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PACE Part D Choice Act of 2023
12/20/2024, 9:06 AM
Summary of Bill HR 3549
The bill aims to give PACE participants more flexibility and control over their healthcare by allowing them to select a Part D plan that best meets their individual needs. This would enable them to access a wider range of prescription drugs and potentially lower their out-of-pocket costs.
Additionally, the PACE Part D Choice Act of 2023 seeks to streamline the coordination of benefits between PACE and Part D plans, making it easier for beneficiaries to navigate the healthcare system and receive the medications they need. Overall, this legislation is designed to improve the healthcare experience for Medicare beneficiaries enrolled in PACE by expanding their options for prescription drug coverage and enhancing the coordination of benefits between different healthcare programs.
Congressional Summary of HR 3549
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.
