PACE/PACENET — PA's signature Rx assistance program
PACE (Pharmaceutical Assistance Contract for the Elderly) and PACENET (Needs Enhancement Tier) are PA’s state- funded prescription-drug assistance programs for older adults. Operated by the PA Department of Aging, funded primarily by the PA Lottery.1
- PACE: Income up to $14,500 (single) / $17,700 (married). Covers prescription costs with low copays ($6 generic / $9 brand).
- PACENET: Income up to $33,500 (single) / $41,500 (married); rising to $45,000 / $55,000 starting July 1, 2026. Higher copays than PACE but still meaningful savings.
PACE/PACENET coordinates with Medicare Part D?— PA residents enrolled in both get coverage that’s often substantially better than Part D alone. Enrollment is through the Department of Aging or AAA? offices.
The under-65 Medigap protection
Federal Medigap?rules don’t require insurers to sell policies to Medicare-eligibles under 65 (those who qualify through disability). Many states have nothing in this space — under-65 disabled Medicare enrollees often cannot purchase Medigap at any price.
Pennsylvania is different. 31 Pa. Code §89.778 requires Medigap insurers active in PA to make policies available to under-65 Medicare enrollees on the same terms as those 65+.2 A rare consumer protection.
Medicare Advantage in PA's two big markets
PA Medicare Advantage? penetration runs ~50% statewide, with Philadelphia and Pittsburgh metros showing different patterns:
- Philadelphia metro: 55%+ MA penetration. Heavy competition; many $0-premium plans available; dental/vision/hearing bundles common
- Pittsburgh metro: 40–50% MA penetration. UPMC dominates as both provider and insurer; UPMC Medicare Advantage is the most common selection; Highmark also major
- Central / Rural PA: 35–45% MA penetration. Fewer plan options; Original Medicare + Medigap often the better fit
Medicare Savings Programs (MSPs) in PA
MSPs in PA are administered by DHS. Income thresholds align with federal floors:
- QMB: up to 100% FPL
- SLMB: 100–120% FPL
- QI: 120–135% FPL
PA MSP enrollment is below what it could be — many eligible PA seniors don’t apply. APPRISE counselors screen for MSP eligibility as a standard part of Medicare counseling.
APPRISE — free PA Medicare counseling
APPRISE is Pennsylvania’s SHIP?, operated by the PA Department of Aging. Free, unbiased counseling, organized through the 52 county-based AAA offices. Call 1-800-783-7067.
What to do this month
- Pull last month’s prescription drug bills. If $200+/month, check PACE/PACENET eligibility — the savings can be substantial
- Call APPRISE before AEP (Oct 15–Dec 7)
- If your parent is in the Pittsburgh metro and considering MA, verify specific provider networks
- If your parent qualified for Medicare under 65 through disability, check Medigap options under 31 Pa. Code §89.778