PACE: The Program of All-Inclusive Care for the Elderly Explained

The Program of All-Inclusive Care for the Elderly, known as PACE, is one of the most comprehensive long-term care programs in the United States. For seniors who qualify, PACE bundles every type of medical and supportive care, from doctors and prescription drugs to in-home aides and adult day health, into a single program with no out-of-pocket cost for those who also qualify for Medicaid. PACE is available in 33 states with more than 170 active programs serving over 75,000 participants nationwide.

What Is PACE?

PACE was authorized as a permanent Medicare and Medicaid benefit in 1997. The model was developed in San Francisco's Chinatown in the 1970s as a way to keep older adults out of nursing homes by surrounding them with a coordinated team of medical and social services. Today PACE organizations operate as integrated providers, meaning the same nonprofit (or sometimes for-profit) organization both pays for and delivers all of the participant's care.

What PACE Covers

PACE is the most comprehensive coverage available to American seniors. It includes:

• Primary care from a PACE-employed physician.
• All specialist care, including cardiology, neurology, and orthopedics.
• Hospital care and emergency services.
• Prescription drugs (Part D coverage is built in).
• Physical, occupational, and speech therapy.
• Dental, vision, and hearing care.
• Personal care and homemaker services in the home.
• Adult day health center attendance, usually two to five days per week.
• Transportation to medical appointments and to the day center.
• Meals and nutritional counseling.
• Social work and mental health services.
• Respite care and end-of-life care.
• Skilled nursing facility care if needed.

There are no co-pays, no deductibles, and no benefit limits for participants who qualify for both Medicare and Medicaid.

Who Is Eligible for PACE?

To enroll in PACE you must:

• Be 55 years of age or older.
• Live in a PACE service area (typically a defined zip code list).
• Need a nursing facility level of care, as certified by the state.
• Be able to live safely in the community at the time of enrollment, with PACE services in place.

You do not need to be on Medicaid to enroll, but if you are not, you will pay a monthly premium for the long-term care portion. Most participants qualify for both Medicare and Medicaid, in which case there is no premium.

How PACE Works Day to Day

Most PACE participants attend an adult day health center several days each week. The center provides medical visits, therapies, meals, social activities, and transportation. On non-center days, PACE provides in-home care, meal delivery, and transportation as needed. A single interdisciplinary team (physician, nurse, social worker, therapist, dietitian, home care coordinator, and others) meets regularly to update the care plan.

Because the same organization is both insurer and provider, PACE has strong incentives to keep participants healthy and at home. This results in lower hospitalization rates and higher participant satisfaction than traditional Medicare and Medicaid.

The Trade-Off: Provider Network Restrictions

The biggest catch with PACE is that you must use PACE physicians and providers for all of your care, except in emergencies. If you have a long relationship with a primary care doctor or specialist outside the PACE network, you will need to switch. For some families this is a deal-breaker. For others, the comprehensive coverage and care coordination outweigh the loss of provider choice.

Cost

• Dual-eligible (Medicare + Medicaid): No premium, no co-pays.
• Medicare only: A monthly premium for the long-term care portion, typically $4,000 to $6,000 per month depending on the program. Most people in this category find it cheaper to spend down to Medicaid first.
• Private pay: Possible but rare; you pay the full PACE rate out of pocket.

How to Find a PACE Program

1. Visit the National PACE Association directory and search by zip code.
2. Contact the local PACE organization to request an enrollment information packet.
3. Schedule an in-person assessment at the PACE center or in your home.
4. Complete the Medicaid application if you have not already.
5. Once approved, choose your enrollment date. Enrollment is on the first of the month.

PACE vs HCBS Waivers vs Medicare Advantage

PACE is more comprehensive than a Medicaid HCBS waiver because it includes all medical care. It is more comprehensive than a Medicare Advantage plan because it includes long-term care. The trade-off is the network restriction. For seniors with multiple chronic conditions, frequent specialist needs, or complex care plans, PACE often delivers better outcomes than piecing together separate programs.

Read our related guides on Medicaid HCBS waivers and SCAN Health Plan in-home benefits to compare options.

Estimate Your Family's Need

Use our free Care Needs Assessment to evaluate your loved one's level of need before contacting a PACE organization.

Need Professional Home Care?

If PACE is not available in your area, or if your loved one needs care while you complete enrollment, A licensed home care agency provides flexible in-home care that can be scaled up or down. Visit a licensed home care agency or use our free Find Your Care Match tool to get a personalized recommendation.