Program of All-Inclusive Care for the Elderly (PACE)
Program of All-Inclusive Care for the Elderly, or PACE, are programs that provide complete health care for people 55 and older deemed nursing home eligible by Medicaid. PACE can help those people meet their long-term care needs instead of using services Original Medicare does not cover.
What Are PACE Medicare Programs?
Program of All-Inclusive Care for the Elderly (PACE) is a program run by Medicare and Medicaid. Its mission is to provide health care services to seniors within their own community without the need of a nursing home or long-term care facility.
Medicare does not cover long-term care, so PACE can help some people get the care they need without having to rely on a nursing home. PACE finds alternatives for nursing homes.
PACE seeks to allow most people to continue living in their homes and communities for as long as possible. Only about 7 percent of PACE participants live in nursing homes even though all of them are certified as needing nursing home care.
PACE delivers comprehensive medical and support services to its participants to maintain this level of independence.
PACE provides care in your home, community or at a PACE center depending on your needs and the types of medical services you require. PACE centers are required to meet all state and federal safety requirements. PACE contracts with specialists and other health care providers in the community to provide medical services.
PACE programs are not available everywhere. But as of 2020, there were 133 PACE programs operating 264 PACE centers in 31 states. More than 51,000 Americans were enrolled in some type of PACE program.
Eligibility for PACE Programs
Before you can join a PACE program, you must first be enrolled in Medicare, Medicaid or both. In some states, PACE is only available to people on Medicaid. You will need to check with your state Medicare or Medicaid office about the rules in your state.
In addition, you will need to meet other requirements to join PACE.
- Be age 55 or older.
- Live in the PACE program’s service area.
- Be certified by your state as needing nursing home-level care.
- Be able to safely live in your community with help from PACE.
Enrollment in PACE is voluntary, but if you want to join and meet the eligibility requirements, you sign an enrollment agreement. Your enrollment continues as long as you want it to, regardless of changes in your health. If you decide that PACE isn’t for you, you can leave it at any time.
What Services Does PACE Cover?
PACE covers all health care and medical services that would be covered by Medicare and Medicaid, so long as your health care team determines you need it. If your team determines you need care Medicare and Medicaid does not cover, PACE may cover it anyway.
- Adult day care, including nursing
- Home health care
- Hospital and nursing home care when needed
- Lab and X-ray services
- Meals and nutritional counseling
- Medical care from a PACE doctor familiar with your condition and medical history
- Medically necessary transportation to the PACE center for activities or medical appointments
- Medical specialties including vision, hearing, dental and other care or therapy
- Medical transportation to some medical appoints in your community
- Occupational, physical and recreational therapy
- Prescription drug coverage
- Preventative care
- Social services such as caregiver training, support groups and temporary care in a nursing home, hospice inpatient facility or a hospital
- Social work-related counseling
PACE Interdisciplinary Provider Team
PACE uses an interdisciplinary team of health care providers to deliver medical services to its participants. The team consists of a staff of health care professionals and paraprofessionals that assess your needs, develop care plans tailored for you and then deliver the services you require.
Those services can include acute care services or nursing facility services if you need them.
- Primary care doctor
- PACE center supervisor
- Home care liaison
- Occupational therapist
- Personal care attendants
- Physical therapist
- Recreational therapist or an activity coordinator
- Social worker
Teams usually meet daily to discuss the status of participants in the PACE program and to ensure each of them is getting their medical and social needs met.
Costs of PACE for Medicare Beneficiaries
Your costs to join a PACE program depends on your financial situation. But there is no deductible or copayment for any drugs, medical services or any type of care approved by your interdisciplinary team regardless of your situation.
If you qualify for Medicaid, it can cover the premium for the long-term care portion. If you don’t have Medicare or Medicaid, you can still pay your PACE premiums out of your own pocket.
6 Cited Research Articles
- National Pace Association. (2020, June). PACE in the States. Retrieved from https://www.npaonline.org/sites/default/files/PDFs/PACE%20in%20the%20States%20June%202020_0.pdf
- U.S. Centers for Medicare & Medicaid Services. (2017, December). Quick Facts About Programs of All-Inclusive Care for the Elderly (PACE). Retrieved from https://www.npaonline.org/sites/default/files/11341-PACE.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Programs of All-Inclusive Care for the Elderly Benefits. Retrieved from https://www.medicaid.gov/medicaid/long-term-services-supports/pace/programs-all-inclusive-care-elderly-benefits/index.html
- U.S. Centers for Medicare & Medicaid Services. (n.d.). PACE. Retrieved from https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/pace
- National Pace Association. (n.d.). PACEFinder: Find a PACE Program in Your Neighborhood. Retrieved from https://www.npaonline.org/pace-you/pacefinder-find-pace-program-your-neighborhood#:~:text=Currently%2C%20133%20PACE%20programs%20operate,click%20on%20your%20state%20below.
- National Pace Association. (n.d.). Is PACE for You? Retrieved from https://www.npaonline.org/pace-you