You have a Medicare prescription drug plan (PDP or Part D plan), but you are finding that the premium for the plan and the costs for your medications are taking a big bite out of your income. Is there any way to cut the costs?
The answer is yes, if your income falls within certain limits. This is officially known as “Extra Help.” This term covers federal and state plans which help people with lower income get their prescription drug plans and their medications at a more affordable amount.
In New Jersey one plan is called Pharmaceutical Assistance to the Aged & Disabled or, simply, PAAD. Residents of New Jersey whose 2015 income is less than $26,575, if single, or less than $32,582, if married, may be eligible. The 2016 incomes have not been published yet, but should be out in the near future. These rates can be found on the NJ Department of Human Services site by searching for “PAAD”. To be eligible a person must be in a Medicare prescription drug plan in New Jersey. In addition to people 65 and older, PAAD is available for people 18 and older who are receiving Social Security Title II Disability benefits.
PAAD does several things for its members. First and foremost is that it lowers the copayments for covered medications to $5 for generic drugs and $7 for brand drugs. PAAD copayments are the most a person who has PAAD will have to pay, regardless of what the prescription drug plan’s copayments are. A drug must be covered in the drug list (formulary) for the member’s Medicare prescription drug plan for the PAAD copayments to apply. PAAD will also pay the monthly premium for the prescription drug plan as long as the premium is the same or below certain amounts. To find out those Part D plans in New Jersey for which PAAD pays the monthly premium, call 800-792-9745. PAAD also keeps people out of the Coverage Gap (aka “the donut hole”).
If a person’s income is higher than the income limits for PAAD, there is an alternative plan, the Senior Gold Prescription Discount Program. This plan is for New Jersey residents whose 2015 income is between $26,575 and $36,575, if single, or between $32,582 and $42,582, if married. Again the person must be in a Medicare prescription drug plan to be eligible.
Senior Gold provides discounts for those who are in the program. Senior Gold members’ copayment for a covered drug is $15 + 50% of the remaining cost of the prescription or actual drug cost, whichever is less. Once members reach annual out-of-pocket expenses exceeding $2,000 for single persons or $3,000 for married couples, they pay only a flat $15 co-payment per prescription for the balance of that eligibility period.
Applying for PAAD or Senior Gold is easy. All that is necessary is to fill out the Universal Application for PAAD, Senior Gold and Other Special Benefit Programs Form AP-2 which is available online at state.nj.us/humanservices/doas/home/ap2.html.
Notice that this form is also an application for some other benefits including hearing aids and some help with utilities. In addition the State of New Jersey will enroll people for other programs for which they are eligible on the basis of the AP-2 form. For example, if in reviewing the AP-2 form the state discovers that a person is eligible for state payment of her or his Part B premium, the person will be signed up for this program.
Just to be clear PAAD and Senior Gold are available to people who have Medicare Advantage (Part C) plans.
So as we enter the Medicare Open Enrollment Period (October 15 - December 7), this is a good time to look into getting “Extra Help” with your Medicare prescription drug plan costs.
Scott Bennett is a licensed insurance agent who helps people understand the sometimes confusing world of Medicare. He is also a member of Senior Ministries, Diocese of Newark, and a parishioner at the Church of the Saviour, Denville. Contact him at scott@bennettfinancial.net or 973-219-4701. There is no cost for his help. Check The VOICE Online for upcoming Senior Ministries presentations on Medicare.
