What Are PACE Programs?

• by Christian Worstell
• August 1, 2023
• Reviewed by John Krahnert

PACE is an acronym for Programs of All-Inclusive Care for the Elderly.

PACE is a voluntary Medicare and Medicaid program that helps people meet their health care needs at home instead of having to move into a nursing home or other inpatient facility.

What is the main goal of the PACE program?

The main goal of a PACE program is to allow patients to “age in place.” That is, the goal of a PACE program is for patients to avoid living in a nursing home and instead continue living at home and within their own community. 

There are a number of benefits to aging in place:

• It can be much more affordable than nursing home living.
• It can allow people to remain more socially engaged within their communities.
• It can help foster independence and empowerment.

Plus, more than 90% of seniors say they want to remain in their own homes as they age. 

How does PACE work?

PACE programs typically work with a small group of people, so the PACE team gets to know each member and works to coordinate care within the participating team of care providers.

Each PACE program is required to have at least one of the following types of providers as part of its team:

• Primary care physician
• Registered nurse
• Masters-level social worker
• Physical therapist 
• Occupational therapist 
• Dietician 
• Recreational therapist or activity coordinator 
• PACE center manager
• Home care coordinator 
• Personal care attendant
• Transportation driver 

PACE programs have a PACE center that includes a primary care clinic, adult day health program and areas for therapeutic recreation, restorative therapies, socializing, personal care and dining.  

You may have to use a PACE-preferred doctor when enrolled in a PACE program, but there is never a deductible or copayment required for any covered service that is approved by your PACE program. 

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 and Medicaid Services (CMS) and are monitored by state and federal regulating agencies.

Which states have PACE programs?

There are 148 PACE programs operating in 32 different states. You can use the National PACE Association (NPA) PACE Program lookup tool to find a PACE program in your state.  

In some states, PACE programs are referred to as LIFE programs, or Living Independence For the Elderly. 

What are the eligibility requirements for PACE programs?

You must meet the following conditions to qualify for a PACE program:

• Be at least 55 years old
• Live in the area serviced by the PACE program you wish to join
• Require a nursing-home level of care (as certified by your state)
• Be able to live safely in the community with help from the PACE program

While PACE is a Medicare/Medicaid program, you may still enroll in a PACE program and pay for it privately even if you are not enrolled in Medicare or Medicaid. 

What do PACE programs cover?

A PACE program covers the same services and items that are generally covered by Medicare and Medicaid. These include:

• Adult day primary care
• Dentistry 
• Emergency services
• Home care
• Hospital care
• Laboratory and x-ray services
• Meals 
• 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. 

If your health care team determines you need some services not covered by Medicare or Medicaid, your PACE program may still cover it.  

How much does it cost to belong to a PACE program?

You will not pay a premium for your PACE program if you have Medicaid. If you do not have Medicaid, you will be charged a monthly premium for the long-term care portion of your PACE benefits. 

You may need to pay a separate premium for Medicare Part D drug coverage. 

PACE enrollment continues until death, regardless of any changes in health status. 

How do you enroll in a PACE program?

Use the PACE program plan finder tool at the National PACE Association or at Medicare.gov to find a PACE program near you. Once you do, use the contact information provided to begin the enrollment process.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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