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Bob O’Connor and Denise King on PACE

About the Experts: Bob O' Connor is the vice president of Medicare for Aetna in Pennsylvania. Denise King is the director of Medicare for Aetna in Pennsylvania.

Q: What is PACE?
A: PACE stands for Pharmaceutical Assistance Contract for the Elderly. PACE is a program, funded by the Pennsylvania lottery, that provides residents of the Commonwealth of Pennsylvania, age 65 or older, some of the care and services they need that are not covered by Medicare and Medicaid. For example, PACE may help pay a portion of your prescription drug plan cost, except for the monthly co-payments of $6 for generic drugs and $9 for brand name drugs. It’s designed for people with limited resources whose incomes are not low enough to qualify for Medicaid.

Q: Are there any requirements for PACE?
A: You have to be a Pennsylvania resident for a minimum of 90 days. There are also income guidelines. Currently, the annual income limit is $14,500 for a single person and $17,700 for a married couple.

Q: Is there a difference between PACE and PACENET?
A: PACENET has similar benefits, but has co-payments of $8 for generics and $15 for brand name drugs. In addition, the income limits are slightly higher than those for PACE. The total income for a single person is between $14,500 and $27,500; and total combined income for a married couple ranges from $17,700 to $35,500. Income guidelines for PACE and PACENET change annually, so it’s important to review them each year.

Q: What is D-SNP?
A: D-SNP stands for Dual Eligible Special Needs Plan. D-SNP is a Medicare Advantage Plan designed for people who are eligible for both Medicare and Medicaid. Unlike PACE and PACENET, a D-SNP is not only for seniors. You have to qualify for both Medicare (65 and older or under 65 with certain disabilities) and Medicaid (receive assistance with Medicare premiums or eligible for full Medicaid benefits and assistance with Medicare costs). So someone who is 40 years old and living with certain disabilities can qualify for a D-SNP. A D-SNP will help you maximize your Medicare and Medicaid benefits. Keep in mind, if you are dual eligible and are on other programs, you may be overpaying on your co-pays and missing out on some additional benefits. It’s always good to examine what you are eligible for so you can maximize your benefits.

Q: What is LIS?
A: LIS is also referred to as Part D Low Income Subsidy or Extra Help. This federal program is for people who have resource and income limits. It helps people with Medicare pay for prescription drugs. If your monthly income is under $1,581 for an individual or under $2,134 for couples, and your assets are below specified limits, you may be eligible for LIS. To apply, you can fill out an “Application for Extra Help with Medicare Prescription Drug Plan Costs” form with your local Social Security office.

Q: Do you have any final takeaways for our readers?
A: Financial situations change over time. Maybe your spouse passed away, your income level decreased, or you had to sell your assets. There are several programs available for help, but understanding your options can be confusing at times. We offer a Benefits Checkup — a single site that a trusted agent can walk you through and help you determine if you qualify for any programs.

For more information, visit www.aetnamedicare.com and https://aetna.benefitscheckup.org/welcome-aetna/             

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