What Is PACE? Program of All-Inclusive Care for the Elderly
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The Program of All-Inclusive Care for the Elderly (PACE) provides medical care and social services that help adults age 55 and older keep living in their communities rather than moving to a nursing home or other institution.
If you qualify for PACE, you and your family work with a health care team on your health care plan and goals. The team coordinates your care to help ensure that you get everything you need to live safely in your community.
PACE is a federal program under Medicare. Most people in the PACE program are dually eligible for Medicare and Medicaid, but it’s still possible to join if you have only one or the other. And if you don’t have either, you might still be able to join PACE if you pay for it yourself.
PACE eligibility
You can join PACE if all of the following are true, according to the Centers for Medicare & Medicaid Services (CMS):
You’re 55 or older.
You live in a PACE organization’s service area.
Your state certifies that you need a nursing home level of care.
You would be able to live safely in the community with the help of PACE services.
PACE isn’t available everywhere. As of August 2023, there are 154 PACE programs in 32 states and Washington, D.C., according to the National PACE Association, an industry group representing PACE programs.
You don’t need to be enrolled in Medicare or Medicaid to join a PACE program, but your costs may differ depending on whether you’re eligible for one or both programs.
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PACE costs
There’s never any cost sharing for items or services covered by PACE. That means no deductibles, copays or coinsurance.
However, you might have to pay premiums for PACE coverage, depending on whether you’re eligible for Medicare and/or Medicaid, according to CMS:
If you qualify for Medicaid, there are no premiums.
If you qualify for Medicare but not Medicaid, you’re responsible for monthly premiums to cover long-term care and prescription drugs.
If you don’t qualify for Medicare or Medicaid, you can pay the full cost of PACE privately. You’d be responsible for the full cost of the program, which could be over $7,000 per month, according to the National Pace Association.
PACE benefits
PACE covers everything Medicare and Medicaid cover, plus more. All services are coordinated and delivered by an interdisciplinary team of health care providers and other staff.
Health care benefits include things like office visits, specialists, hospitalizations, emergency care, dentistry, home care, physical therapy, nursing home stays and more.
Other benefits include things like meals and nutritional counseling, transportation, social work, adult day care and recreational therapy.
In addition, PACE covers any other services necessary to improve or maintain your health, as determined by your PACE health care team.
PACE and other parts of Medicare
As an all-inclusive program, PACE isn’t compatible with other kinds of Medicare coverage.
PACE and Medicare Advantage
PACE isn’t a Medicare Advantage plan. Because PACE covers all of your Medicare benefits, you can’t have a Medicare Advantage plan and PACE at the same time.
If you leave a PACE plan, you’ll have a two-month special enrollment period during which you can enroll in a Medicare Advantage plan.
PACE and Medicare Part D
PACE covers all medically necessary prescription drugs. That includes:
Outpatient prescription drugs, which would typically be covered by Medicare Part D.
Inpatient (hospital) drugs, which would fall under Medicare Part A.
Certain drugs that are administered in doctor’s offices or hospital outpatient departments, which fall under Medicare Part B.
If you’re in a PACE program and sign up for a Medicare Part D plan, you’ll lose your PACE coverage, according to CMS.
If you leave a PACE plan, you’ll have a two-month special enrollment period during which you can enroll in a stand-alone Medicare Part D plan.
PACE and Medigap
Medicare Supplement Insurance, or Medigap, covers certain out-of-pocket costs such as copays, coinsurance and deductibles for people with Original Medicare (Part A and/or Part B).
Because there are no out-of-pocket costs with PACE plans, there’s no need to buy a Medigap plan.
If you leave a PACE plan, you’ll have guaranteed issue rights to enroll in a Medigap plan without medical underwriting for 63 days.
Sign up for PACE
You can work with a local PACE program and/or your state Medicaid office to get started with PACE.
Medicare.gov has a tool to help you find nearby PACE plans.
Medicaid.gov has listings for each state’s Medicaid office that include contact information.
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