Does Social Security Count as Income for PACE?

In this article...
  • PACE is a Medicare and Medicaid program that allows older adults to receive care in their own homes. Social Security benefits may count as income for PACE.

Medicare's Program of All-Inclusive Care for the Elderly, better known as PACE, is an initiative designed to allow older adults to stay in their own homes while receiving the care they require. This program is specifically designed to provide comprehensive care outside the Medicaid nursing home environment. By enrolling in PACE, you can access Medicare and Medicaid benefits and dental care, vision care and many other services and support options from your local community.

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

Does Social Security Count as Income for PACE?

There is no simple answer to this question. If you meet the income requirements for Medicaid, you will not have to pay a monthly premium for care through PACE. If, however, your income level is too high to qualify for Medicaid, you will need to be enrolled in Medicare Part A and Part B, also known as Original Medicare, to qualify for PACE. In this instance, you will generally be required to pay a monthly premium for the long-term care portion of the PACE program. Social Security benefits do not directly affect eligibility for PACE. However, if they are considered income for purposes of Medicaid eligibility, these benefits can have an indirect impact on the price you will pay for PACE participation.

Currently, more than 130 PACE programs are available in 31 states. Nearly 55,000 older people can access these programs to remain in their own homes, in the home of a family friend or family member or in assisted-living facilities. The ability to stay in a comfortable, home-like environment can have a positive impact on the overall quality of life experienced by those who participate in PACE.

What Services Are Covered by PACE?

PACE is intended to provide access to the same level and array of services as are provided by Medicare and Medicaid. Your health care team will be responsible for authorizing this care, which will include the following services:

  • Emergency services and hospital care
  • Laboratory work, including scans and X-rays
  • Occupational therapy and physical therapy
  • Prescription drugs
  • Meals
  • Preventive care
  • Social services for patients, including counseling
  • Transportation to and from the PACE location
  • Nutritional counseling
  • Care in a nursing home and home care
  • Support groups, respite care and training for caregivers
  • Dental care

Eligibility for PACE Enrollment

Medicare and Medicaid have established some criteria for PACE enrollment:

  • You must also be enrolled in Medicare, Medicaid or both.
  • You must be aged 55 or older and live in an area that is served by a PACE program.
  • You must be able to live safely in your chosen residence and in the community if you are provided services through PACE.
  • You must require an equivalent level of care to that provided by a nursing home, as certified by your state.

If you meet these basic requirements, you may be able to enroll in PACE.

What Are The Income Limits For PACE?

Not every state offers PACE programs, and they can vary slightly in eligibility. That being said, generally there isn't an income limit for PACE programs, but it depends on the state you reside in. For example, the income limit for PACE in Pennslyvannia is $14,500 for an individual and $17,700 for a couple.

What Are the Benefits of PACE?

PACE eliminates the deductibles and copayments for the prescription drugs, treatment regimens and services that are approved by your PACE healthcare team. This can significantly reduce the cost that you will pay for these services. While you will need to pay a monthly premium for Medicare Part D coverage, you will generally save money on your care by enrolling in PACE.

Does Social Security Count as Income for PACE?

As previously discussed, PACE is available to those who qualify for Medicaid as well as Original Medicare enrollees. The monthly premiums you will pay for PACE, however, will vary depending on whether you are enrolled in Medicaid, Original Medicare or both. Medicaid does have some fairly stringent income limits:

  • Individuals aged 65 and older can receive Medicaid if they have an income of $2,349 per month or less.
  • Married couples can qualify for Medicaid if their joint income is $4,698 or less each month.

Social Security benefits may be factored into those income limits for Medicaid. In this way, your Social Security income can have an indirect effect on the price you will pay to participate in PACE programs in your area.

To learn more about PACE or to determine the price you will pay for the services offered through this program, you can contact your local Medicaid or Medicare office.