Medicare PACE Program: How It Works and How to Qualify

June 30, 2020

It’s not uncommon for older adults to need nursing home care as they age. An estimated 52% of people turning 65 will need this care at some point.1

Fortunately, it is possible to receive nursing home-level care but stay living independently in your own home. That’s where a small but growing program called PACE comes in.

PACE—which stands for Programs of All-Inclusive Care for the Elderly—is an alternative to the most common types of Medicare coverage.

What is the PACE program?

If you are 55 or older, PACE can help you stay in your home instead of moving to a nursing home facility. A team of health-care providers coordinates your care so all your needs are met.

PACE provides both medical care and support services, such as meals and household chores. If you join PACE, you can receive care in your home, in the community, or at a PACE center in your area.

PACE is not an add-on to Medicare, and you don’t need to be enrolled in Medicare to join the program. If you qualify for PACE, it will become your only health-care coverage program.

(While this program is known as PACE in most states, in a few others it’s called LIFE—“Living Independence for the Elderly”.)

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What services does PACE provide?

PACE covers everything Medicare does, plus a few extras. Here is what’s included beyond standard Medicare coverage:

  • An adult day health center (PACE center): A place to have appointments with your medical team, get a lunchtime meal, pick up prescriptions, and participate in activities and exercise.
  • Transportation: Rides to medical appointments or activities at the PACE center.
  • Home care services: Includes personal care, chore services, and meal preparation.
  • Family/caregiver support: Respite care and caregiver education to help your family and caregivers.
  • Primary care: Access to an on-call doctor any time of day.
  • Specialist care: Includes dental care (dentures), optometry (eyeglasses), and audiology (hearing aids).
  • Prescriptions/medications: Includes over-the-counter medicines.

Learn about the home health services covered by Medicare.

Do I qualify for PACE?

To join a PACE program, you must meet the following requirements:

  • Be 55 or older
  • Live in a state with a PACE program (currently 31 states have them)
  • Need nursing home-level care, according to your state’s definition
  • Be able to live safely in your home, with PACE support

How much does PACE cost?

It depends on what health coverage you have. If you qualify for Medicare and Medicaid (also known as being dual eligible), you won’t pay anything for PACE.
If you are eligible for Medicare (but not Medicaid), you’ll pay a monthly premium for PACE that covers long-term care and prescription drugs.

According to the National PACE Association, which advocates for the PACE program and its recipients, the average premium for a Medicare-only PACE enrollee is $4,781 per month. But PACE programs vary greatly by state.

Find out the difference between Medicare and Medicaid.

As far as other costs, there aren’t any. As long as the care you receive is approved by your medical team, there are no deductibles or copays for any drug or service.

What rules do I have to follow while on PACE?

There are two main guidelines to know:

  • You may use only doctors that are part of the PACE program.
  • You cannot have a separate Part D prescription drug plan. The PACE program will provide any prescriptions you need.

How do I apply for PACE?

Apply for a PACE program with the individual PACE provider in your area. The Medicare website has a searchable list of PACE programs by state.

You aren’t committed to stay on PACE for any length of time. You can leave your PACE program any time.

The bottom line

PACE can help adults 55 and over receive complex care while remaining in their homes. PACE covers everything Medicare does, plus some additional services to help you maintain independence. If you have Medicare (but not Medicaid), you’ll pay a monthly premium for PACE services. If you have Medicaid, you’ll pay nothing for PACE.

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Sources:

1. U.S. Department of Health and Human Services, “Long-term Services and Supports for Older Americans: Risks and Financing Research Brief.

Content on this site has not been reviewed or endorsed by the Centers for Medicare & Medicaid Services, the United States Government, any state Medicare agency, or any private insurance agency (collectively "Medicare System Providers"). Eligibility.com is a DBA of Clear Link Technologies, LLC and is not affiliated with any Medicare System Providers.

Kathryn Anne Stewart
Written by
Kathryn Anne Stewart
Kathryn Anne Stewart is a freelance writer who covers the intersection of health and money. She has written for Johns Hopkins Medicine, Weight Watchers, Newsmax Magazine, Franklin Prosperity Report, and the National Hemophilia Foundation, often crafting clear explanations of complex topics. When she's away from her desk, you can find her reading a library book, watching stand-up comedy, or cycling with her husband.
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