The PACE Program for Senior Care: What to Know

The Program of All-Inclusive Care for the Elderly, or PACE, is a Medicare and Medicaid program that coordinates medical and long-term care services for eligible older adults who need a nursing home level of care and can live safely in the community with medical and social support. Seniors can enroll in PACE through Medicare, Medicaid, or both. PACE is only available in certain locations, and your loved one must meet eligibility requirements to enroll. Learn about the advantages and disadvantages of using PACE for long-term senior care, and whether this program could be a good fit for your family.

Key Takeaways

The Program for All-Inclusive Care for the Elderly (PACE) isn’t available everywhere; to be eligible, seniors need to live in an area that offers it.
PACE provides participants with comprehensive care team, including a primary care doctor, a nurse, therapists, caregivers, and social workers.
PACE doesn’t pay for assisted living but can be used to cover the cost of some care services delivered to residents of assisted living communities.
Seniors can enroll through Medicare, Medicaid, or privately; how a senior enrolls affects their monthly premium.

What is PACE

PACE stands for Program of All-Inclusive Care for the Elderly and is a Medicare and Medicaid program. PACE is currently offered in 33 states and the District of Columbia. [01] Enrollment in PACE is often also accompanied by enrollment in Medicaid. Once a senior enrolls in PACE, the program becomes their only source of health care coverage.

PACE provides coordinated care through an interdisciplinary care team for each enrollee. This care team can include:[01]

Primary care doctor
Physical therapist
Caregiver
Social worker
Dietitian
PACE center supervisor

Working with seniors and their families, care teams create an individualized plan to ensure the senior’s social and medical needs are met. Depending on an individual’s care plan, services covered by PACE may include:[01]

Adult day care
Laboratory and X-ray services
Dentistry
Transportation to the PACE center and medical appointments
Home health care
Social services
Emergency services
Hospital care
Nursing home care
Nutritional counseling
Physical, speech, and occupational therapy
Preventive care

Image Credit: Inside Creative House / iStock

What is a PACE center?

PACE centers are physical locations where many services are provided. Transportation to and from the center may be provided, and a typical day for seniors might include health checks, a hot meal, social activities, and physical or rehabilitative therapy, although services vary depending on the center location and individual care plans.[02]

Who’s eligible for PACE?

Seniors can enroll for PACE if they meet the following requirements:[01]

Are 55 or older
Need a nursing home level of care, as defined by the state where they live
Are able to live safely in their home or community with the program’s help
Live in a PACE service area

About 90% of seniors enrolled in PACE are “dually eligible,” meaning they’re eligible for both Medicare and Medicaid, and it’s possible to enroll under either of these programs. Seniors who aren’t enrolled in Medicaid or Medicare can also enroll in PACE.[03]

The criteria used to determine a senior’s need for nursing home level of care vary by state but generally include the need for full-time medical and non-medical care and supervision. A representative from the state’s Medicaid program or a contracted agency will assess a senior’s requirement for nursing home level of care.

To find out if there’s a PACE program near your loved one, use Medicare’s Find a PACE Plan tool. Once you find a nearby PACE program, contact their offices directly to confirm its service area and terms of enrollment.

Image Credit: Jacob Wackerhausen / iStock

How to enroll

To enroll in PACE, a senior must contact the nearest PACE program to find out the steps required in their state. These may include:[05]

Confirming PACE eligibility with senior’s address and nearest PACE program
Gathering documents confirming personal identification, medications, medical records, and insurance
Contacting local PACE program to schedule an assessment
Determining when enrollment could begin and how insurance transition is handled
Reviewing program terms and possible costs
Completing enrollment when accepted

Does PACE pay for assisted living?

PACE doesn’t pay for assisted living, but it can cover several long-term care services that may be provided in your loved one’s home or in a senior living community.

The national average monthly cost of assisted living is $5,830, according to A Place for Mom proprietary data.[06] This rate may include room, board, and some care services, while other communities bill for care separately. Whether PACE-covered services reduce any assisted living charges depends on the community’s pricing model, your loved one’s PACE care plan, and coordination between the community and local PACE organization.

Ask the community for an itemized price and confirm in writing which services the community and PACE organization will each provide and charge for. Your loved one will still be responsible for room and board and for services that aren’t covered by their PACE care plan.

Advantages and disadvantages of PACE

PACE programs vary in what they offer depending on location, which is why you and your loved one may need to monitor and coordinate the services provided by the nearest PACE program.

