A Guide to PACE: Programs of All-Inclusive Care for the Elderly

Over the years, many seniors, including our own family members, have fought to age peacefully in their own homes, even beyond the point when it is unsafe for them to do so. Thanks to Programs of All-Inclusive Care for the Elderly (PACE), seniors have a better way to stay in their homes and avoid nursing home placement. 

This nationally recognized model gives seniors access to medical care, long-term care and an array of supportive community-based services to help them live safely and independently. Services are coordinated by an interdisciplinary team of professionals working within a single organization to provide a better continuity of care. You can access these services starting at age 55 if you have significant health needs. Read on to see how PACE can help you or a loved one. 

Programs of All-Inclusive Care for the Elderly, also called Living Independence for the Elderly (LIFE), is an integrated care model that grew out of a grassroots initiative in San Francisco's Chinatown neighborhood back in the 1970s. Local medical professionals saw a need for comprehensive community-based care to accommodate older adults in multiple ethnic groups. 

As of 2023, PACE provides personalized care and supports to over 60,000 seniors in 32 states. There are more than 270 PACE community centers operated by 149 providers. Even if PACE is not available in your ZIP code, don't be discouraged — new programs are being added all the time.

Most people who qualify for PACE are eligible for Medicare, Medicaid or both, but private-pay options are also available. PACE was officially authorized as a care model by Medicaid and Medicare through the Balanced Budget Act of 1997. It covers all the services offered by Medicaid and Medicare plus other supports that are deemed necessary by the member's care team.

Payment options depend on your financial situation and whether you qualify for Medicaid. If you have Medicare only, you'll pay an additional monthly fee on top of your Part B premium to cover PACE long-term care benefits and prescription drugs typically offered by Part D. Medicare and private-pay members typically pay between $4,000 and $5,000 per month for PACE, which covers the Medicaid portion of the bill. However, there are no deductibles or copays once you're enrolled. 

If you qualify for Medicaid, you are exempt from this additional long-term care premium, which can save you quite a bit.

PACE covers a wide array of supports to help seniors live safely in their communities, ranging from daytime recreation to skilled nursing and in-home care. Although PACE is designed for adults who require nursing home care, just 7% of participants live in these facilities. 

While it's primarily for older adults who want to stay in the community, seniors in assisted living can also receive covered services through the program. Plus, interdisciplinary providers may authorize additional supports that may not be available through Medicare or Medicaid otherwise. Here's what's included.

• Medical Care: In-house physicians provide routine care, including wellness visits, health screenings and acute or emergency care.
• Daytime Recreation: PACE community centers provide medical care, rehabilitative therapies and recreational programs. They also provide transportation to and from the center.
• Human Services: Participants have access to social workers, family counselors, support groups and other resources to increase their physical and mental well-being.
• Long-Term Care: When needed, the program provides skilled nursing, in-home medical services and meal deliveries.
• Extras: Participants can also receive dental care, prescription medications and nutritional counseling through PACE.

To qualify for PACE, you must meet several requirements related to your age and personal needs, and you must live in a qualifying service area. According to the National PACE Association, the typical participant is 80 years old, has eight chronic medical conditions and needs help with three activities of daily living. 

PACE also serves dementia patients—about 50% of enrollees—while helping them remain in the community. To qualify for services, you must:

• Be age 55 or older
• Live in a qualifying ZIP code
• Require a nursing home level of care as determined by Medicaid
• Be able to live safely in the setting you choose

The easiest way to apply for services is by contacting your local PACE provider. You can see if PACE is available to qualifying residents in your ZIP code by visiting the National PACE Association. You can also find helpful information on your state's PACE website.