3. If I have PACE or PACENET, why should I enroll in Part D?
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1 The following Questions and Answers address program policies and procedures as they relate to how the PACE Program is working with Medicare Part D in What is PACE Plus? A. This is the term that is used when PACE and PACENET cardholders are also enrolled in Medicare Part D. Persons enrolled in PACE Plus will receive the same coverage that they now receive with PACE and PACENET at the same, or lower, cost. 2. Are PACE and PACENET being eliminated? A. No, PACE and PACENET will continue to exist. They will provide full coverage to those who are not enrolled in Part D. For those who have Part D coverage, they will operate behind the scenes to reduce costs and maintain full coverage. 3. If I have PACE or PACENET, why should I enroll in Part D? A. It helps the program save money that can be used to help more Pennsylvanians. And, many PACE or PACENET cardholders will save money by being enrolled in both programs at the same time. 4. Can I decide not to enroll in Part D at all? A. Yes, this program is voluntary. If you are in PACE/PACENET and you choose not to enroll in Part D, PACE/PACENET will continue to pay for your drugs as it has in the past. 5. Are all PACE/PACENET cardholders enrolled in Part D? A. No. We will not enroll the following groups of consumers into a Part D Plan: those who are not eligible for Part D, those in Medicare Advantage Plans, and those in employee retirement plans with drug coverage. We will also not enroll anyone who notifies us that they do not want to be enrolled in a Part D plan for Individuals who have previously enrolled in Part D by joining a Prescription Drug Plan (PDP) on their own will receive information from the program telling them which partner plan the program recommends they join in order to get the most help with Part D costs. Individuals can decide to stay enrolled in their current plan. They will not be required to change plans. However, the program may not be able to help pay the Part D plan premium for individuals who are not enrolled in a partner plan.
2 6. How do I know if PACE/PACENET has enrolled me in Medicare Part D? A. If PACE/PACENET enrolls you into a Part D plan, you will receive a letter from the program telling you the name of the Medicare Part D plan that they have selected for you. The program reviews your information and selects a plan that will cover your medications at the lowest cost and allow you to go to the pharmacy that you prefer. If you are enrolled in a Medicare Advantage plan (HMO) or have creditable coverage through your employer-sponsored retiree plan, the PACE Program will not enroll you into a stand-alone Part D plan. If we enrolled you in Part D it would disrupt your health insurance or cause you to lose coverage completely. If you have either of these coverages, you should contact your insurance company for further instructions on whether you should enroll in Part D. 7. I have not received any letter or other information from PACE or PACENET about how they will work with my Part D plan. Does that mean that I will not get any help from PACE or PACENET with Part D costs? A. PACE and PACENET intend to help all members with Part D costs; however, the program currently does not have agreements to work with all Part D plans. PACE and PACENET are working to get agreements with all non-partner plans so that the program can help pay the Part D premium for PACE members. If you have questions about how PACE/PACENET can work with your Part D plan, you should call the program at Will I receive an identification card from the Part D plan PACE/PACENET enrolled me in? A. Yes, you will receive an identification card from the Part D plan. You will use your Part D plan identification card along with your PACE/PACENET card at the pharmacy, and the program will help pay Part D costs so that you will not have to pay more under Part D than you would under PACE and PACENET. 9. How will pharmacies know about these changes? A. The PACE Program has informed pharmacies about how PACE works with Part D. We continue to share information with the pharmacies each month. 10. I am not currently enrolled in PACE or PACENET. If I enroll in the program, will I be automatically enrolled in Part D? A. If you are enrolled in a Part D plan when you enroll in PACE or PACENET, you can stay enrolled in the Part D plan. If you are not enrolled in Part D when you enroll in PACE or PACENET, we will not assign you to a Part D plan immediately but may provide recommendations to you within a few months.
