New Income Limit Expansion For State Discount Prescription Programs Benefits More Seniors And Residents With Disabilities

By: Follow South Jersey Staff

SOUTH JERSEY — Income thresholds for the Pharmaceutical Assistance to the Aged and Disabled (PAAD) and the Senior Gold Prescription Discount drug assistance programs have each increased by $10,000, making drug prices more affordable and allowing more than 20,000 seniors and individuals with disabilities throughout the state to qualify for the first time.

The PAAD and Senior Gold Prescription drug assistance programs are available to state residents 65 and older and those with disabilities. PAAD reduces drug prices to $5 for covered generic drugs and $7 for covered name brands. Senior Gold reduces prices in half after a $15 co-pay for covered prescriptions.

The new PAAD income limits are $38,769 if single and $45,270 for a couple. Income limits for the Senior Gold program are now $48,769 if single and $55,270 if married. Assets are not an eligibility consideration for either program.

According to the PAAD website:

You may be eligible for PAAD if you meet the following requirements:

  • You are a New Jersey resident;
  • You are age 65 or older or between ages 18 and 64 and receiving Social Security Title II Disability benefits; and
  • Your income for 2022 is less than $38,769 if single or less than $45,270 if married.
  • Medicare-eligible PAAD beneficiaries are also required to enroll in a Medicare Part D Prescription Drug Plan. PAAD will pay the monthly premium for certain standard basic Part D plans with a monthly premium at or below the regional benchmark. These plans will cover medically necessary prescription medications under Medicare Part D. If a beneficiary self-enrolls in an enhanced plan at or below the regional benchmark premium amount, PAAD will pay the premium as long as the plan agrees to follow all the billing requirements.
  • The federal Medicare Plan and/or PAAD will pay any costs above the PAAD copayment of $5 for each covered generic drug or $7 for each covered brand name drug, including premiums. However, if a Medicare Part D plan does not pay for a medication because the drug is not on its formulary, PAAD beneficiaries will have to switch to a drug on their Part D plan’s formulary, or their doctor will have to request an exception due to medical necessity directly to their Part D plan. Medicare Advantage participants must add a prescription benefit to their coverage, and PAAD will contribute up to the regional benchmark amount towards the prescription portion of their total premium.

Applications are available online in English and Spanish at: Requests for a paper application can be made by calling 1-800-792-9745.

Atlantic County State Health Insurance Program counselors are available to assist those who would like to apply. Residents may call the county at 1-888-426-9243, Monday through Friday, 8:30 a.m. – 4:30 p.m.

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