Uh first potential client and...

MrStan · 03-25-2007, 12:15 AM

I have NO idea - fortunately - she's family so were good.

Details are as follows -

PA resident - Medicare A B & D - will be in the doughnut hole by the end of this year - tells me she has a sup. plan (?) through Highmark PACENET.

She is very concerned that she won't be able to afford her Rx's next year - and wonders if she should look into other options. She's also concerned because she wonders if she needs to get it done by 3/31 (which this I really have no idea)

According to the research I have done - PACENET will not allow there to be a gap in coverage - Therefore there is not need to worry about the additional out of pocket expense.

Anyone have any idea what I am talking about??? Because I sure as H*ll don't... LOL. Any help is appreciated.

Thanks in advance!

Cenla Agent · 03-25-2007, 12:22 AM

Originally Posted by MrStan

I have NO idea - fortunately - she's family so were good.

Details are as follows -

PA resident - Medicare A B & D - will be in the doughnut hole by the end of this year - tells me she has a sup. plan (?) through Highmark PACENET.

She is very concerned that she won't be able to afford her Rx's next year - and wonders if she should look into other options. She's also concerned because she wonders if she needs to get it done by 3/31 (which this I really have no idea)

According to the research I have done - PACENET will not allow there to be a gap in coverage - Therefore there is not need to worry about the additional out of pocket expense.

Anyone have any idea what I am talking about??? Because I sure as H*ll don't... LOL. Any help is appreciated.

Thanks in advance!

1st potential client for what? What are you selling?

3/31 is the end of the Open Enrollment Period for Medicare beneficiaries to enroll in a MAPD (Medicare Advantage plan with Part D built in).

The supp with PACENET is just that, a supp. Probably a F plan that covers all the A and B gaps but it has NOTHING at all to do with Part D. She will hit the coverage gap with Part D if her total Rx costs for the year exceed $2400. At that point they are basically paying full price. Look up Senior Rx for your state through google, they connect people with options to help them if they hit the coverage gap. Also, the Medicare website (medicare.gov) has a link entitled "Bridging the Coverage Gap."

MrStan · 03-25-2007, 12:45 AM

The "potential client part" was a joke - I am not selling anything. Just a family member - I'd like to help - but don't know the answer.

It's an E plan from what she tells me -

What I have read states "there will be no donught hole. The PACE/PACENET program will fill in the gaps, so that you can continue to get your drugs just as you did under PACE/PACENET."

Sounds to me like she's ok then?

Cenla Agent · 03-25-2007, 12:56 AM

Apparently PACENET is some kind of low income Rx help for PA residents that will pay what their plan doesn't pay. Hopefully someone from PA on the board can give more information.

MrStan · 03-25-2007, 12:59 AM

Yes, Sorry - I should have said that. Indeed - I just checked out PA dept of aging - And I am getting the same info -

If anyone from PA can confirm - I;d sure appreciate it.

wilkin · 03-25-2007, 09:12 AM

PACE and PACENET are prescription plans run through the Pennsylvania Dept of Aging. You can find all the details here: http://www.aging.state.pa.us just follow the links to PACE. Individuals are encouraged to sign up for a Part D plan in addition to PACENET and the two work together because this ultimately costs the state less. It costs the individual less also. There is no coverage gap with PACENET and regardless of which Part D plan they enroll in their co-payments for meds are 8/generic and 15/brand.
-Bill

MrStan · 03-25-2007, 09:29 AM

Thanks wilkin - Thats where I got the information I had - I just wanted to verify that what I was reading was what I thought I was reading...

arnguy · 03-27-2007, 02:16 PM

As wilkin stated, the applicants to PACE/PACENET are encouraged to purchase a Part D. However, it is not required. The income qualifications for PACE/PACENET are stated on the website that wilkin gave.

Cenla Agent · 03-28-2007, 12:40 AM

Originally Posted by wilkin

PACE and PACENET are prescription plans run through the Pennsylvania Dept of Aging. You can find all the details here: http://www.aging.state.pa.us just follow the links to PACE. Individuals are encouraged to sign up for a Part D plan in addition to PACENET and the two work together because this ultimately costs the state less. It costs the individual less also. There is no coverage gap with PACENET and regardless of which Part D plan they enroll in their co-payments for meds are 8/generic and 15/brand.
-Bill

The generic copay for many Part D plans is less than $8 but I guess it is offset by the very low brand copay and no coverage gap.