Full answer: Pennsylvania seniors aged 65 or older may qualify for PACE or PACENET, the state's two-tier pharmaceutical assistance program funded by the Pennsylvania Lottery. PACE covers those with the lowest incomes (single: $14,500 or less; married couple: $17,700 or less in annual income for 2026). PACENET serves those with somewhat higher incomes (single: $14,501 to $33,500; married couple: $17,701 to $41,500 for the period through June 30, 2026; after July 1, 2026 the PACENET income ceiling rises to $45,000 for singles and $55,000 for couples under Pennsylvania SB 731, signed June 2, 2025). Both programs dramatically reduce prescription drug costs and coordinate with Medicare Part D to eliminate coverage gaps. Neither program considers assets, only income.
Pennsylvania runs two of the most generous state pharmaceutical assistance programs in the country: PACE and PACENET. Both are funded by the Pennsylvania Lottery and administered by the Pennsylvania Department of Aging. Together they help qualifying seniors pay for almost any prescription drug at a flat copay far below retail price. As of 2026, PACE copays are $6 for generics and $9 for brand-name drugs. PACENET copays are $8 for generics and $15 for brand-name drugs per 30-day supply.
A major eligibility expansion takes effect July 1, 2026. Pennsylvania SB 731, signed June 2, 2025, raises the PACENET annual income ceiling from $33,500 to $45,000 for single individuals and from $41,500 to $55,000 for married couples. This page covers the full eligibility rules, income limits, copay structure, how PACE and PACENET coordinate with Medicare Part D, and the step-by-step application process. To see if you qualify for other Pennsylvania assistance programs, use the eligibility screener at CoveredUSA.
Quick answer: do you qualify for PACE or PACENET in 2026?
Yes, if you meet three requirements: age 65 or older, Pennsylvania resident for at least 90 days, and annual income within program limits. PACE serves lower-income seniors (single: $14,500 or less; married couple: $17,700 or less in 2026). PACENET covers those with higher but still modest incomes (single: $14,501 to $33,500; married couple: $17,701 to $41,500 through June 30, 2026). Neither program evaluates assets. Your savings, home value, or vehicle do not affect eligibility.
Pennsylvania PACE and PACENET income limits 2026 (and the July 2026 PACENET expansion)
Pennsylvania's PACE and PACENET programs divide eligible seniors into two tiers based on prior-year gross income. Income is measured using the previous calendar year, so 2026 enrollment uses your 2025 income. The thresholds are fixed by statute and do not adjust annually for inflation, which is why the 2026 legislative update under SB 731 matters significantly.
For the period January 1 through June 30, 2026: PACE covers single individuals with annual income of $14,500 or less and married couples with combined annual income of $17,700 or less. PACENET covers single individuals with annual income of $14,501 to $33,500 and married couples with combined annual income of $17,701 to $41,500. After July 1, 2026, the PACENET ceiling increases to $45,000 for single individuals and $55,000 for married couples. Seniors who were already enrolled and would have exceeded limits only because of a Social Security COLA are protected through December 31, 2027.
Pennsylvania PACE and PACENET income thresholds 2026| Program | Applicant Type | 2026 Annual Income Limit (Jan 1 to June 30) | After July 1, 2026 |
|---|
| PACE | Single individual | $14,500 or less | $14,500 or less (unchanged) |
| PACE | Married couple (combined) | $17,700 or less | $17,700 or less (unchanged) |
| PACENET | Single individual | $14,501 to $33,500 | $14,501 to $45,000 |
| PACENET | Married couple (combined) | $17,701 to $41,500 | $17,701 to $55,000 |
Income includes Social Security, pensions, taxable retirement distributions (401(k)/IRA), interest, dividends, capital gains, wages, rental income, and gambling winnings. Medicare Part B premiums are excluded. Assets are never counted. Source: Pennsylvania Department of Aging; Pennsylvania SB 731 (signed June 2, 2025).
