Centre County Office of Aging

PACE/PACENET and Medicare Part D Questions and Answers

  1. What is PACE (Pharmaceutical Assistance Contract for the Elderly) Plus Medicare?

    This is the term that is used to describe how PACE/PACENET will combine benefits with Medicare Part D. You receive the same coverage that you currently receive with PACE/PACENET plus, in most cases, additional benefits with Medicare Part D.

  2. Are PACE and PACENET being eliminated?

    No. PACE and PACENET will still be offered to current enrollees and to those that qualify but have not yet enrolled in the program.

  3. If I have PACE or PACENET, why should I enroll in Part D?

    Many PACE and PACENET cardholders will receive additional benefits by being enrolled in both programs at the same time. And, it helps the program achieve significant savings that can be used to help more older Pennsylvanians.

  4. Will I have to pay a premium penalty since I am joining Part D after the May 15, 2006 deadline?

    Because you are enrolled in PACE or PACENET, you can enroll in Part D between May 16 and November 14, 2006 without being charged a penalty on the Part D premium. In fact, the PACE program will pay the Part D premiums for PACE cardholders. PACENET cardholders who enroll in Part D will have to pay the Part D premium to the plan, but they will no longer have to pay the PACENET deductible.

  5. If I am enrolled in Part D and PACE or PACENET at the same time, when can I use my PACE or PACENET card?

    You will be able to use your PACE or PACENET card to cover any medications that the Part D plan does not cover, to cover any copayments in excess of your PACE or PACENET copayments, and you can use the card during any coverage gaps associated with Part D, such as the deductible and donut hole, so that you never go without coverage.

  6. If I enroll in Part D, will I have to pay more out of pocket for my prescriptions than I currently pay with my PACE or PACENET card?

    No. If you qualify for "Extra Help," you will pay copayments that are lower than what you pay with PACE and PACENET. However, if the Part D plan's copayments are higher than PACE and PACENET, the program will pay any amount in excess of the PACE and PACENET copay amount.

  7. When will PACE/PACENET start working with Medicare Part D?

    The program's initial enrollment process for Part D will be effective September 1, 2006.

  8. What Part D plans did PACE/PACENET select?

    For 2006, the program has made the decision to partner with Humana's Standard and Enhanced plans, Ovations' United MedAdvance and AARP MedicareRx plans, MemberHealth Community Rx Basic plan, Highmark's BlueRx Basic plan, AmeriHealth Advantage's Option 1 plan, First Health's Premier plan and Pacificare's Saver plan.

  9. If I am enrolled in a Part D plan that is not one of the plans that PACE/PACENET selected, will I have to change plans?

    No. If you want to change plans, however, you qualify for a special enrollment period during which you can change plans one time before November 15, 2006.

  10. How do I change plans?

    You will have to inform your current Part D plan that as a PACE or PACENET cardholder you want to use your "special enrollment period" to disenroll from their plan. You can notify the PACE program of which plan you want to change to and the program will help you with the enrollment process.

  11. What is the auto assignment process PACE/PACENET is using?

    The program has compared the enrollee's medication and pharmacy usage with the Part D plans' formularies and pharmacy networks. From this comparison, the program is identifying the plan that will provide the best overall benefit specific to the individual's needs. The program has mailed letters to their cardholders informing them of this process.

  12. I am already enrolled in a Part D plan and have been paying my premium. Will I have to contact my plan to stop billing me?

    If you are enrolled in one of the Part D plans that PACE has selected, the program has notified the plan on your behalf that the program will begin taking over your premium payments on September 1, 2006 and that the plan should stop billing you for the premium. If you are enrolled in a Part D plan that the program has not selected, the program will need to contact the plan to work out the arrangements to pay the Part D premiums for PACE enrollees. If you are enrolled in PACENET, you would continue to pay your Part D premium as you do today.

  13. If I am enrolled in a Medicare Advantage plan, do I have to change plans to enroll in Part D?

    You should contact your Medicare Advantage plan to see if they offer a Part D benefit. If they do and you want to enroll in Part D, you should enroll through your Medicare Advantage plan's benefit so that you can keep your doctor and hospital coverage, too.

