Key Takeaways: Quick Answers About PACE 📋
| ❓ Critical Question | ✅ Quick Answer |
|---|---|
| What does PACE cover? | ALL Medicare- and Medicaid-covered care and services, plus anything else the health care team decides you need—including prescription drugs |
| How much does PACE cost? | If you have Medicaid, you won’t pay a monthly premium for the long-term care portion of the PACE benefit |
| Where is PACE available? | 195 PACE programs serving 88,726 participants in 33 states and the District of Columbia |
| Who qualifies for PACE? | Age 55+, need nursing home level care, can live safely in community, live in PACE service area |
| Do I lose my own doctor? | You must use PACE healthcare providers. You cannot keep your own doctor. |
| Can I leave PACE anytime? | Individuals can leave the program at any time and for any reason |
🏠 Yes, PACE Covers EVERYTHING—And 96% of Nursing-Home-Eligible Seniors Stay Home
The Programs of All-Inclusive Care for the Elderly (PACE) provides comprehensive medical and social services to certain frail, community-dwelling elderly individuals, most of whom are dually eligible for Medicare and Medicaid benefits. An interdisciplinary team of health professionals provides PACE participants with coordinated care.
Here’s what “all-inclusive” actually means:
| 🏥 Service Category | What’s Included | 💡 Key Detail |
|---|---|---|
| Primary Care | Primary care (including doctor, dental and nursing services) | On-site at PACE center |
| Specialty Care | Audiology, dentistry, optometry, and podiatry | Often unavailable in nursing homes |
| Prescription Drugs | All Part-D covered drugs and all other necessary medication from the PACE program | Average participant has 6 prescriptions/month |
| Transportation | Transportation to and from the center and all off-site medical appointments is provided | 7 trips per participant per month |
| Adult Day Center | Adult day health care, recreational and social activities | Average 3 visits to PACE center per month |
| Home Care | Home and personal care services, nutrition services | As determined by care team |
| Hospital/Nursing Home | Hospital and nursing home care if and when needed | Covered when medically necessary |
| Meals | Nutritious meals at center + counseling | All PACE organizations together serve 23,564 meals a day |
| Therapies | Physical, occupational, speech, recreational | Personalized to your needs |
There’s no deductible or copayment for any drug, service, or care your health care team approves.
💰 The Real Cost: $0 for Most Participants vs. $9,000+/Month for Nursing Homes
States pay PACE programs 12% less than the cost of caring for a comparable population through other Medicaid services, including nursing homes and home and community-based waiver programs.
| 💵 Your Situation | What You Pay | What’s Covered | 💡 Reality |
|---|---|---|---|
| Medicare + Medicaid (Dual-Eligible) | A PACE organization may not charge a premium to a participant who is eligible for both Medicare and Medicaid | 100% of all services | 80.5% of PACE participants are dually eligible |
| Medicaid Only | $0 | 100% of all services | 19% are enrolled in Medicaid alone |
| Medicare Only | Long-term care premium + Part D premium + Part B monthly premium ($185 in 2025) | All Medicare + long-term care | Must pay monthly premium |
| Private Pay (No Medicare/Medicaid) | The average cost of PACE care can be $4,000 to $5,000 a month | All services | Only 0.4% pay a premium |
The Math That Should Make You Furious:
- Average nursing home: $9,000-$10,000/month
- PACE (with Medicaid): $0/month
- Only 4.42% of nursing home eligible PACE participants currently reside in a nursing home
✅ The 4 Eligibility Requirements Nobody Explains Clearly
To be eligible, a person must be 55 years or older, reside in a PACE service area, be determined eligible at the nursing home level of care by the Department of Health Care Services, and be able to live safely in their home or community at the time of enrollment.
