Here's the short answer. PACE stands for Program of All-Inclusive Care for the Elderly. It gives frail older adults their Medicare and Medicaid care through one team. For most members, that lets them stay in the community instead of moving to a nursing home. Most members have both Medicare and Medicaid.
Who can join PACE
You can join if you meet all four conditions:
- You are age 55 or older.
- You live in the service area of a PACE organization.
- You are eligible for nursing home care.
- You can live safely in the community when you enroll.
Joining is voluntary. If you qualify and choose PACE, you sign an enrollment agreement. You can stay as long as you want, no matter how your health changes. You can leave at any time and for any reason. PACE only works where a PACE organization serves your area.
What PACE covers
PACE covers all Medicaid and Medicare covered services. It also covers other services your care team decides you need to improve and keep up your health. The list includes:
- Primary care, including doctor and nursing services
- Hospital care and emergency services
- Prescription drugs
- Nursing home care
- Home care and adult day care
- Dentistry
- Physical, occupational, and recreational therapy
- Meals and nutritional counseling
- Social services and social work counseling
- Transportation
PACE programs give services mainly in an adult day health center. Home visits and referrals add to that, based on your needs.
Your care team
A team of health professionals checks your needs, makes your care plan, and delivers your care. The team includes at least a primary care provider, a registered nurse, a social worker, therapists, a dietitian, a center manager, a home care coordinator, a personal care attendant, and a driver. The team typically meets daily to talk about how each person is doing.
What PACE costs
PACE members pay no deductibles, coinsurance, or other Medicare or Medicaid cost-sharing. Premiums depend on your coverage:
- Medicare and Medicaid both: The two programs pay the PACE provider. See Dual Eligibility.
- Medicare only: You pay a monthly premium equal to the Medicaid payment amount, plus an amount for Part D drug coverage.
- Neither: You can enroll and pay privately.
The big trade-off: PACE replaces your other coverage
PACE becomes the only source of Medicare and Medicaid services for its members. That means you use PACE doctors, the PACE center, and PACE-approved services. If you want hospice, you must leave PACE first. Ask whether your current doctors work with the PACE organization before you decide.
How PACE compares with other options
| Option | How it works |
|---|---|
| PACE | One team provides Medicare and Medicaid care. You use PACE providers. |
| Medicaid HCBS waivers | Your state pays for home and community services. Some waivers have waiting lists. |
| Special needs plans (D-SNPs) | Private plans that coordinate Medicare and Medicaid for dual eligibles. |
| Long-term care coverage | Our long-term care page explains what Medicare and Medicaid each pay for. |
MediPrimer does not recommend one option over another. The right fit depends on your health, your doctors, and where you live.
How to find out if PACE is near you
Ask your state Medicaid agency whether it offers PACE and which organizations serve your area. Use our State Medicaid Directory. Your local SHIP can also explain your choices for free. Ask to visit the PACE center before you sign anything.
Common questions
Do I have to have Medicaid to join PACE?
No. Most members have both Medicare and Medicaid. People with Medicare only pay a premium. People with neither can pay privately.
Do I have to live in a nursing home?
No. You must be eligible for nursing home care. You must also be able to live safely in the community. For most members, PACE lets them stay in the community instead of going to a nursing home.
Can I keep my own doctor?
Your care comes from the PACE team and its providers. Ask the PACE organization whether your current doctor can work with it before you enroll.
Can I leave PACE?
Yes. You can leave at any time and for any reason.
Does PACE cover drugs?
Yes. Prescription drugs are on the list of PACE benefits.
Related pages
- Dual Eligibility: Medicare and Medicaid Together
- Medicaid Home Care and HCBS Waivers
- Medicare and Long-Term Care
- Special Needs Plans
- Caregivers
- Glossary
- Medicaid.gov: PACE
- Medicaid.gov: PACE benefits