programs funded primarily by proceeds from the Pennsylvania lottery and from tobacco settlement funds that went to the state.
To qualify, according to the Pennsylvania Department of Aging, you must meet these guidelines:
- For PACE, you must be 65 years of age or older, a Pennsylvania resident for at least 90 days prior to the date of application and cannot be enrolled in the U.S. Department of Human Service's Medicaid prescription benefit. For a single person, total income must be $14,500 or less, while a married couple’s combined total income must be $17,700 or less.
- For PACENET, same age and residency rules apply, and you cannot be enrolled in the U.S. Department of Human Service's Medicaid prescription benefit, but the income limits are slightly higher.
For a single person, total income can be between $14,500 and $33,500, while a married couple’s combined total income can be between $17,700 and $41,500, according to the state. Assets, such as the value of a home, vehicle, and savings are not considered as factors determining eligibility.
Two recent developments are worth noting because they are tied to eligibility.
Because the programs’ eligibility are based on income from the prior calendar year, people who were at the income limit could be kicked off — by simply receiving a cost-of-living adjustment increase to their Social Security checks.
In response, a moratorium had been placed on this disqualifying event, but that was set to expire on Dec. 31, 2021. The good news is Act 92 of 2021 provides relief by extending the moratorium an additional two years.
Additional relief in light of the financial restrictions is provided by Act 94 of 2021, which increases the PACENET income threshold by $6,000. Single and married program participants can now have $33,500 and $41,500, respectively, and still qualify.
According to the Department of Aging, this increased income limit will open up the program for an additional 100,000 seniors across the state.
The change becomes effective 60 days after Gov. Tom Wolf signed it, so seniors newly enrolled can start receiving their benefits on Feb. 21, 2022.
The state Department of Aging commented that seniors who have applied for PACE/PACENET over the past year — but who were not previously eligible — will automatically have their applications processed. If they qualify under the new rule, they should receive their benefits cards as soon as the new law takes effect.
Prescription drugs have changed modern medicine and have become a part of everyday life, but they can be expensive. These programs have helped many Pennsylvanians afford much needed medicine, and it is good to see that our state Legislature in conjunction with the Department of Aging have kept pace with the needs of seniors in this area.
If you think you may qualify for one of these programs, call the PACE hotline at 800-225-7223.
Julian Gray and Frank Petrich are certified elder law attorneys who practice in the Pittsburgh area at Gray Elder Law. Send questions to [email protected] or visit grayelderlaw.com.
First Published January 24, 2022, 9:00am
source: https://www.post-gazette.com/business/money/2022/01/24/pennsylvania-prescription-drug-program-eligibility-rules-changes-department-of-aging/stories/202201230053
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