- Members receive assistance for prescribed legend drugs, insulin and insulin supplies.
- Senior Gold does not pay for diabetic testing supplies (e.g., test strips and lancets). If Senior Gold beneficiaries have health insurance coverage, such as Medicare Part B that pays for diabetic testing supplies, a pharmacy must bill that insurance plan. Senior Gold will not pay for them.
- Members pay a co-payment of $15 plus 50% of the remaining cost of each Senior Gold covered prescription.
- Once members reach annual out-of-pocket expenses exceeding $2,000 for single persons or $3,000 for married couples, they pay only a flat $15 co-payment per prescription for the balance of that eligibility period;
- A Senior Gold beneficiary must be a New Jersey resident;
- A Senior Gold beneficiary must be 65 years of age or older, or at least 18 years of age and receiving Social Security Title II Disability benefits;
- A Senior Gold beneficiary must have annual income for 2016 between $26,575 and $36,575 if you are single or between $32,582 and $42,582 if you are married.
- For more information call toll free 1-800-792-9745.
- All Medicare-eligible Senior Gold beneficiaries must participate in Medicare Part D. Senior Gold beneficiaries must pay the monthly premium directly to the Medicare Part D plan of their choice. They also are responsible for paying any late enrollment penalty imposed by Medicare for each month they were eligible to enroll in Medicare Part D but did not enroll.
- Senior Gold benefits help to make Medicare prescription drug coverage more affordable by reducing any other out-of-pocket costs associated with that coverage, such as deductibles, co-insurance, and the coverage gap known as the "donut hole."
For more information about how Senior Gold will work with the Medicare Prescription Drug Coverage Program, call toll free 1-800-792-9745.
The Senior Gold Prescription Discount program helps eligible New Jersey residents pay for prescription drugs, insulin, insulin needles and syringes and needles for injectable medicines used for the treatment of multiple sclerosis. Only drugs approved by the Food and Drug Administration are covered. Drugs purchased outside the State of New Jersey are not covered, nor is any pharmaceutical product whose manufacturer has not agreed to provide rebates to the State of New Jersey. The Senior Gold card works together with Medicare Part D Prescription Drug Plans. Senior Gold can reduce out-of-pocket expenses associated with participation in Medicare Part D.
Senior Gold is not considered creditable coverage with regard to Medicare Part D.
The Universal Application (UA-1) is available in Word and Adobe Acrobat PDF.
The application is stored in Adobe Acrobat (PDF). PDF formatted documents appear the same as the original printed forms. To view and print these forms, you must have a PDF Reader which is available free from Adobe. Click here to learn more about Adobe Acrobat or to download the latest version of the Adobe Acrobat viewer from the Adobe Web site.
Once Senior Gold has determined your eligibility, you should receive an identification card within 30 days. With your Senior Gold card, you pay the pharmacist $15 plus 50% of the remaining cost of the drug for each Senior Gold covered medication. Once a Senior Gold beneficiary reaches Out-of-Pocket expenses exceeding $2,000 for single persons or $3,000 for married couples, he pays a flat $15 co-payment for the balance of that eligibility period.
By signing the Universal Application (UA-1) , you are authorizing the State of New Jersey to collect payments made on your behalf from any other assistance program, insurance or retirement benefits which may cover prescription drugs.
If you have health insurance or retirement benefits that provide prescription coverage equal to or better than Senior Gold, you would NOT be eligible. However, you may be eligible if your health insurance or retirement plan offers limited or partial coverage.
Senior Gold beneficiaries must reapply every year.
Approximately four months before your Senior Gold card expires, you should receive a Senior Gold renewal form. Complete this form and return it by mail. Call the Senior Gold toll-free number (1-800-792-9745) if you have not received a renewal form at least two months before your card expires.
The PAAD and Senior Gold programs are required by law to provide generic substitution on brand name drugs that have approved generics available. Generic drugs are less costly substitutes with the same active ingredients as drugs sold under a brand name. In order for a PAAD or Senior Goldcardholder to receive the brand name version instead of the approved generic when PAAD or Senior Gold is the primary payer for a prescription, the prescribing physician must request Prior Authorization. However, certain brand name drugs with a narrow therapeutic index or a lower cost per unit than the generic may be excluded from the Prior Authorization process.
Initial prescriptions are limited to a 34-day supply when Senior Gold is the primary payer. Subsequent refills may be dispensed up to a 34-day supply or 100 unit doses, whichever is greater. This regulation prevents the waste of medication should the initial prescription prove to be inappropriate to the beneficiary and allows person on maintenance drugs to receive up to 100 unit doses for subsequent refills.
The State of New Jersey has established an enhanced Drug Utilization Review (DUR) component for the PAADand Senior Gold programs to safeguard against harmful drug/drug interactions, doses that are too small or too large, over-extended drug therapy or drug duplication. This will not prevent you from obtaining medicine that your doctor believes to be medically necessary.