PACE and PACENET Pennsylvania: Income Limits, Copays, and the Deductible Nobody Quotes Correctly
You will find "$40 a month" on a great many pages. The Commonwealth's own provider guidance says something different: the PACENET monthly deductible is established each year based on the Medicare Part D premium benchmark set annually by the federal government. It is not a fixed number written into the programme. Sites that print one figure and never revisit it are quoting whichever year they happened to write in. Ask what this year's deductible is when you call.
Pennsylvania runs one of the largest state prescription programmes in the country, paid for out of the state lottery. Two tiers, one application, no asset test, and copays of $6 to $15 depending on where you land.
Income limits
Eligibility runs on your previous calendar year's income, and the ceiling for the upper tier is in the middle of a legislated increase. Both sets of figures below are real; which one applies to an application filed this week is a question for the programme, not for a website.
| Tier | Single | Married, combined |
|---|---|---|
| PACE | $14,500 or less | $17,700 or less |
| PACENET as published by the state |
$14,501 – $33,500 | $17,701 – $41,500 |
| PACENET under Senate Bill 731 of 2025 |
up to $45,000 | up to $55,000 |
→ swipe the table sideways
Sources: Commonwealth of Pennsylvania service page, as published. Pennsylvania General Assembly fiscal note to Senate Bill 731 of 2025, signed 2 June 2025, raising the PACENET ceiling with an effective date of 1 July 2026. Confirm the operative figure on 1-800-225-7223.
If you sit between $33,500 and $45,000, that gap is the whole question, and it is worth one phone call rather than an afternoon of reading.
Two things that are not part of the test. There is no asset test — savings, a paid-off house, a retirement account, none of it counts. And there is no waiting for an enrolment season; applications are taken all year.
What you actually pay at the counter
| Tier | Generic | Brand name |
|---|---|---|
| PACE | $6 | $9 |
| PACENET | $8 | $15 |
→ swipe the table sideways · Based on a 30-day supply
Source: PACECares, the programme administrator for the Pennsylvania Department of Aging.
Those are ceilings, not fixed prices. The administrator states that a significant number of cardholders pay less than these amounts — in some cases nothing at all — because another plan or subsidy pays first and PACE covers what is left. If you hold federal Extra Help, your copays are governed by that and can be lower still.
The PACENET deductible, and why we will not print a figure
PACENET cardholders satisfy a monthly deductible before the programme starts paying. PACE cardholders do not have one.
What that deductible is, though, is set annually and tied to the federal Part D premium benchmark. The Commonwealth's provider guidance says so explicitly, and it also tells providers that income limits are subject to change and to check the administrator's site for current figures. When a state tells its own pharmacies not to rely on printed numbers, a website printing one from two years ago is not doing you a service.
So: ask. When you call 1-800-225-7223, ask what the PACENET monthly deductible is for the current year. It is one question and it changes your budget.
Three routes, four rules that decide eligibility, and the cost-of-living protection that keeps existing cardholders in when a Social Security rise would otherwise push them out.
How to apply for PACE and PACENET →How it sits alongside Medicare Part D
This is where PACE earns its reputation. It is not an alternative to Part D — it works on top of it, and on top of retiree coverage, union plans, employer plans, Medicare Advantage and VA benefits.
Two things it does that most people do not expect.
It may help pay your Part D premium — and the administrator states this includes the full Part D late enrolment penalty. That penalty follows people for life once incurred, and a state programme absorbing it is unusual.
You can hold PACE while holding other coverage. The programme is designed as the payer of last resort: other insurance is billed first, PACE covers what remains. That is why cancelling a Part D plan because you "have PACE now" is a mistake — you lose the first payer and keep the second.
How Pennsylvania compares
Most states have nothing like this. A retiree in Florida or Texas with drug costs has the federal Extra Help subsidy and then the open market. A Pennsylvanian has a third layer, funded by the lottery rather than by general taxation, with income ceilings far above what Extra Help allows.
The trade-off is that PACE is age-based — 65 and over, with no route in for younger people with disabilities — and it requires 90 days of residence. It is also, strictly, a Pennsylvania programme: the medicines are dispensed through pharmacies located in Pennsylvania.
Seven things people get wrong
It is set each year against the federal Part D benchmark. There is no permanent figure, whatever a website tells you.
The upper ceiling is being raised to $45,000 single and $55,000 married. If you sit in that band, call and ask which limit is being applied.
They do not. This programme looks at income only.
PACE is the payer of last resort. Drop the first payer and you shift cost onto yourself, and you may earn a late-enrolment penalty into the bargain.
The programme may help with the Part D premium including the full penalty. People carry that charge for years without asking whether it can be covered.
Eligibility runs on the previous calendar year. A recent retirement does not show up until the following year's determination.
The programme runs through Pennsylvania pharmacies. Winter elsewhere needs planning before you go, not after.
| Agency | Pennsylvania Department of Aging |
| Programme | PACE and PACENET — funded by the Pennsylvania Lottery |
| Phone | 1-800-225-7223 |
| PACE/PACENET, PO Box 8806, Harrisburg, PA 17105-8806 | |
| Programme page | pa.gov — PACE and PACENET |
| Administrator | PACECares |
Related programs
The procedureHow to apply for PACE and PACENET→ The federal layerExtra Help for prescription costs→ If you file for that tooHow to fill out Form SSA-1020→ Pays your Part B premiumMedicare Savings Programs: all 50 states→Tools you'll need
pacecares — copays, forms, current figures
medicare.gov/plan-compare — which drug plan costs least
shiphelp.org — free Medicare counseling
eldercare.acl.gov — 1-800-677-1116
211.org — local help finder
Sources. Commonwealth of Pennsylvania, Apply for the Pharmaceutical Assistance Contract for the Elderly (PACE) Program. Pennsylvania Department of Aging, PACE Provider Guide — payer of last resort, the annually set PACENET deductible tied to the federal Part D premium benchmark, and the note that income limits are subject to change. PACECares, programme administrator — copay amounts and Part D premium and late-enrolment-penalty assistance. Pennsylvania General Assembly, fiscal note to Senate Bill 731 of 2025.
Verified: August 1, 2026. Income limits and the monthly deductible change; confirm by phone before relying on any figure here.
This page explains a public program. It is not legal or financial advice and it is not an eligibility decision. Only the Pennsylvania Department of Aging can determine whether you qualify.
Comments
Post a Comment