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New Jersey State Pharmacy Assistance Programs (SPAP)

New Jersey Pharmaceutical Assistance to the Aged and Disabled Program (PAAD), New Jersey Division of Medical Assistance and Health Services, and
New Jersey Senior Gold Prescription Discount Program




New Jersey Senior Gold Prescription Discount Program


Eligibility Requirements: You must be a New Jersey resident, age 65 year of age or older 18 years of age or older and receiving Social Security Title II Disability benefits; and
  • Annual income for 2014 is between $26,130 and $36,130 if you are single or between $32,037 and $42,037 if you are married.
  • All Medicare-eligible Senior Gold beneficiaries are also required to enroll in a Medicare Part D Prescription Drug Plan of their choice. They will be responsible for paying the monthly premium directly to the Medicare Part D plan. They also will be responsible for paying any late enrollment penalty imposed by Medicare for each month they were eligible to enroll in Medicare Part D but did not enroll.
  • Important Notes: The state will not cover premiums for SPAP members, but it will offer assistance with deductibles, copayments, and the coverage gap. The state is not auto-assigning the Senior Gold members into PDPs. Instead, the state applied their criteria for auto-assignment to these members and sent them a letter recommending the plans that best meet their needs, and encouraging them to enroll.

    Senior Gold does not pay for diabetic testing supplies (e.g., test strips and lancets) and Medicare Part D excluded drugs except benzodiazepines and barbiturates. If Senior Gold beneficiaries have health insurance coverage, such as Medicare Part B that pays for diabetic testing supplies, a pharmacy must bill that insurance plan. Senior Gold will not pay for them.

    Senior Gold participants can receive their prescription drugs at the pharmacy of their choice. The total cost of the prescription to the Senior Gold Beneficiary will be a $15 co-pay plus 50% of the remaining cost of the drug. Senior Gold participants with prescription costs exceeding $2,000 a year (if single) or $3,000 a year (if married) will have 100% of their prescription costs paid after paying the $15 co-pay per prescription during the annual 12 month eligibility period. This period is based on the initial date of enrollment. Applications are available at local pharmacies, senior citizen centers, county Offices on Aging, visiting the Senior Gold Website, or by writing to the address listed above.

    NOTE: PAAD and Senior Gold only cover drugs approved by the Food and Drug Administration. Drugs purchased outside the State of New Jersey are not covered, nor are any pharmaceutical products whose manufacturer has not signed a rebate agreement with the State of New Jersey.
    Contact Information: Phone
    (800) 792-9745

    Address
    New Jersey Department of Health and Senior Services
    Senior Gold Prescription Discount Program
    P.O. Box 715
    Trenton, NJ 08625
    » New Jersey Senior Gold Prescription Discount Program




    New Jersey Pharmaceutical Assistance to the Aged and Disabled Program (PAAD)


    Eligibility Requirements: You must meet the following requirements:
    • You must be a N.J. resident.
    • You must be 65 years of age or older or at least 18 years of age and receiving social security title II disability benefits.
    • You must not be receiving Medicaid benefits or have any other prescription drug coverage that is better than PAAD. However, you are eligible if your insurance plan offers limited or partial coverage.
    • You must have annual income of $26,130 or less if single, or a combined annual income of $32,037 or less if married.
    • Medicare-eligible PAAD beneficiaries are also required to enroll in a standard Medicare Part D Prescription Drug Plan in New Jersey with a monthly premium below the regional benchmark. These plans will cover medically necessary prescription medications under Medicare Part D. The federal Medicare Plan and PAAD will pay any costs above the PAAD copayment of $5 for each covered generic drug or $7 for each covered brand name drug, including premiums. However, if a Medicare Part D plan does not pay for a medication because the drug is not on its formulary, PAAD beneficiaries will have to switch to drug on their Part D plan's formulary, or their doctor will have to request an exception due to medical necessity directly to their Part D plan. Medicare Advantage participants must add a prescription benefit to their coverage, and PAAD will contribute up to the regional benchmark amount towards the prescription portion of their total premium.
    Important Notes: PAAD provides coverage for prescribed legend drugs, insulin and insulin supplies.

    The PAAD co-payment will be $5 for each PAAD covered generic drug prescription and $7 for each PAAAD covered brand name drug prescription. PAAD beneficiaries may pay less for generic drugs if their Medicare prescription drug plan charges them less than the $5 PAAD co-payment for generics.

    PAAD does not pay for diabetic testing supplies (e.g., test strips and lancets) and Medicare Part D excluded drugs except benzodiazepines and barbiturates. If PAAD beneficiaries have health insurance coverage, such as Medicare Part B that pays for diabetic testing supplies a pharmacy must bill that insurance plan. PAAD will not pay for them.

    All PAAD participants, if they are eligible for Medicare Part A or enrolled in Medicare Part B, must enroll in a Medicare Part D Prescription Drug Plan.

    All PAAD applicants must also submit information to PAAD to help determine if they may be eligible for "Extra Help" from the federal government to help pay for Medicare Part D. Medicare eligible PAAD participants will use PAAD benefits together with Medicare Part D benefits. If a Medicare Part D plan is the primary payer for a medication covered on its formulary, PAAD will provide coverage as secondary payer if needed for that drug, and the PAAD beneficiary will pay up to the regular PAAD copayment for PAAD covered drugs. However, if a Medicare Part D plan does not pay for a medication because the drug is not on its formulary, PAAD beneficiaries will have to switch to a drug on the Part D plan's formulary, or their doctor will have to request an exception due to medical necessity directly to their Part D plan.
    Contact Information: Phone
    (800) 792-9745

    Address
    PAAD-HAAAD
    Department of Human Services P.O. Box 715
    Trenton, NJ 08625
    » New Jersey Pharmaceutical Assistance to the Aged and Disabled Program (PAAD)




    New Jersey Division of Medical Assistance and Health Services


    Eligibility Requirements: Includes IMD excluded population, essential spouses, and residents of institutions and veteran’s homes with Medicare-only, no Medicaid.
    Important Notes: Part D optional but strongly encouraged.

    The Division of Medical Assistance and Health Services (DMAHS) administers the state-and federally- funded Medicaid and NJ FamilyCare programs for certain groups of low- to moderate- income adults and children. Through these programs, DMAHS serves about 1.3 million New Jersey residents:

    Medicaid provides health insurance to parents/caretakers and dependent children, pregnant women, and people who are aged, blind or disabled. These programs pay for hospital services, doctor visits, prescriptions, nursing home care and other healthcare needs, depending on which Medicaid program the person is eligible for.

    NJ FamilyCare is a Medicaid program for uninsured children whose family income is too high for them to qualify for "traditional" Medicaid but not high enough to be able to afford private health insurance. Some low-income uninsured parents/caretakers may also be eligible for NJ FamilyCare.

    Most NJ FamilyCare/Medicaid clients are enrolled in managed care. With managed care, clients are enrolled in a Health Maintenance Organization (HMO) that manages their healthcare.
    Contact Information: Phone
    (800) 356-1561

    Address
    NJ Department of Human Services
    Division of Medical Assistance and Health Services
    P. O. Box 712
    Trenton, NJ 08625
    » New Jersey Division of Medical Assistance and Health Services

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    Tips & Disclaimers
    • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
    • Medicare has neither reviewed nor endorsed the information on our site.
    • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
    • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
    • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
    • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
    • Limitations, copayments, and restrictions may apply.
    • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
    • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
    • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
    • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
    • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
    • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
    • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
    • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
    • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
    • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
    • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
    • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
    • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
    • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
    • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.