If you’re helping your loved one navigate Medicare or Medicaid, you may have come across PACE, the Program of All-Inclusive Care for the Elderly. While seniors may be eligible for PACE through Medicare, Medicaid, or both if they have dual eligibility, PACE can be a little confusing. It’s only available in certain locations across the country, and your loved one will need to meet eligibility requirements to be accepted into the program. This article covers the PACE program requirements, as well as the advantages and disadvantages of using it to pay for long-term senior care.
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PACE is a Medicare program that provides comprehensive health care to eligible seniors who require a nursing home level of care but don’t want to live in a nursing home. PACE is offered in certain states that have chosen to provide PACE to seniors. 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.[01]
PACE provides coordinated care through an interdisciplinary care team for all enrollees. At minimum, this care team includes the following health care professionals:[02]
This care team creates individualized plans for the seniors enrolled in their program, and they work together to help ensure that all needs — both social and medical — are met.
Services covered by PACE may include the following:[03]
Seniors can apply for PACE if they meet the following requirements:[03]
While many seniors enrolled in PACE are dually eligible for both Medicare and Medicaid, it’s possible to enroll under either of these programs. In fact, you can apply for PACE even if you’re not enrolled in Medicare or Medicaid.[03]
The most important requirement for PACE is living within a PACE service area. PACE is only available in states that offer it, and even then, it may not be available throughout the entire state. To see if there’s a PACE program near your loved one, use Medicare’s Find a PACE Plan tool.
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PACE doesn’t pay for assisted living, but it does cover several long-term care services, either at home or in a senior living facility. If your loved one lives in an assisted living community, they may still access care services covered under the PACE program.
For seniors that live at home, PACE provides a driver to take them to the PACE center for activities, services, and appointments. A senior enrolled in PACE in an assisted living facility would have a similar experience, where a driver would pick them up from their community and take them to the PACE center.
Depending on your community’s pricing model, this may save your loved one some money, as the community wouldn’t be providing as much care and therefore wouldn’t charge your loved one for it. But you or your loved one would still need to pay for room and board as well as other community expenses.
As with many programs, PACE varies in what it offers depending on location, and seniors may have a variety of experiences with PACE.
For many seniors and their families, the biggest benefit of PACE is being able to keep seniors living comfortably at home or in their chosen assisted living community. Because one of the requirements for the program is requiring a nursing home level of care, the alternative for many seniors would be to move into a Medicaid-approved nursing home. PACE offers seniors a choice of where they want to age in place.
And since PACE takes a holistic approach to care, you know that your loved one’s team of caregivers is concerned not only about their health, but also their overall well-being.
PACE offers comprehensive care and social stimulation (this can vary by center), which helps avoid the long-term risks of senior isolation.
The major downside of the PACE program is its limited availability. PACE is only available in select areas, and seniors are generally required to live near the PACE center in order to participate. This requirement varies by location but is typically set to a certain mile radius of the local PACE center.
Currently, there are only approximately 300 PACE centers serving 70,700 participants across the United States.[04]
Additionally, once a senior begins accepting care through PACE, they can only receive their Medicare or Medicaid benefits through the program. For example, if your loved one enrolls in PACE, they wouldn’t be able to join another Medicare drug plan without losing their PACE enrollment.[03] Depending on the PACE program in your loved one’s area, you may have other rules or stipulations to follow.
Because seniors can only receive health care services through PACE once they enroll, they may need to change doctors or other caregivers, which some seniors may be reluctant to do.
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Seniors 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 private home. Many PACE services are medical in nature, but anything that your loved one’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 in the following ways:[03]
While PACE covers a wide range of long-term care costs, it doesn’t quite pay for everything. For seniors living at home, family caregivers may still need to help their loved one or hire an in-home caregiver for part of the day, because PACE doesn’t provide 24-hour care. However, if your loved one lives in an assisted living facility, these gaps in care are typically covered.
If you need help discussing senior living options with a senior loved one or finding an in-home caregiver or an assisted living community, the Senior Living Advisors at A Place for Mom can help. They’ll work with you to determine what kind of care would suit your loved one’s needs and budget — all at no cost to you.
Centers for Medicare and Medicaid Services. Program of All-Inclusive Care for the Elderly. Medicaid.gov.
Centers for Medicare and Medicaid Services. Programs of All-Inclusive Care for the Elderly benefits. Medicaid.gov.
Centers for Medicare and Medicaid Services. PACE. Medicare.gov.
National PACE Association. Find a PACE program.
The information contained on this page is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom and the reader. Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter, and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not endorse the contents of the third-party sites.
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