The Program of All-Inclusive Care for the Elderly (PACE) is a system that provides comprehensive medical and social services to senior citizens. PACE services aim to assist those in need of help and to address their health care needs in their communities as opposed to providing them in a nursing home or other assisted living facility. The PACE program uses a team of health care professionals to coordinate with families to ensure the proper regimen of care is provided. Individuals typically qualify for PACE if they are considered to be frail and meet the eligibility requirements for Medicare and Medicaid benefits. PACE centers that provide the staff and service must meet the state and federal safety guidelines.
About PACE Requirements
To be eligible for PACE, the program requires that residents meet the minimum age requirements and reside in a location where a PACE organization provides services. During the PACE application process, petitioners must also demonstrate the need for a level of care that meets the standard of care one would receive in a nursing home as determined by the state. Applicants must also be able to live within the community safely with the assistance of services from PACE, as the program is not a substitute for total supervision. Petitioners may have Medicare, Medicaid or both to qualify to join PACE.
What does the Program of All-Inclusive Care for the Elderly cover?
PACE services provide the same care and services that you would receive from your Medicare or Medicaid plans, so long as your PACE program health care team is authorized to do so. The PACE program typically uses small teams of professionals to ensure that they are familiar with their charges to maximize the effectiveness of the care they provide. Even if your PACE team determines you require certain care or services not covered by Medicare or Medicaid, then PACE may cover them anyway.
Some of the services provided by PACE include home care, emergency care, hospital care and adult day care (such as doctor and recreational therapy nursing services). Residents who enroll in PACE may also receive occupational therapy, nutritional guidance, prescription drugs and specialty care. Seniors can also apply for PACE if they need assistance with dentistry, meals, lab and X-ray work. Care under the PACE program can also include preventative care, social services, various types of counseling and transportation to and from PACE centers for activities and appointments so long as they are deemed medically necessary.
Download our health care guide for more details on comprehensive medical coverage from government programs like PACE, Medicare and Medicaid.
What does the PACE program cost?
The cost for PACE services you would be responsible for varies depending on your financial situation. For instance, you will not be obligated to make monthly premium payments for long-term care according to the PACE program benefits agreement if are enrolled in and receive the services and benefits of the Medicaid program. However, the PACE program may assess charges if you do not meet the requirement for Medicaid but you are enrolled in a Medicare coverage plan. In the event that PACE charges you a monthly premium, it will be to cover the long-term care portions of the PACE services benefits.
You have the option of paying for PACE programs if you do not have coverage through Medicare or Medicaid. PACE programs do not assess or charge deductibles or copayments for any office visits, prescription medications or other services or care approved by your PACE care team. However, you will also be responsible for paying a monthly premium for a Medicare Part D plan for prescription medication.
What is the PACE Application Process
To apply for PACE, you can visit the Centers for Medicare and Medicaid Services website to obtain the application form. You can complete the application for PACE using the Health Plan Management System before downloading and printing. There is also a web portal that you can use to locate a PACE plan in your area. Since PACE programs are typically varied and administered at the state level, you may wish to visit your state’s department for elderly affairs to obtain more information about what other requirements or guidelines may exist. Additionally, forms and the PACE application process may have slight variations from state to state as well.
Learn how to apply to PACE by downloading our guide here.