Medicare
Changes to Medicare Part D in 2024 and 2025 Under the Inflation Reduction Act and How Enrollees Will Benefit
The Inflation Reduction Act is capping Out-of-pocket drug spending will at $2,000 - Beginning in 2025, Part D enrollees’ out-of-pocket drug costs will be capped at $2,000. Employers should be aware their pharmacy benefits may soon not be considered "Credible Coverage." If not - employees over 65 must obtain a Part D Plan, or they will be penalized when they do. Beneficiaries must be enrolled in Part A ($0) and/or Part B (Premiums start at $164.90) to purchase a Part D Plan. If contributing to an HSA, you must stop contributions 6 months before you enroll in Part A or B. I am currently scheduling Medicare 101 talks - please email me to learn if this would benefit your group! Learn more about the upcoming changes!
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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.
- Age: You must be 65 years or older.
- Residency: You must be a Pennsylvania resident for at least 90 consecutive days before applying.
- 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.
- PACE Income Limits:
- 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:
- Mail: PACE/PACENET, PO Box 8806, Harrisburg, PA 17105-8806
- Fax: 1-888-656-0372
- Email: papace@magellanhealth.com
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.
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