|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
|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.
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
|Eligibility Requirements:||You must meet the following requirements:
|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.
Department of Human Services P.O. Box 715
Trenton, NJ 08625
» New Jersey Pharmaceutical Assistance to the Aged and Disabled Program (PAAD)
|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.
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