  14. What should I do if I am enrolled in PACE/PACENET and I also receive prescription coverage through my former employer (retiree plan)?

    In this instance, you should check with your retiree plan to see if you need to enroll in Part D. If you do, PACE/PACENET can help you enroll in a Part D plan. If your retiree plan says you do not have to enroll in Part D, you should provide this information to PACE/PACENET, if you are enrolled in the program, so we can coordinate benefits with your plan.

  15. I do not want to enroll in the Part D plan that PACE/PACENET has assigned for me. What should I do?

    You have a couple of options: First, you should contact the program's toll-free number 1-800-225-7223 for more information. Our customer service staff can provide you with additional details that may help you understand our selection for you. Second, by calling this number, you can also select a different Part D plan. Keep in mind though, that the program has already selected the plan that will best meet your needs. And, third, since Part D is a voluntary program, you do have the option to decline enrollment. You can do this through our toll-free number as well. In this case, however, you will not be able to take advantage of any additional savings or mail-order services.

  16. If I am enrolled in PACENET and Part D, will I have to pay the PACENET deductible and the Part D premium?

    No. You will only have to pay the Part D premium to the plan in which you are enrolled. In some instances, this can be as low as $10.14 but no more than $32.54 for 2006.

  17. Some Part D plans offer mail-order services. Will PACE/PACENET allow me to use mail order pharmacies?

    If the Part D plan you enroll in provides mail-order services, PACE/PACENET will allow you to continue receiving your prescriptions from the mail-order pharmacy even when you use your PACE or PACENET card during the Part D deductible phase and donut hole. If you continue to use the mail-order services when you use your PACE or PACENET card, you will have to pay three (3) copayments at one time. For example, a PACE cardholder would pay $18 for a 90-day supply of generic medications.

  18. Can I keep my Medigap coverage if I enroll in Part D?

    Yes. If your insurance company offers Part D coverage, you can enroll through them or you may enroll through a separate Part D plan without affecting your Medigap coverage.

  19. Where can I get a list of the mail-order pharmacies that I can use?

    PACE/PACENET cardholders enrolled in Part D will have to use the pharmacies that participate in the Part D plan's pharmacy network. If your Part D plan offers mail-order services, the plan will provide information to you regarding these pharmacies in their Welcome Kit and enrollment documents.

  20. I am not currently enrolled in PACE or PACENET. If I enroll in the program, will I be automatically enrolled in Part D?

    If you are enrolled in a Part D plan when you enroll in PACE or PACENET, you can stay enrolled in the Part D plan. If you are not enrolled in Part D when you enroll in PACE or PACENET, the program will not assign you to a Part D plan immediately but will provide recommendations to you within a few months.

  21. I am enrolled in PACENET but do not take any medications. If I do not enroll in Part D, will I have to pay a premium even though I do not use the benefit?

    In this instance, you will not have to pay the Part D premium. However, when you use your PACENET card, you will have to pay a monthly premium that is equal to the regional benchmark premium for Part D which is $32.54 for 2006. This is a change for PACENET cardholders. In the past, you had to pay a $40 monthly deductible, which will be eliminated on September 1, 2006.

  22. How will I pay the premium at the pharmacy?

    Although the PACENET deductible will now be referred to as a premium, it will work exactly like the PACENET deductible except it will be a lower amount for the remaining months of 2006. If you have not used your PACENET card and you do not currently take medications, you will not have to pay this premium until you activate your card at the pharmacy. If you have used your PACENET card, effective September 1, 2006 through December 31, 2006, the monthly amount you will have to pay at the pharmacy will be $32.54 plus your PACENET copayments. This process is only for PACENET cardholders that do not enroll in Part D.

  23. How do I enroll in PACE or PACENET?

    The eligibility criteria for the program have not changed. Pennsylvania residents age 65 and older can apply as long as they meet the income guidelines (up to $23,500 for single persons and up to $31,500 for married couples). You can contact the program directly at 1-800-225-7223 to apply, or contact an APPRISE counselor at your Area Agency on Aging, or contact your local legislative office or senior center for assistance.