Source: Pennsylvania Department of Aging; PACECares (Prime Therapeutics); Pennsylvania SB 731 enacted June 2, 2025
How to apply for Pennsylvania PACE or PACENET
Pennsylvania makes the PACE and PACENET application process straightforward. Three channels are available: phone, online, and mail. The phone line at 1-800-225-7223 (Monday through Friday, 8 a.m. to 5 p.m.) connects you with a PACE representative who can guide you through the application in a single call and confirm which tier you qualify for. The online enrollment wizard at pacecares.primetherapeutics.com is available 24 hours a day and processes applications in approximately three business days. Paper applications are available in English and Spanish; completed forms go to PO Box 8806, Harrisburg, PA 17105-8806 or by fax to 1-888-656-0372.
After Pennsylvania approves your application, your PACE or PACENET card arrives by mail within a few business days. Take your new card to any participating pharmacy along with your Medicare card (and Part D card if applicable). Pharmacies in Pennsylvania are broadly networked under the program, so most major retail pharmacies and independent pharmacies participate.
Documents needed to apply for PACE or PACENET
Pennsylvania PACE requires income verification for the prior year. The documents needed are straightforward because assets are excluded entirely from the eligibility calculation. You need proof of your age, Pennsylvania residency, prior-year income, and Medicare enrollment. For seniors who receive only Social Security income and did not file a federal tax return, the SSA-1099 form sent each January by the Social Security Administration serves as sufficient income proof.
- Proof of age: birth certificate, driver's license, or Medicare card showing date of birth
- Proof of Pennsylvania residency for 90 consecutive days: utility bill, bank statement, or lease
- 2025 federal tax return or SSA-1099 for Social Security income
- 1099-R forms for pension and retirement account distributions
- Medicare card (Parts A and B)
- Medicare Part D Evidence of Coverage letter or plan card (if enrolled)
What PACE and PACENET actually cover
Pennsylvania PACE and PACENET cover most FDA-approved prescription medications at the flat copays described above. Both programs cover insulin, syringes, and insulin needles. The programs do not cover over-the-counter medications, medical equipment, dental services, vision services, hospital care, or physician fees. For prescription coverage, the benefit is broad rather than a restricted formulary, though some drugs may require prior authorization.
Pennsylvania PACE and PACENET operate as State Pharmaceutical Assistance Programs (SPAPs) that coordinate directly with Medicare Part D. When a PACE or PACENET member also has a Medicare Part D plan, the coordination works as wraparound coverage: PACE or PACENET covers the cost-sharing that Part D charges above the PACE copay rate, eliminates the Medicare Part D coverage gap (the donut hole), and assists with prior authorization requests if a Part D plan denies a medication. The 2026 regional benchmark for Part D premium assistance from PACE is $32.71 per month.
Common reasons Pennsylvania PACE applications are denied
Pennsylvania PACE denials fall into five main categories. The most common is an income over the applicable limit for the prior year. Because PACE uses prior-year income, a senior whose 2025 income exceeds $14,500 (single) or $17,700 (couple) is not eligible for PACE but may still qualify for PACENET. A second common reason is age under 65; Pennsylvania offers a separate PACE Clearinghouse program for ages 18 and older who need help finding other assistance options. Third, active enrollment in a Medicaid prescription drug benefit through the Pennsylvania Department of Human Services disqualifies the applicant. Fourth, insufficient Pennsylvania residency below the 90-day minimum disqualifies recent movers. Fifth, incomplete income documentation causes applications to be pended rather than approved.
How to appeal a PACE or PACENET denial in Pennsylvania
Pennsylvania PACE applicants who are denied have the right to appeal to the Pennsylvania Department of Aging for a review of the eligibility determination. The denial notice will include instructions for initiating an appeal, the grounds for denial, and the appeal deadline. To begin an appeal, contact the Pennsylvania Department of Aging at 1-800-225-7223 or write to the address on your denial letter. Additionally, free assistance navigating PACE appeals is available from PA MEDI (Pennsylvania's Medicare Education and Decision Insight program) at 1-800-783-7067. PA MEDI counselors are available free of charge to all Pennsylvania Medicare beneficiaries.