Advantages of PACE

Seniors can remain living at home or in their chosen senior living community instead of a Medicaid-approved nursing home.
PACE programs offer comprehensive care, which typically includes social stimulation, helping to prevent the long-term risks of isolation.
PACE takes a holistic approach to senior care, which may be reassuring to families, knowing that a team of caregivers is concerned about their senior loved one’s health and overall well-being.

Other benefits of PACE depend on a senior’s unique needs and whether their individualized care plan meets those needs.

Disadvantages of PACE

The PACE program isn’t available everywhere. There are 204 PACE programs located in 33 states and the District of Columbia which provide care services to more than 97,000 participants, according to a report from the National PACE Association.[07] If a senior moves outside of the local PACE program’s area, their eligibility may be affected and lead to involuntary disenrollment, unless the move is temporary or another exception applies.
Participation in the PACE program is voluntary, and participants may leave at any time, but this must be done carefully. Seniors must follow local PACE program steps for disenrollment and time their transition to other healthcare coverage with care. They can resume their Medicare or Medicaid benefits but should seek guidance from the PACE program, Medicare representative, and state Medicaid agency before disenrolling.
Because seniors can only receive health care services through PACE, they may need to change doctors, specialists, other caregivers, or pharmacies.

How PACE covers senior care costs

Seniors who are enrolled in PACE have access to a range of health care professionals and receive numerous services either at their local PACE center or in their home. Many PACE services are medical, but any care that a senior’s care team deems necessary to improve or maintain health is also covered.

PACE works much as any other health insurance coverage would, and how your loved one enrolls will affect their individual costs:[08]

Seniors who have Medicare but don’t qualify for Medicaid may pay monthly premiums that depend on whether they have Medicare Part A, Part B, or both. These costs include a premium for the long-term care portion of the PACE benefit and a premium for Medicare Part D prescription drug coverage.
Seniors who have Medicaid don’t pay a monthly PACE premium.
Seniors who don’t have Medicare or Medicaid may pay the PACE premium themselves. The amount is set by the local PACE organization. [01]
PACE participants don’t pay deductibles, copayments, or coinsurance for drugs, services, or care approved by their PACE care team.[04]

Costs of PACE vs a nursing home

PACE and nursing home care have different cost structures, so one isn’t always less expensive. The national median monthly cost of a nursing home is $10,798 for a private room and $9,581 for a semi-private room, including room, board, and nursing care.[09]

Supplementing your loved one’s care

To make sure that enrolling in PACE is the right choice for your loved one, consider the following:

Confirm that a PACE program is available in your senior loved one’s area.
Verify that your loved one meets eligibility requirements.
Review PACE program terms.
Compare cost of PACE with costs of alternative care scenarios.
Identify next steps for your chosen care route.

Identifying your senior loved one’s needs and preferences is critical for making the right care choice. Consider your senior loved one’s:

Care needs, both medical and non-medical
Proximity to nearest PACE program
Willingness to use the PACE provider network
Preferred care setting
Funds available for care

Before choosing PACE enrollment: questions to ask

Answers to these questions can help you and your loved one prepare for participation in the PACE program:

What assessments are needed to determine the level of care your loved one needs?
Which current doctors, specialists, or pharmacies will need to change?
What medical, long-term care, transportation, meals, social, and homebound services does the program include?
What premiums and out-of-pocket fees does the senior have to pay?
When and where is care available, including hospital, emergency, after hours, and nursing home care?
How does the PACE organization coordinate service with an assisted living community and what charges are paid by a resident?
What are local PACE program rules and timelines for voluntary and involuntary disenrollment and how is the coverage transition handled?

Seniors who aren’t eligible for PACE enrollment or who prefer a different type of care may consider hiring professional in-home care, accessing community-based services, and looking into assisted living and nursing home communities.

Supplementing your loved one’s care

If PACE isn’t available or isn’t the right fit, A Place for Mom’s Senior Living Advisors can help your family explore in-home care and senior living options based on your loved one’s needs, location, preferences, and budget.

Families Also Ask

Can someone living with dementia enroll in PACE?

Yes. As long as the individual meets all current PACE eligibility requirements, including being 55 or older, needing the state defined nursing home level-of-care, and the ability to live safely in the community with PACE support at enrollment.

Can a PACE participant receive hospice care?

The PACE program is comprehensive, so it does provide end-of-life services. However, if a senior enrolled in PACE wishes to receive a Medicare or Medicaid hospice benefit, they must voluntarily disenroll from PACE.

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The PACE Program for Senior Care: What to Know