PACE: all-inclusive care that helps people stay at home
PACE is a Medicare and Medicaid program that helps some older adults who need a high level of care keep living at home. This guide explains what it covers, who qualifies, how it works day to day and how to find a program.
General information only. This guide is not medical, legal or financial advice. Talk with a physician, and with an elder-law or financial professional where money or legal papers are involved, about your own situation.
What PACE covers
PACE covers everything Medicare and Medicaid cover, plus other care the PACE team decides the person needs, including prescription drugs. Because its funding is capped, the program can pay for services fee-for-service plans would not.
- Primary care, specialist care, hospital and emergency care
- Home care, personal care and social services
- Physical, occupational and speech therapy
- Dental care, lab work, X-rays and mental health counseling
- Nursing home care when it is medically necessary
Who qualifies
Medicare.gov lists four conditions, and a person has to meet all of them:
Most people in PACE have both Medicare and Medicaid, but that is not a requirement to join.
- Age 55 or older
- Living in the service area of a PACE organization
- Needing a nursing home level of care, as certified by the state
- Able to live safely in the community with help from PACE
How it works day to day
Once a person joins, PACE becomes the only source of their Medicare and Medicaid benefits. The PACE team coordinates the person's care across all of those benefits.
Much of the care happens around a PACE center. Medicare.gov lists adult day care with meals and recreation, and rides to the center and to medical appointments.
- A team of health professionals plans and coordinates the person's care.
- Care is shaped around the person's medical, social and emotional needs.
- Home care and personal care are part of the service list.
Finding a program and what it costs
PACE is offered only in some states, and only in the areas a PACE organization serves. Medicare.gov suggests two ways to look for one:
Costs depend on the person's coverage. Medicare.gov says people with Medicaid pay no monthly premium. People with Medicare only may pay monthly premiums, and nobody pays deductibles or copayments for care the PACE team approves.
- Search for PACE plans in your area with the plan search tool on Medicare.gov.
- Contact your state Medicaid office to ask about eligibility and nearby programs.
- A SHIP counselor can help compare PACE with other Medicare choices.
Frequently asked questions
Yes. Medicaid.gov says people can leave PACE at any time and for any reason.
Not always. Medicare.gov says a person with neither Medicare nor Medicaid can pay the PACE premium privately. Most participants have both Medicare and Medicaid.
Medicare.gov says joining a separate Medicare drug plan while in PACE ends PACE enrollment. PACE already covers prescription drugs.
Sources
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