February 6, 2013 by MDOPKIN

Need Help Paying Medicare Part D Premiums, Copays & Deductibles?

Even with the best of Medicare coverage, you can expect that it will not cover all the costs that an elder will spend for health care and prescription drugs. The rest will need to be paid from supplemental insurance, long-term care insurance or out of pocket.

Depending upon your household income and your assets, you may qualify for help from Medicare to pay for prescription drug coverage. If you qualify, you will pay a minimal fee for generic or brand name drugs, or you may pay only a portion of the premium for your drug plan, with deductibles based on your income. The exact dollar amounts can vary from year to year.

State Pharmaceutical Assistance Programs

Your may also qualify for help under the State Pharmaceutical Assistance Program for your state. Our law firm can assist in both New Jersey and Pennsylvania. Here are some of the basics of the assistance programs for those two states. Please remember this is only a summary and not a comprehensive explanation of the programs.


New Jersey has two programs for seniors: the Senior Gold Prescription Discount Program and the Pharmaceutical Assistance to the Aged and Disabled Program (PAAD).

  • To qualify for the Senior Gold program, your income must be between $25,312 and $35,312 for a single person or $31,035 and $41,035 for a couple. You must be enrolled in Medicare Part D and you are responsible for paying the monthly premium. The state plan will assist with deductibles, copayments and the coverage gap. The Senior Gold program does not pay for diabetes supplies and some drugs are excluded.
  • To qualify for the PAAD program (Pharmaceutical Assistance for the Aged and Disabled), you must not be receiving Medicaid or enrolled in a prescription drug plan that offers better coverage than PAAD. If your drug coverage is partial, then you can apply for PAAD. Your income must be $25,312 or less if single, or $31,035 or less if married. You MUST have Medicare Part D coverage. If you are part of a Medicare Advantage plan (private insurer), you must add a prescription benefit to that coverage. Medicare will pay any costs above the PAAD copay for generic or name brand prescription drugs. There are some drugs that PAAD will not cover. It also does not cover diabetes-testing supplies.


Pennsylvania has two programs for seniors: PACE and PACENET.

  • In order to qualify for PACE (Pharmaceutical Assistance Contract for the Elderly), your income must be less than $14,500 for a single person or less than $17,700 for a married person. You cannot be eligible for drug benefits under medical assistance or receiving Medicaid prescription benefits.
  • In order to qualify for PACENET (Pennsylvania PACE Needs Enhancement Tier), your income from the previous year must not to exceed $23,500 if single and $31,500 if married. (Assets and resources are not counted as income) You cannot be enrolled in the Medicaid prescription benefit. If you are NOT enrolled in a Part D Plan, you will have to pay a $34.32 premium each month at your pharmacy. Generic and name brand prescription drugs are then available for a low flat-fee. If you ARE covered by a Part D plan, you will have to pay that plan’s premium but will not pay the PACENET deductible. If the cost of your medicine is more than your premium, you will only pay for your medication. If the cost is less than your premium, any amount remaining after you have paid for your prescription will carry over to the next month.

Paying for medical care and prescription drugs after age 65 is a source of stress for many people. Advance planning to ensure you have chosen the best type of Medicare plan for your situation is the first step in reducing stress.

Creating a Special Needs Trust to cover ancillary medical costs, particularly for those who may need nursing home care, can be another tool that gives you peace of mind.

If you have questions, talk to Matthew Dopkin about your options BEFORE you retire.


Dopkin Law Firm advises clients on the intricacies of business and tax law matters. To discuss these or other issues with attorney and CPA Matt Dopkin, contact us at 215-519-4269 or via email at mdopkin@dopkinlawfirm.com.

© 2013 Dopkin Law Firm

This Alert is published by Dopkin Law Firm. It is provided solely as legal information, not legal advice. Legal advice depends, to a large extent, upon the particular facts of a matter. For legal advice, contact your legal advisor.