Did You Know: Pace vs. Extra Help

In Pennsylvania, PACE (Pharmaceutical Assistance Contract for the Elderly) and Extra Help are not the same, but they both aim to assist with prescription drug costs.

PACE is a state program that helps qualified residents aged 65 and older get prescription medications at a lower cost. It works with Medicare Part D and other prescription drug plans to reduce out-of-pocket expenses.

When you are enrolled in PACE/PACENET and have a Medicare Part D plan that is not partnered with PACE/PACENET, there are a few key points to keep in mind:

  1. Premium Payments: You will need to pay your Medicare Part D premium directly to your insurance provider. PACE/PACENET will not cover this premium 
  2. Prescription Costs: At the pharmacy, you will still benefit from PACE/PACENET's assistance with prescription costs. Your pharmacist will bill your Medicare Part D plan first and then PACE/PACENET for any remaining costs, ensuring you pay the lowest possible amount
  3. Deductibles: The program also helps with deductibles. If you qualify for PACE/PACENET, you may not have to pay the annual deductible for your Part D plan
  4. Formulary Differences: If your Medicare Part D plan does not cover certain medications that PACE/PACENET does, PACENET will either cover those medications or work with your Part D plan to get them covered
  5. No Late Enrollment Penalty: If you qualify for PACE/PACENET, you won't have to pay a late enrollment penalty. This assistance ensures that you won't have to bear the additional cost of the penalty if you enroll in PACE. 

Extra Help, also known as the Low-Income Subsidy (LIS), is a federal program that helps people with limited income and resources pay for Medicare prescription drug plan costs, such as premiums, deductibles, and co-payments.

Here's how it works with a Part D plan:

During the OEP, do not:

  1. Premiums: Extra Help can cover all or part of your Medicare Part D plan's monthly premium. This means you may pay a reduced premium or none at all, depending on your level of Extra Help
  2. Deductibles: The program also helps with deductibles. If you qualify for Extra Help, you may not have to pay the annual deductible for your Part D plan
  3. Co-payments and Coinsurance: Extra Help significantly reduces the cost of prescription drugs. You will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug in 2024
  4. Coverage Gap: Extra Help eliminates the coverage gap (often referred to as the "donut hole") in Medicare Part D, ensuring continuous coverage for your prescription medications
  5. No Late Enrollment Penalty: If you qualify for Extra Help, you won't have to pay a late enrollment penalty if you join a Medicare drug plan after your initial enrollment period 

While both programs provide financial assistance for prescription drugs, PACE is specific to Pennsylvania residents and has different eligibility criteria compared to the federal Extra Help program.

How to apply for PACE: https://pacecares.primetherapeutics.com/Enrollment.html 

How to apply for Extra Help: https://www.ssa.gov/medicare/part-d-extra-help

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