3 11. Who will pay the Part D premium? A. That depends on whether you are in PACE or PACENET. The PACE Program will pay the Part D premiums for PACE cardholders enrolled in one of the program s partner Part D plans. If PACE has secured an agreement with a non-partner plan to pay the Part D plan premium, PACE will pay up to the regional benchmark which is currently $26.59 for In these instances, if you enroll in a plan with a premium higher than $26.59, you must pay the difference. PACENET cardholders enrolled in Part D will have to pay the Part D plan s premium at the pharmacy (for both partner and non-partner plans) but will no longer have to pay the PACENET deductible. 12. I am enrolled in PACENET. If I do not enroll in Part D, what will I have to pay? A. When you first use your PACENET card, and in the months that follow, you will have to pay a monthly deductible that is equal to the regional benchmark premium for Part D, which is $26.59 for After you pay this deductible at the pharmacy, you will pay the PACENET copays for your medications ($8 for generics and $15 for name brand medications). 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 2008, but do not use my card until March, In March, I pay a deductible of $ If I do not purchase any medications in April, my deductible in May will be $53.18 ($26.59 from April plus $26.59 from May) and so forth. 13. If I am enrolled in Part D, will I still use my PACE or PACENET card? A. Yes, show both cards at the pharmacy. This will tell your pharmacist to bill your Part D plan first, and bill PACE or PACENET second. It will also tell your pharmacist that you are entitled to all of the drugs that are available under PACE and PACENET, with no hassle. 14. Will my co-payments be higher with PACE and Medicare Part D? A. No. If your Part D plan charges higher co-payments than you were paying under PACE/PACENET, the program will pay the difference. Your pharmacist should bill the cost of the drug to the Part D plan. If the plan s co-payments are higher than the PACE or PACENET co-payments, the pharmacist can bill PACE/PACENET the difference
4 between the plan s co-payment and the PACE or PACENET s co-payment so that you do not pay a higher co-payment than what you are use to paying. If you run into any confusion at your pharmacy, call the program's toll free number while you are at the pharmacy. 15. What happens if my Part D Plan charges lower co-payments than PACE/PACENET? A. You will pay the lower co-payments. 16. Many Part D plans stop their coverage after you reach a certain dollar limit. This is referred to as the donut hole. How will this work under Medicare Plus PACE? A. There will be no donut hole no matter which Part D plan you have. 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. 17. What happens if my Part D Plan doesn't cover all of the drugs that PACE/PACENET covers? A. The PACE/PACENET program will automatically pay for drugs that your Part D Plan won't cover, so long as these are drugs covered by PACE/PACENET. That means that if your Part D plan has a restrictive drug formulary, PACE will cover your medications or work directly with the plan to process a prior authorization on your behalf. 18. Can I go to any pharmacy I choose if I am in PACE and Medicare Part D? A. No, You must use the pharmacies that are in your Part D plan's network. We picked a plan for you that includes the pharmacy where you usually get your prescriptions filled. If you decide to change pharmacies, check with your new pharmacy to make sure they participate in your Part D plan. 19. If my Part D plan offers a mail-order service, can I use it? A. Yes, but the mail-order pharmacy must participate with the PACE Program in order for the program to help pay for your extra copayments. Also, since you will be ordering a three-month supply of your drug by mail, you will be paying up to three PACE/ PACENET co-payments at once. For example, a PACE cardholder would pay $18 for a 90-day supply of generic medications.
5 20. Where can I get a list of the mail-order pharmacies that I can use? A. PACE/PACENET cardholders enrolled in Part D will have to use the pharmacies that participate in the Part D plan s pharmacy network. If your Part D plan offers mail-order services, the plan will provide information to you regarding these pharmacies in their Welcome Kit and enrollment documents. If you want to find out whether a mail-order pharmacy also participates with PACE/PACENET, you can contact the program at How did the program decide which Part D plan to enroll me in? A. We looked at the drugs that you take and the pharmacy you use most often. Then, we tried to match you up with a partner plan that covers your medications and works with your pharmacy. 22. Which Part D Plans are partnering with PACE/PACENET? A. For a list of the Part D partner plans and their premium amounts, please contact the program at Are these the only plans that I can enroll in? A. No, but these plans have signed agreements with the program for 2008 that make it easier for the PACE program to coordinate with them and avoid confusion. Enrolling in a partner plan guarantees that you get the most help with your Part D plan costs. 24. Where can I get more information about the Part D plans available in PA? A. Information about premiums, participating pharmacies and covered drugs for these companies, and any other Part D plan operating in Pennsylvania is available by calling Medicare ( or (TTY)) or going on the web at: Can I pick a different plan from the one that the program has chosen for me? A. Yes. During the Open Enrollment Period from November 15, 2007 through December 31, 2007 anyone on Medicare can change their Part D plan. The program will send you information about your options. If you make changes during this period, your new Part D plan will start on January 1, If you would like to pick a different partner plan, you should call If you want to enroll in a Part D plan that is not one of our partner plans, you should call Medicare at
6 26. If I am already enrolled in a Part D plan and have been paying my monthly premiums to the plan, will I still be switched over to the Part D plan that the PACE program picked for me? A. During the Open Enrollment Period, you will receive a letter from the program if you are already enrolled in Part D giving you the opportunity to switch to a partner plan. The choice is yours, and you are not required to change plans. 27. What should I do if I receive a bill from my Part D Plan for the monthly premium? A. For 2008, if you are enrolled in one of the PACE/PACENET program s partner plans, you should not receive a bill from the Part D plan. If you receive a bill from your Part D plan, you should contact the PACE/PACENET program at If I am in a Medicare Advantage Plan without prescription drug coverage, do I have to change plans to enroll in Part D? A. If you are in a Medicare Advantage Plan without prescription drug coverage and you would like to enroll in Part D, you need to contact your Medicare Advantage Plan to see if they offer a Part D benefit. If they do, you should enroll through your Medicare Advantage plan in order to keep your doctor and other health care providers. If you are in PACE (as opposed to PACENET) the program will pay the Part D premium portion for you (up to $26.59) if the plan has signed a premium payment agreement with the program. If your Medicare Advantage Plan does not offer a Part D benefit, then you may need to join a different Medicare Advantage Plan to get Part D. Keep in mind that changing Medicare Advantage plans may affect your choice of doctors. 10/16/07
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