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The Medicare Prescription Payment allows you to spread the annual cost of your prescription’s over 12 months. The donut hole is now gone and the max out of pocket for any beneficiary, despite their insurance plan is $2000/year. Under the Medicare Prescription Payment, you would pay your insurance company for the amount due and not pay anything at the pharmacy. 

If you’ve had a life-changing event that reduced your household income, you can ask to lower the additional amount you’ll pay for Medicare Part B and Part D.

Parts B & D IRMAA Reassessment >

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PACE and PACENET aim to provide low-cost prescription medication to qualified Pennsylvania seniors. 

To qualify for PACE (Pharmaceutical Assistance Contract for the Elderly) and PACENET, you need to meet specific criteria.

  1. Age: You must be 65 years or older.
  2. Residency: You must be a Pennsylvania resident for at least 90 consecutive days before applying.
  3. Income: Your eligibility is determined based on your previous calendar year’s income.
    • PACE Income Limits:
      • For a single person, the total income must be $14,500 or less.
      • For a married couple, the combined total income must be $17,700 or less.
    • PACENET Income Limits:
      • For a single person, the total income can be between $14,500 and $33,500.
      • For a married couple, the combined total income can be between $17,700 and $41,500.
  4. Medicaid Enrollment: You cannot be enrolled in the Department of Human Services’ Medicaid prescription benefit.

To apply, you have several options:

  • Phone: Call 1-800-225-7223 to apply by phone. Make sure to have your income and insurance information available.
  • Online: Visit PACECares to complete an online application.
  • Paper: Print an application and send it via mail, fax, or email:
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Turning 65? 

A question I’m commonly asked is – I’m turning 65! Do I need to enroll in Medicare? 

The answer is – it depends. 

If you are on a group employer plan or your spouse’s group employer plan that has more than 20 employees, do you do not need to enroll in Medicare A or B.

If you are not contributing to a Health Savings Account, you may choose to enroll in Medicare Part A through the Federal Govt, via the Social Security website. Part A will be $0 and may be used as additional hospital coverage, if you choose. 

Once you lose employer coverage, you will then have a Special Enrollment Period to enroll in Medicare Parts A & B through the Federal Govt, and choose a Medicare Advantage or Medigap plan. The recommended time frame for this process is 3 months, but could be done in about 4-6 weeks. 

When you know your anticipated retirement date, be sure to confirm your last day of coverage so that you can line up A & B to begin the first day of the next month.

Check out the article from CMS.GOV in the comment link.

#turning65 #medicare