Pennsylvania PACE & PACENET: Medicare Drug Help (2026)

Pennsylvania runs two state programs, PACE and PACENET, that help residents 65 and older pay for prescriptions on top of Medicare Part D. PACE covers a single person with income of $14,500 or less; PACENET covers a higher band, up to $33,500 for a single person and $41,500 for a married couple. There's no asset test, and you apply by phone at 1-800-225-7223.1

In This Guide

• Key Takeaways
• PACE Here Isn't the Federal PACE Program
• What PACE and PACENET Are in Pennsylvania
• Who Qualifies for PACE or PACENET in Pennsylvania?
• How PACE and PACENET Work With Medicare Part D
• The Once-a-Year Rule for Switching Part D Plans
• What PACE and PACENET Cost You
• How to Apply for PACE or PACENET
• Frequently Asked Questions

PACE Here Isn't the Federal PACE Program

Two different programs share the acronym PACE, and confusing them is easy.

In Pennsylvania, PACE stands for the Pharmaceutical Assistance Contract for the Elderly, a state-funded program that helps pay for prescription drugs. That is the program this guide covers.

The federal PACE is a different thing entirely: the Program of All-Inclusive Care for the Elderly, a Medicare and Medicaid program that provides full medical and long-term care for people who need a nursing-home level of care but want to stay in the community. Pennsylvania runs that federal model under a different name, LIFE, precisely to avoid the collision.

So if you're searching for help paying for prescriptions, the Pennsylvania PACE and PACENET programs below are what you want, not the all-inclusive care program.

What PACE and PACENET Are in Pennsylvania

PACE and PACENET are Pennsylvania's two state pharmaceutical assistance programs. They are financed with Pennsylvania state lottery funds, and their day-to-day operations are run by a contractor, Prime Therapeutics State Government Solutions LLC, working under the guidelines of and reporting to the Pennsylvania Department of Aging. Both are for state residents 65 and older.1

They don't replace your drug coverage. They wrap around it. PACE and PACENET coordinate with Medicare Part D, Medicare Advantage drug plans, employer or retiree coverage, and VA benefits to lower what you pay at the pharmacy counter.1

The two programs serve different income bands. PACE serves the lower-income group. PACENET covers a higher band and, because of that, comes with a monthly premium the lower-income PACE group doesn't pay.

That state funding is also what makes these programs qualify under federal Medicare rules. Federal regulation at 42 CFR 423.464(e)(1) defines a State Pharmaceutical Assistance Program and specifically excludes any program funded through Medicaid or federal sources. Because PACE and PACENET are funded by the state, not the federal government, they meet that test, and that status carries the benefits described below.3

Who Qualifies for PACE or PACENET in Pennsylvania?

Eligibility turns on four things. You must be 65 or older, have lived in Pennsylvania for at least 90 days before the date you apply, fall inside the income band for your household, and not be enrolled in the Department of Human Services' Medicaid prescription benefit.1 Pennsylvania's eligibility regulation, 6 Pa. Code 22.21, spells out those conditions, and no asset or resource test is among them, so your home, car, and savings aren't what decide whether you qualify.

Which program you land in depends on your income:

Those bands are based on your total income from the prior calendar year.1 If your income puts you just above the PACE ceiling, you don't lose out; you move into PACENET, which covers the higher band.

The COLA Moratorium: If You Were Already Enrolled, a Raise Won't Push You Out

One rule protects people who are close to the income line. When Social Security issues an annual cost-of-living adjustment (COLA), that raise can nudge someone's income over the PACE or PACENET limit, which would ordinarily end their eligibility.

Pennsylvania blocks that, but only for people who were already in the program. A cost-of-living moratorium, most recently extended by Act 49 of 2025 through December 31, 2027, lets more than 20,000 older Pennsylvanians who were enrolled as of December 31, 2024 stay eligible when a Social Security COLA alone carries their income past the maximum limit.1

That distinction matters, so be clear about which side of it you're on. If you were enrolled by that date and a COLA has since pushed you over the line, the moratorium is what keeps your coverage in place; don't assume a raise ended it. If you were never enrolled and your income is above the limits in the table, the moratorium doesn't open a door for you; those income bands are the test.

How PACE and PACENET Work With Medicare Part D

PACE and PACENET sit on top of Medicare Part D, and the order in which the two pay is fixed by federal rule. Your Part D plan is always the primary payer; the state program pays second. Federal regulation at 42 CFR 423.464(b) states that "a Part D plan is always the primary payer relative to a State Pharmaceutical Assistance Program."3 In practice, your Part D plan adjudicates the claim at the pharmacy first, and PACE or PACENET then helps with what's left, the premium and the cost-sharing.

There's a second federal rule worth knowing. What PACE and PACENET pay on your behalf counts toward your Part D true out-of-pocket cost, the TrOOP total that determines when you hit the annual out-of-pocket cap. Under the federal definition of incurred costs at 42 CFR 423.100, payments made under a State Pharmaceutical Assistance Program count among your incurred costs.2 For 2025 and later years, costs reimbursed through insurance, a group health plan, or certain other third-party payment arrangements generally count toward that total as well. The two things that still do not add to the tally are the basic prescription drug coverage your own Part D or MA-PD plan provides, and manufacturer payments under the Manufacturer Discount Program.2 So the help you get from PACE or PACENET lands on your annual out-of-pocket tally instead of being spent outside it.

Keep both programs. Enrolling in PACE or PACENET does not replace the need for a Part D plan; the two are designed to run together.

The Once-a-Year Rule for Switching Part D Plans

Belonging to a State Pharmaceutical Assistance Program gives you a special enrollment period (SEP) to change your Part D plan outside the usual fall enrollment window. It's a real advantage, but it has a limit that's often misstated.

The SEP lets you make one plan election per year, not unlimited changes. Federal rule at 42 CFR 423.38(c)(17) provides that a person in a qualifying SPAP "is eligible to make one enrollment election per year."4 Some write-ups describe this as being able to switch Part D plans "anytime," which is wrong. If you use the election in, say, March, you can't use this SEP again to switch later the same year.

There's one more piece. If you lose eligibility for PACE or PACENET, the SEP stays open for an additional two calendar months after either the month your eligibility ends or the month you're notified, whichever is later, so you have time to line up other coverage.4

What PACE and PACENET Cost You

PACE, the lower-income program, does not charge a monthly premium. PACENET enrollees do pay a monthly premium, which is the main structural difference between the two.1

Beyond that, the exact premium, copay, and deductible amounts vary and change over time, and they can depend on the other coverage you carry. Rather than print figures that may be out of date by the time you read this, confirm the current PACENET premium and your copays directly with the program when you apply. A counselor can tell you what your specific costs would be based on your income and your Part D plan.

The programs also coordinate with any other drug coverage you have, so what you pay depends in part on your Part D or Medicare Advantage plan. This is a good question to bring to a free Medicare counselor before you enroll.

How to Apply for PACE or PACENET

There are three ways to apply, and the same application covers both programs; the state places you in PACE or PACENET based on your income.1

1. By phone. Call the PACE and PACENET program at 1-800-225-7223.1
2. Online. Apply through the Pennsylvania Department of Aging's PACE and PACENET page.
3. By mail. Request a paper application through the phone line above and return it by mail.1

Have your prior-year income information ready, since eligibility is based on it. If you're close to the line and unsure, apply and let the program run the numbers. And if you were enrolled as of December 31, 2024 and a Social Security raise has since carried you over the limit, the COLA moratorium may still keep you eligible.1

Learn More

Find personalized help sorting out PACE, PACENET, and your Medicare Part D coverage in Pennsylvania at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.