Right now, older adults enrolled in PACE programs (Programs of All-Inclusive Care for the Elderly) are stuck using the prescription drug plan that comes with their PACE coverage. This bill changes that starting in 2025 by letting Medicare-only PACE enrollees choose their own separate prescription drug plan instead, similar to how other Medicare beneficiaries can shop around for drug coverage.

Here's what matters: If you're in a PACE program and don't qualify for Medicaid, you'll now have the option to pick a different prescription drug plan if it saves you money or better fits your needs. The PACE program has to tell you about this choice and help you understand your options. You can switch away from the PACE drug plan if your medications change during the year or if your costs end up being higher than expected after you enroll. The catch is that any new plan you choose has to cost you the same or less out-of-pocket than what the PACE program offers, and it can't cost the government more in subsidies either.

To make this work smoothly, your PACE program and your new drug plan will share information about your medications and claims so they can coordinate your care and make sure nothing falls through the cracks. If you choose an outside drug plan, the PACE program won't get paid by Medicare for providing your drug coverage anymore—that responsibility shifts to your new plan. Essentially, this gives PACE enrollees more control over their prescription drug benefits while protecting them from paying more out of pocket.

PACE Part D Choice Act of 2023

Carper, Thomas R.

PACE Part D Choice Act of 2023 This bill allows Medicare-only beneficiaries who are enrolled in Programs of All-Inclusive Care for the Elderly (PACE) to choose prescription drug plans that are not operated by PACE. (PACE is a program under Medicare and Medicaid that provides in-home and community services for certain individuals as an alternative to nursing home care.) Specifically, the bill allows PACE enrollees who are Medicare (but not Medicaid) beneficiaries to choose a prescription drug plan that is not a Medicare Advantage plan or operated by PACE and for which annual out-of-pocket costs and federal subsidies are equal to or less than that under the applicable PACE prescription drug plan. The bill also allows for disenrollment from a chosen plan upon a change in medication or demonstration of an unexpected increase in out-of-pocket costs. PACE programs must conduct outreach, monitor data, and coordinate benefits with respect to such options.