Middle Income Senior Citizen Drug Programs in New Jersey

In May 2010, the state of New Jersey signed into law an expansion of one of its prescription-drug assistance programs, Senior Gold, to include coverage for middle-income seniors, according to the New York Times. The Senior Gold program has been in existence since 1975 to help low-income senior residents, and was the first of its kind in the country. The expansion, to include middle-income seniors, leads the nation in middle-income drug coverage for seniors.

Qualifications

• In order for senior citizens to qualify for the Senior Gold program, they must be New Jersey residents aged 65 or older. Annual income must be less than $29,238 for a single person or $33,589 for a married couple.

Medicare

• Unless the senior is not eligible for a Medicare Part D drug plan, the Senior Gold participant must be enrolled in one of the Medicare Part D drug-assistance programs and pay monthly premiums directly to Medicare. This includes paying late premiums for any months that the senior was eligible for but did not participate in a Medicare Part D drug-assistance program.

Costs

• The Senior Gold program requires seniors to pay a $15 co-payment as well as half the cost of prescriptions, or the actual cost of the drug, whichever is less. This payment structure is in effect until the senior has paid $3,000 in a year toward the cost of prescriptions. After that threshold has been met, the senior will continue to pay a $15 co-payment for each prescription until the end of the calendar year.

Non-formulary Drugs

• If a necessary drug is not included on the participant's Medicare formulary, the participant will either need to switch to a different drug, or the participant's doctor will need to make a request directly to the Medicare Part D plan for an exception.

Exclusions

• Diabetic-testing supplies such as test strips and lancets are not covered under the Senior Gold plan. Drugs that are not covered under the participant's Medicare Part D plan are also not covered by Senior Gold, with the exception of necessary benzodiazepines or barbiturates.

Applications

• Applications for the Senior Gold drug program are available at pharmacies throughout the state as well as senior centers and New Jersey Department of Health and Senior Services offices. Applications can also be downloaded from the New Jersey Department of Health and Senior Services website at state.nj.us/health.