Additional Medicare Information
MEDICARE PART A – HOSPITAL INSURANCE Benefits: Medicare Part A helps pay for:
- Inpatient hospital care
- Inpatient skilled nursing facility care
- Home health care
- Hospice care
- Inpatient care in a religious nonmedical health care institution In most cases there is no premium for Medicare Part A, however if you are not eligible for free Part A and you didn't buy it when you were first eligible, your monthly premium may be higher.
MEDICARE PART B – MEDICAL INSURANCE Benefits: Medicare Part B helps pay for:
- Outpatient hospital services
- Various medical services and supplies
- Preventative benefits A monthly premium must be paid for Part B.
MEDICARE PART D – PRESCRIPTION DRUG COVERAGE Benefit: Medicare Prescription Drug Coverage is available to everyone with Medicare and is provided by private insurance companies. You choose the plan and pay a monthly premium. Some plans may also have a deductible and other cost-shares such as co-pays or co-insurance, however, some individuals may qualify for help with these costs through the Social Security Administration's Low-Income Subsidy also known as Extra Help.
Additional Medicare Advantage Program Information
Medicare Advantage Program
- Provides for coverage of clinical diagnostic lab tests during the emergency with no cost sharing and no prior authorization or utilization management requirements
- The APPRISE Program provides free, objective, in-person or telephone assistance to help guide Medicare beneficiaries through their many health insurance options including Medicare and Medicaid, Medicare supplement insurance plans, Medicare Advantage Plans, Medicare prescription (Part D), long-term care insurance policies, and public 47 benefit programs. Contact: The APPRISE Program at 800-783-7067 from 9 a.m. to 4 p.m. Monday-Friday.
To ensure adequate health care for low-income seniors and individuals with disabilities and allow them more spendable income by paying their Medicare premiums, the state developed a special Medical Assistance program – Healthy Horizons. Contact your local Department of Human Services County Assistance Office or call (800) 692- 7462 from 9 a.m. until 4:30 p.m. Monday-Friday
PACE AND PACENET
The Pharmaceutical Assistance Contract for the Elderly (PACE and PACENET) programs offer comprehensive prescription coverage to qualified older Pennsylvanians. The programs cover most medications that require prescriptions, including insulin and insulin syringes. PACE or PACENET wrap around Medicare Part D prescription coverage, supplementing this coverage to offer older Pennsylvanians the best 70 benefits of both programs. Older adults continue to receive the same prescription benefits while, in many cases, they save more money, and often have $0 co-pays.
PACE/ PACENET provides a one-month supply of medication for a small co-pay.
- For PACE, $6 for each generic and $9 for each brand-name prescription drug
- As of March 5, 2020, PACE will now reimburse prescription refills even though the required 75% of the days' supply has not passed – except for opioids and other controlled substances – which will be handled on a case by case basis. Enrollees wishing to receive that exception must have their pharmacy provider contact PACE at 1-800-835-8040, 24 hours a day, seven days a week, to make that request. The program has traditionally not offered this exception unless an enrollee's medications were lost or stolen. Enrollees who have difficulties obtaining their refills can call cardholder services at 1-800-225-7223
- For PACENET, $8 for each generic and $15 for each brand name prescription drug
- For PACE, the Program pays Medicare Part D premiums if card holder is enrolled in a premium payment plan.
- For PACENET, the cardholder is responsible for paying the monthly premium.
Find enrollment applications online at PACECares.magellanhealth.com
For more information, call 866-712-2060
PENNSYLVANIA PATIENT ASSISTANCE PROGRAM CLEARINGHOUSE
Pennsylvania Patient Assistance Program Clearinghouse (PA PAP) assists anyone needing prescription help, regardless of income. If you are uninsured, under-insured, over the age of 18 and do not currently have Medicaid or PACE coverage, PA PAP will help you apply for prescription assistance through various patient assistance programs that you may not have known about. Contact: For more information, call 800-955-0989.
PENNSYLVANIA PRESCRIPTION PRICE FINDER
On the Price Finder website, consumers shop for the best medication prices for commonly used drugs. The website includes prices, pharmacy location, store hours, where to find low-cost generics, and drug education materials. Contact: For more information, call 800-835-4080 or visit www.parxpricefinder.com.