About PACE and PACENET: Pennsylvania's prescription assistance programs
Pennsylvania established the Pharmaceutical Assistance Contract for the Elderly (PACE) in 1984, funded by the Pennsylvania Lottery. It was among the first state pharmaceutical assistance programs in the United States. PACENET was added as a second tier for higher-income seniors. Both programs are administered by the Pennsylvania Department of Aging and managed by Prime Therapeutics under contract. As of 2026, enrollment figures regularly exceed 200,000 Pennsylvania seniors across both programs.
PACE and PACENET are not Medicaid programs and are not means-tested by assets. They are a distinct benefit available only to Pennsylvania residents who are 65 or older. Pennsylvania seniors who receive full Medicaid (including the Medicaid prescription drug benefit) are not eligible for PACE or PACENET simultaneously, because their drug coverage is already provided at no cost under Medicaid. However, Medicare beneficiaries who do not have Medicaid can stack PACE or PACENET on top of Medicare Part A, Part B, and Part D to dramatically reduce total drug costs.
Frequently Asked Questions
What is the income limit for PACE in Pennsylvania in 2026?
For 2026, the Pennsylvania PACE income limit is $14,500 or less per year for a single individual, and $17,700 or less combined annually for a married couple. These limits use your prior-year (2025) gross income. PACE income limits did not change under SB 731; only PACENET limits increased starting July 1, 2026.
What is the income limit for PACENET in Pennsylvania in 2026?
For the period January 1 through June 30, 2026, PACENET covers single individuals earning $14,501 to $33,500 per year and married couples with combined income of $17,701 to $41,500. After July 1, 2026, the PACENET ceiling increases to $45,000 for single individuals and $55,000 for married couples under Pennsylvania SB 731, signed June 2, 2025.
What does PACE count as income?
PACE counts prior-year gross income including Social Security, pensions, 401(k)/IRA/annuity taxable distributions, wages, interest, dividends, capital gains, rental income, and gambling winnings over $300. Medicare Part B premiums are excluded from the income calculation. Assets such as your home value, vehicle, and savings accounts are never counted. PACE uses your 2025 income to determine 2026 eligibility.
How much are the PACE and PACENET copays in 2026?
In 2026, PACE copays are $6 for a 30-day supply of a generic drug and $9 for a 30-day supply of a brand-name drug. PACENET copays are $8 for generics and $15 for brand-name drugs per 30-day supply. Both programs cover most prescription medications at these flat rates, including insulin, syringes, and insulin needles.
Can I have both PACE and Medicare Part D?
Yes. PACE and PACENET coordinate with Medicare Part D as wraparound coverage. PACE will pay your Part D premium up to the 2026 regional benchmark of $32.71 per month for approved partner plans. Both programs cover your cost-sharing above the PACE copay rate and fill the Medicare Part D coverage gap, so you will never enter the donut hole. Present both your PACE/PACENET card and Part D card at the pharmacy.
What if I am on Medicaid in Pennsylvania? Can I also get PACE?
No. Pennsylvania residents who receive the Medicaid prescription drug benefit through the Department of Human Services are not eligible for PACE or PACENET simultaneously. Medicaid already covers prescriptions at no or minimal cost. If you lose Medicaid eligibility, you can apply for PACE or PACENET at any time since both programs accept applications year-round.
Does PACE cover prescription drugs that are not on my Medicare Part D formulary?
Yes. If your Medicare Part D plan denies a drug due to formulary restrictions, PACE or PACENET will cover it (if the program covers that medication) or assist in filing a prior authorization on your behalf with the Part D plan. This makes PACE/PACENET valuable wraparound coverage that plugs the gaps in even the most restrictive Part D plans.
How long does a PACE application take to process?
Pennsylvania PACE typically processes applications within three business days. Once approved, your PACE or PACENET card will arrive by mail and is accepted at participating pharmacies statewide. Applications can be submitted by phone at 1-800-225-7223, online at pacecares.primetherapeutics.com, or by mail to PO Box 8806, Harrisburg, PA 17105-8806.
