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PAAD and Senior Gold in New Jersey: How State Drug Help Works With Your Medicare Part D Plan

Mount Tammany and the forested ridges of the Delaware Water Gap on the New Jersey and Pennsylvania line, with thick green woods, a bare rock face, and a clear blue sky, above hook text: PAAD and Senior Gold. Medicare Drug Help.

New Jersey has two state programs that help with prescription costs for older adults and people with disabilities: PAAD and Senior Gold. Both are run by the New Jersey Division of Aging Services, both work alongside a Medicare Part D drug plan, and you apply for both with one NJSave application. The rules are the same in Newark, Jersey City, Paterson, Edison, Trenton, Camden, Toms River, Cherry Hill, or anywhere else in New Jersey.

This article is educational. Instant Health Help is a licensed health insurance agency, and our agent, Lobsang Rivas, is licensed in New Jersey and certified as a broker with Get Covered New Jersey. We are not Medicare, CMS, the Division of Aging Services, Get Covered New Jersey, or an insurance company, and the state decides who qualifies. We do not quote prices or name plans here. See the official rules on the PAAD page.

The short answer

  1. PAAD (Pharmaceutical Assistance to the Aged and Disabled) is a state-funded program for New Jersey residents with incomes under a set limit. Members pay a small copay for each covered prescription.
  2. Senior Gold is for people with incomes above the PAAD limit, up to a higher limit. It has a different copay structure.
  3. If you have Medicare, both programs require you to be in a Part D plan, and they work differently with your plan’s premium. That matters during annual enrollment, October 15 to December 7.

Who may qualify

The Division of Aging Services lists the same basic rules for both programs. You must:

  1. Live in New Jersey.
  2. Be 65 or older, or be 18 to 64 and receiving Social Security Title II disability benefits.
  3. Have income within the program’s limit. Senior Gold’s income range starts where PAAD’s ends.

We don’t list dollar limits here because they are updated each year. Check the current figures on the PAAD page and the Senior Gold page.

How PAAD works with your Part D plan

  1. You must enroll in a Medicare Part D plan if you are Medicare eligible.
  2. PAAD pays the monthly premium for certain basic Part D plans whose premium is at or below the regional benchmark. If you choose an enhanced plan at or below the benchmark, PAAD pays the premium as long as the plan agrees to follow PAAD’s billing requirements.
  3. If you have a Medicare Advantage plan, you must have drug coverage with it, and PAAD contributes up to the regional benchmark amount toward the drug part of your premium.
  4. If your Part D plan doesn’t cover a drug because it isn’t on the plan’s formulary, you would switch to a drug that is, or your doctor asks the plan for an exception based on medical necessity.

A few more PAAD rules: drugs bought outside New Jersey aren’t covered, and PAAD doesn’t pay for diabetic testing supplies such as test strips and lancets. If you have Medicare Part B, the pharmacy bills Part B for those. Most PAAD members renew every two years, and some renew every year. You should get a renewal form about four months before your card expires.

How Senior Gold works

  1. You pay a set copay plus half of the remaining cost of each covered drug. Once your yearly out-of-pocket costs pass a set amount, you pay only a flat copay for the rest of that eligibility period.
  2. You must be in a Medicare Part D plan if you are Medicare eligible, and you pay the plan’s monthly premium yourself, plus any Part D late enrollment penalty.
  3. If you already have drug coverage that is equal to or better than Senior Gold, for example through a retirement plan, you are not eligible. You may be eligible if that coverage is limited or partial.
  4. You reapply every year. If you qualify, the state says your card should arrive within 30 days.

What to check during annual enrollment

Because PAAD pays premiums only for certain plans, the plan you pick matters. Before December 7, check whether your current Part D plan, or the one you are considering, is still at or below the regional benchmark for next year, and whether your drugs are on its formulary. If you are not sure, call the PAAD hotline before you switch.

Medicare.gov also says that people enrolled in a State Pharmaceutical Assistance Program, like PAAD or Senior Gold, can join a Medicare drug plan or a Medicare Advantage Plan with drug coverage once during the calendar year, outside the regular enrollment dates. See Medicare.gov’s Special Enrollment Periods page. Our New Jersey Medicare annual enrollment guide covers the rest of what to review this fall.

One application: NJSave

You apply for PAAD and Senior Gold with NJSave. The Division of Aging Services says NJSave enrolls eligible applicants in PAAD, Senior Gold, Lifeline Utility Assistance, Medicare Savings Programs (QMB, SLMB, and QI), Extra Help with Part D costs, and Hearing Aid Assistance to the Aged and Disabled (HAAAD). You can apply online in English or Spanish, and paper applications are available in both languages too. See the NJSave page. For help completing the application, contact your county Area Agency on Aging or SHIP, or call 1-800-792-9745.

Unbiased help in New Jersey

New Jersey’s State Health Insurance Assistance Program (SHIP) has trained volunteer counselors who help with Medicare questions, and the state says they don’t sell or recommend any specific insurance product. Call 1-800-792-8820 or see the NJ SHIP page.

If you live across the line in Pennsylvania or Delaware, apply in your own state. Our agent is not licensed in those states, so use Medicare.gov or that state’s SHIP counselors through SHIP’s national locator. We are licensed in New York too.

Watch for scams

Medicare.gov says Medicare will never call you to sell you anything or visit you at your home. Don’t give your Medicare number to someone who calls you out of the blue. If someone pressures you, hang up. See Medicare.gov’s fraud page.

Someone in your house under 65?

Our agent is certified as a broker with Get Covered New Jersey, so for a spouse or adult child under 65, we can go through the application with you, compare plans, and help you enroll, at no extra cost to you for our help. We are not Get Covered New Jersey, and Get Covered New Jersey decides what you qualify for. Read our New Jersey open enrollment guide for the steps.

How we help

We are licensed in New Jersey and help people with Medicare by phone and online, in English or Spanish. Learn more on our New Jersey health insurance help page. We can explain how PAAD or Senior Gold fits with your Medicare coverage, point you to NJSave to apply, and compare Part D plans and Medicare Advantage plans with drug coverage with you, with PAAD’s benchmark rule in mind, and help you enroll if you decide to. We are not Medicare, the Division of Aging Services, or the government, and the decision is always yours.

Want to talk it through?

Have your Medicare card, your PAAD or Senior Gold card if you have one, and your list of prescriptions with doses ready, and we can go over your options together.

Call (321) 315-0054 | agent@inshh.com

We do not offer every plan available in your area. Currently we represent 10 organizations which offer 489 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, is available 24 hours a day, 7 days a week, except some federal holidays. Instant Health Help is not connected with or endorsed by the U.S. government or the federal Medicare program.

Featured photo: Delaware Water Gap by RollerFanatic000, CC BY-SA 4.0, cropped with text added.