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The PACE Program will pay the Part D premiums for PACE cardholders enrolled in one of the plans that has a signed agreement. PACE will pay up to the regional benchmark, which is $35.50 for 2014. If you enroll in a plan with a premium higher than $35.50, you must pay the difference.
The Program will not be able to help pay the Part D plan premium for individuals who are not enrolled in a Part D plan that does not have a signed agreement.
PACENET cardholders enrolled in one of the program's partner Part D plans will have to pay the Part D plan's premium at the pharmacy but will no longer have to pay the PACENET deductible. You will never be charged more than the cost of your medication at one time. Therefore, if the cost of your medication is less than the amount of premium you owe, you only pay the cost of the medication and the remaining amount of the premium you owe will be carried over until you need another medication filled (that same month or the next month).
EXAMPLE: Part D plan's monthly premium is $34.00.
Prescription filled on 1/12/14 – cost of the drug was $8.25 – cardholder charged $8.25 and this amount goes toward the premium of $34.00 ($25.75 remaining).
Prescription filled on 1/13/14 – cost of the drug was $14.20 – cardholder charged $14.20 and this amount goes toward the remaining premium of $25.75 ($11.55 remaining).
Prescription filled on 1/13/14 – cost of the brand drug was $153.24 – cardholder charged $11.55 to meet the remaining amount of the premium plus a $15 co-payment for the brand name medication.
PACENET cardholders enrolled in a non-partner Part D plan will have to pay the Part D plan's premium directly to the Part D plan each month, but they will not have to pay the PACENET deductible at the pharmacy.
If you have not used your PACENET card and you do not currently take medications, you will not have to pay this deductible until you activate your card at the pharmacy. Once you activate your PACENET card, the monthly deductible will accumulate if it is not met each month. This process is only for PACENET cardholders that do not enroll in Part D.
EXAMPLE: I sign up for PACENET in January 2014, but do not use my card until March, 2014. In March, I pay a deductible of $35.50. If I do not purchase any medications in April, my deductible in May will be $71.00 ($35.50 from April plus $35.50 for May) and so forth.
If you are enrolled in a non-partner Part D plan, you may receive a bill for the monthly premium:
* If you are a PACE member in a non-partner Part D plan that has signed a premium payment agreement with the program, you should not receive a monthly bill because PACE will pay the premium to the plan for you, as long as the monthly premium does not exceed $35.50.
In addition, you should not sign up for deductions from your Social Security checks for payment of your Part D premiums or send payment for any coupon booklets you receive without first checking with the PACE/PACENET program.
* If you are a PACE member in a non-partner Part D plan that does NOT have a signed premium payment agreement with the program, you will have to pay the monthly premium to the plan.
* All PACENET members who are in a non-partner Part D plan should receive a monthly premium bill from their Part D plan and are responsible for paying that premium directly to the plan.