What Is a PACE Program?
- PACE programs help older adults live at home instead of nursing homes. Learn how the program works and find out if there’s a Medicare-Medicaid PACE program available near you.
PACE (Programs of All-Inclusive Care for the Elderly) is a Medicare and Medicaid program designed to help older adults who require a nursing home-level of care continue to live at home instead of moving into a nursing home facility.
What Is the Main Goal of the PACE Program?
The primary goal of PACE is to help program members remain at home and avoid having to move into a nursing home or other long-term care facility.
PACE helps older adults maintain a standard of independence and integrity while allowing them to remain more socially engaged with their community.
Living at home with a PACE enrollment is more affordable than a nursing home, and more than 90% of seniors say they wish to age in place at home instead of a nursing home.
How Does a PACE Program Work?
A PACE program consists of a team of health care professionals that provide a level of care identical to what you would find in a nursing home setting. The main difference is that the care is provided at the patient’s home or elsewhere in the community.
PACE members typically are required to use health care providers who are part of the PACE program network or otherwise approved.
Each PACE program is made up of the following types of health care providers:
- Primary care physician
- Registered nurse
- Master’s level social worker
- Physical therapist
- Occupational therapist
- Recreational therapist or activity coordinator
- PACE center manager
- Home care coordinator
- Personal care attendant
- Transportation driver
In addition to a staff of providers, a PACE program will also have a physical building that contains a primary care clinic and facilities for:
- Adult day care
- Therapeutic recreation
- Restorative therapies
- Personal care
PACE programs typically work with a relatively small number of people, so the care team is able to get to know each individual on a personal basis.
PACE programs are required to have a governing body with community representation, safeguards against conflict of interest and a formal Participant Bill of Rights.
All PACE programs are approved by the Centers for Medicare & Medicaid Services (CMS) and are monitored by state and federal regulating agencies.
How Many States Have PACE Programs?
Thirty-two states have at least one PACE program, and there are 148 different PACE programs in operation throughout the United States. Some states refer to their PACE programs as LIFE (Living Independence For the Elderly) programs.
Use the online PACE program locator to find a PACE program near you.
What Are the Eligibility Requirements for PACE?
The main eligibility requirements for PACE include:
- Requiring a nursing home-level of care as defined and certified by your state
- Being at least 55 years old
- Living in an area serviced by a PACE program
- Being able to safely live at home with assistance from the program
While PACE is a Medicare and Medicaid program, enrollment in Medicare or Medicaid is not a requirement for PACE eligibility. PACE enrollment continues until death, regardless of any changes in health status.
What Does PACE Cover?
A PACE program will typically cover the same services and items that are covered by Medicare and most state Medicaid programs.
If your PACE health care team determines you are in need of a service or item not covered by Medicare or Medicaid, it may still be covered after approval.
Below are some of the things commonly covered by PACE:
- Adult day primary care
- Emergency services
- Home care
- Hospital care
- Laboratory and x-ray services
- Medical specialty services
- Nursing home care
- Nutritional counseling
- Occupational therapy
- Physical therapy
- Prescription drugs
- Preventive care
- Social services such as caregiver training, support groups and respite care
- Social work counseling
- Transportation to the PACE center for medically necessary appointments and activities
How Much Does It Cost to Belong to a PACE Program?
There are no deductibles or copayments for services and items covered by a PACE program.
If you are enrolled in Medicaid, you will not owe a monthly premium. If you are not enrolled in Medicaid, you will likely be charged a premium for your PACE membership.
PACE programs provide coverage of some prescription drugs, but many PACE members choose to enroll in a Medicare Part D plan as well for additional drug coverage. If you do, you will owe a separate premium for your Part D plan.