Participants must be 55 or over, live in a PACE service area, and be certified as needing nursing home level care. The programme provides medical care, day centre attendance, therapy, transport and in-home support.
It is not available everywhere; coverage is by service area.
Why it matters
Where it exists it is one of the most comprehensive options available, and many families have never heard of it.
Questions people ask
What is the PACE program for seniors?
PACE, the Program of All-inclusive Care for the Elderly, is a Medicare and Medicaid program that helps older adults who need a nursing home level of care stay in the community. Medicare.gov says a team of health professionals coordinates all Medicare- and Medicaid-covered care, prescription drugs, and anything else the team decides is needed, including adult day care and transportation to the PACE center.
Who qualifies for the PACE program?
Medicare.gov says you can join PACE if you are at least 55, live in the service area of a PACE organization, need a nursing home level of care as confirmed by your state, and can live safely in the community with help from PACE. It is only available in some states that offer PACE under Medicaid. The National PACE Association counts 206 programs in 33 states and Washington, DC.
How does the PACE program work with Medicare?
If you have Medicare and join PACE, the PACE team coordinates your care, and you get your Part D drugs and all other necessary medication through PACE. Medicare.gov warns that if you join a separate Medicare drug plan while in PACE, you will be disenrolled from PACE. Members with Medicaid pay no monthly premium; others with Medicare pay premiums for the long-term care part and for drugs.
How much does the PACE program cost?
If you have Medicaid, you pay no monthly PACE premium. Medicare.gov says people with Medicare but not Medicaid pay a monthly premium for the long-term care part of the benefit and a premium for Part D drugs, and people without either can pay the premium themselves. Whatever your finances, there is no deductible, copayment or coinsurance for any drug, service or care your PACE team approves.
Does the PACE program help people with dementia?
PACE can serve people with dementia who need a nursing home level of care but can live safely at home with support. CMS notes that PACE is designed for frail older adults in general rather than for dementia, and most members have both Medicare and Medicaid. People in PACE cannot also join Medicare's GUIDE dementia model, which is built for Medicare patients with dementia at any stage, including mild.
Sources
Where to check this, and where to read more. All external and all authoritative.