Box 715 Trenton, NJ 08625-0715 www.nj.gov/humanservices UNIVERSAL APPLICATION FOR PAAD, SENIOR GOLD AND OTHER SPECIAL BENEFIT PROGRAMS By filling out the attached application, you may be eligible for benefits provided by the Pharmaceutical Assistance to the Aged and Disabled (PAAD) or the Senior Gold Prescription Discount programs. This application is ONLY for people who are applying for PAAD or Senior Gold benefits for the first time. If you are married, and you and your spouse wish to apply.

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How to fill out the Nj Paad Application Form online

The Nj Paad application form is essential for individuals seeking assistance with prescription costs through the Pharmaceutical Assistance to the Aged and Disabled program and Senior Gold. This guide will provide clear, step-by-step instructions to help you easily fill out the application online and ensure you provide all necessary information.

Follow the steps to complete the Nj Paad Application Form online.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Provide your name, date of birth, and sex in the appropriate fields. Ensure to fill these out clearly, using capital letters, and provide your Social Security number.
  3. If married, include your spouse's details like name, Social Security number, and date of birth. If your spouse is not applying, their information is still required.
  4. Indicate your current marital status by checking the appropriate box. Answer questions regarding any changes in marital status within the last year.
  5. Enter your New Jersey address as your principal place of residence. You will need to submit proof of this address.
  6. If you or your spouse filed a Federal or State income tax return last year, indicate so and attach signed copies.
  7. Report your yearly income and that of your spouse, indicating if you receive income from specified sources. Avoid including Social Security and public assistance benefits in this section.
  8. List any relevant assets and property, noting that this information will not affect your eligibility for PAAD benefits, but is required for other assistance programs.
  9. Fill in your Medicare information, including claim numbers and effective dates, ensuring to attach copies of your Medicare card.
  10. Enter details regarding any additional health insurance coverage, submitting the required copies of your health insurance card.
  11. If applying for the Lifeline Utility Benefit or other assistance programs, complete the requisite sections, ensuring clarity and accuracy.
  12. Sign the application in the designated area, ensuring that all information is correct and true to the best of your knowledge.
  13. Once you have completed the form, review it for any errors, save your changes, and download or print a copy to retain for your records before submitting.

Complete your Nj Paad application online today to ensure you receive the benefits you may be eligible for.

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How does PAAD work in NJ?

Monthly Premiums for Part D coverage: When you are enrolled in PAAD, the program pays for certain Medicare Part D plans in New Jersey. Co-payments for prescription drugs*: You will pay no more than $5 copayment for generic drugs and no more than $7 for most brand name drugs at the pharmacy.

You may be eligible for PAAD if you meet the following requirements: You are a New Jersey resident; You are age 65 or older or between ages 18 and 64 and receiving Social Security Title II Disability benefits; and. Your income for 2023 is less than $42,142 if single or less than $49,209 if married.

You enter the donut hole when your total drug costs—including what you and your plan have paid for your drugs—reaches a certain limit. In 2023, that limit is $4,660.

PAAD will use this information to determine PAAD income eligibility. NOTE: This question does NOT ask the applicant or spouse (if applicable) to include income from Social Security Benefits, Wages, Self-Employment, Interest, or Dividends. These sources of income will be asked for in Questions 10 and 14.

The PAAD program income limits are now $38,769 if single and $45,270 for a couple. The Senior Gold Prescription Discount program limits are now $48,769 if single and $55,270 if married. Assets are not an eligibility consideration for either program.

This program pays the monthly premium for certain standard basic Medicare Part D plans — plans must have a premium that is at or below the regional benchmark. PAAD also pays the cost of prescription medications, minus the $5 co-pay for covered generic drugs and $7 for covered brand name drugs.

You may be eligible for PAAD if you meet the following requirements: You are a New Jersey resident; You are age 65 or older or between ages 18 and 64 and receiving Social Security Title II Disability benefits; and. Your income for 2023 is less than $42,142 if single or less than $49,209 if married.

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