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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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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.

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.

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.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232