Universal Application
for PAAD, Senior Gold and Other Special Benefit Programs
Form AP-2

There is a new universal application form that all first-time applicants to the Pharmaceutical Assistance to the Aged and Disabled (PAAD) and Senior Gold Prescription Discount Programs should use to apply for benefits.

By using this application, you can apply for PAAD, Senior Gold and several other special State of New Jersey benefit programs that could save you money.

This application is only for people who are applying for PAAD or Senior Gold benefits for the first time. Please download the application, print it in color, fill it out and return it to the address on the form. If you are not able to print in color, you may use a form printed in black. The application is several pages long because it screens you for a number of valuable benefit programs.

Please fill out the AP-2A form (Medicare Part D PDP Formulary Enrollment Assistance) and mail it back with the AP-2 Universal Application for PAAD, Senior Gold and Other Special Benefit Programs. In order to use PAAD or Senior Gold benefits, you must join a Medicare Part D prescription drug plan if you haven’t done so already unless you are not eligible for Medicare Part D or unless you have other exceptional prescription coverage, known as "creditable coverage." If you have other prescription coverage, please be sure to include a copy of the front and back of prescription coverage card with your application.

Here’s what you may be eligible for by filling out the initial application for PAAD/Senior Gold:

• Prescription drug benefits.  PAAD and Senior Gold are state-funded prescription programs that help with the cost of prescribed medication (including insulin, insulin needles, and needles for injectable medicines used for the treatment of multiple sclerosis).  If you are eligible for PAAD benefits, you would have a copayment of $5 for generic drugs or $7 for brand name drugs (copayment costs could be lower if a PAAD beneficiary’s Medicare Part D prescription drug plan charges less for a prescription).
  
  
• Medicare Part D (prescription coverage) premium savings.  If you are eligible for PAAD benefits, you may be screened for a subsidy from the federal government that pays for Medicare Part D premiums, co-insurance, and other out-of-pocket costs.  With this subsidy, a person also could qualify for a lower prescription drug copayment than the PAAD copayment.
  
  
• Medicare Part B (medical coverage) premium savings.  If you are eligible for PAAD benefits, you may be screened for the Specified Low-Income Medicare Beneficiary (SLMB) and Specified Low-Income Medicare Beneficiary Qualified Individual (SLMB-QI-1) programs.  Both SLMB and SLMB QI-1 are Medicare Savings Programs that pay for a person’s monthly Medicare Part B premium. 
  
  
• Utility cost assistance.  If you are eligible for PAAD benefits, you may also be eligible for benefits under the Lifeline utility assistance program, the Universal Service Fund (USF), and the Low-Income Home Energy Assistance Program (LIHEAP). 
  
  
• Hearing aid assistance.   If you are eligible for PAAD benefits, you may also be eligible for a $100 reimbursement for the purchase of a hearing aid.

In addition, if you are eligible for PAAD benefits, you may also be eligible for other benefits, such as reduced motor vehicle fees, discounted prices for spaying or neutering your cat or dog, and the property tax freeze.

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