Programs of All-Inclusive Care for the Elderly (PACE)
PACE (Programs of All-Inclusive Care for the Elderly) provides a variety of services that help eligible older adults stay in the community through delivery of a comprehensive package of services and benefits.
Learn about PACE, eligibility requirements, what it covers, associated costs and how to apply for PACE.
What Is PACE?
Individuals benefiting from PACE services receive their health care needs within their community instead of living in a nursing home. PACE also provides recipients with social services. The National PACE Association reveals that PACE programs across the U.S. also utilize behavioral health resources, development of end-of-life and palliative care services within PACE organizations.
An interdisciplinary team of professionals helps recipients receive coordinated care by working with PACE clients and their family, if applicable, to develop a comprehensive care plan. PACE organizations typically have contracts with multiple community providers and specialists to help make sure that every participant receives the comprehensive services needed to remain in the community.
Although PACE is a Medicare program, eligible individuals are likely dually eligible for both Medicare and Medicaid. The Medicaid site indicates that PACE becomes the sole source of Medicare and Medicaid benefits. This is likely especially important for individuals in need of senior care or senior housing services.
Who Qualifies For PACE?
Participants meet specific eligibility requirements before receiving PACE benefits. Qualifications include that you must be at least 55 years of age and be able to continue living safely in the community as long as you receive help from PACE. You also must live within a PACE service area and be eligible for nursing home care, based on certification from your state.
Once you or your family member enrolls in PACE, there is no requirement that a PACE recipient continues in the program. Receiving services and benefits through PACE is an optional choice and if you choose to leave the program you can do so without penalties.
What Does PACE Cover?
Once enrolled, PACE recipients receive a comprehensive package of services and assistance, based on individualized needs. Medicare and the National PACE Association reveal benefits such as adult day primary care services. This includes onsite medical supervision, physical therapy, occupational therapy, recreational therapy, nursing services, social services, meals, dental care and other services. These comprehensive services are potentially helpful to individuals considering adult day care as one of their senior care and senior housing options.
PACE participants also qualify for care from medical specialists such as a cardiologist, rheumatologist or podiatrist. Participants receive other specialized care such as women‘s services, dental care, including dentures, audiologist care including hearing aids, and products such as diabetic shoes and eyeglasses.
Participants benefit from an on-call physician, available 24 hours a day and a variety of outpatient services.
The Centers for Medicare and Medicaid Services (CMS) explains that PACE also covers prescription drugs, regular physician check-ups and medical care, transportation to PACE Center medical visits and hospital visits. Recipients also have access to transportation to medically necessary medical appointments in the community and social work counseling.
Other benefits covered likely prove particularly crucial for individuals in need of senior care and senior housing services, including coverage for nursing home care and skilled inpatient rehabilitation care when needed, along with respite care and caregiver education.
Covered medical supplies include diabetic testing supplies, wheelchairs, walkers, hospital beds and oxygen.
How Much Does PACE Cost?
There is no set fee for receiving PACE (Program of All-Inclusive Care for the Elderly) services and benefits. Your cost depends upon your specific financial situation.
Medicare reports that if you have Medicaid you will not have to pay the monthly premium for the long-term care portion of PACE. If you have Medicare but do not have Medicaid, you pay the monthly premium that covers the long-term care portion of PACE as well as a premium for a Part D prescription drug plan.
There are no co-payments or deductibles required to receive any care, services or prescription drugs approved by members of your interdisciplinary health care team.
If you do not have Medicare or Medicaid, there is a private self-pay option to receive benefits and services.
How Do I Apply For PACE?
The Program of All-Inclusive Care for the Elderly (PACE) operates in 31 states. There are over 240 PACE centers within those states. You have to live in an area serviced by PACE to apply.
Apply for PACE online by searching for plans in your area or call your local Medicaid or Medicare office for more information about applying for PACE.
If you already receive skilled nursing, adult day care, other senior care or senior living services, ask your social worker or agency representative to help you with the application process.