| ✅ Requirement | What It Means | Who Decides | 💡 Critical Detail |
|---|---|---|---|
| Age 55+ | Must be at least 55 years old | Self-reported | Some sources say 65+ for Medicare; 55+ is PACE minimum |
| Nursing Home Level of Care | Presence of a mental or physical impairment which limits your ability to perform essential everyday activities, such as eating, bathing, personal hygiene, dressing, or moving around your home | State + PACE organization | PACE is intended to prevent nursing home placement |
| Able to Live Safely in Community | Can live at home with PACE support | PACE interdisciplinary team | Must be safe AT TIME of enrollment |
| Live in PACE Service Area | PACE services are only available in specific Counties and zip codes | Geographic restriction | PACE programs have no length of residency requirements |
Medicaid eligibility: Have income under 300% of the Federal Benefit Rate – $2,901/month. Have assets valued at $2,000 or less (excluding the primary home). Require a Nursing Home Level of Care.
👥 The Interdisciplinary Team: 11 Professionals Managing YOUR Care
The PACE model fosters continuous collaboration among participants, their families and caregivers, primary care physicians, the entire PACE staff, and other care providers to facilitate shared decision-making.
| 👨⚕️ Team Member | Their Role | Why It Matters |
|---|---|---|
| Primary Care Physician | Manages overall health | On-site, knows you personally |
| Registered Nurse | Daily health monitoring | Catches problems early |
| Social Worker | Benefits, resources, family support | PACE participants have access to a social worker who can help them find and apply for additional resources |
| Physical Therapist | Mobility, strength, fall prevention | With therapy comes the strength and confidence needed for seniors to stay happy and independent |
| Occupational Therapist | Daily living skills | Adapts home for safety |
| Recreational Therapist | Mental stimulation, socialization | Combats isolation |
| Dietitian | Nutrition, meal planning | Manages diabetes, heart disease |
| Home Care Coordinator | Schedules in-home services | Ensures seamless care |
| Personal Care Attendants | Bathing, dressing, hygiene | Dignity in daily activities |
| Transportation Staff | Door-to-door rides | PACE transportation staff can assist you with getting in and out of your home if needed |
| Center Manager | Coordinates all services | Single point of contact |
Eight of 11 IDT members for each new participant must conduct initial and annual comprehensive health assessments.
📊 The Outcomes Data That Proves PACE Works
| 📈 Outcome Measure | PACE Results | Compared To | 🔬 Source |
|---|---|---|---|
| Living at Home | Although all PACE participants qualify for nursing home care, 96% remain living in their communities | 0% of nursing home residents | DataPACE3 2021 |
| Hospitalization Rate | PACE has a 24% lower hospitalization rate than dually-eligible beneficiaries who receive nursing home services through Medicaid | Traditional Medicaid | NPA Research |
| Rehospitalization | PACE has 16% less than the national rehospitalization rate of 22.9% for dually-eligible beneficiaries age 65 and over | National average | CMS Data |
| Depression Improvement | 27% of new PACE participants scored as depressed before enrollment. 9 months later, 80% of those individuals no longer scored as depressed | Pre-enrollment | Mood Study |
| COVID-19 Protection | PACE participants experienced 1/3 the rate of COVID cases and deaths as compared to residents in nursing homes during the COVID-19 pandemic | Nursing homes | Pandemic Research |
| Caregiver Satisfaction | 95% of family caregivers would recommend PACE to someone in a similar situation | N/A | Vital Research |
| Caregiver Burden | The percentage of caregivers experiencing a high burden level decreased from 48% to 17% | Pre-enrollment | Caregiver Study |
Reviews have demonstrated that the average PACE participant experienced lower hospitalization rates, fewer readmissions, and fewer potentially avoidable hospitalizations than comparable populations, with shorter hospital stays (less than 6 days) within 12 months compared to other programs.
🗺️ PACE Is Available in 33 States + DC: Find Your Program
As of Dec. 2025, PACE is available in the District of Columbia and the following 33 states: Alabama, Arkansas, California, Colorado, Delaware, Florida, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Massachusetts, Maryland, Michigan, Missouri, North Carolina, North Dakota, Nebraska, New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, Washington, and Wisconsin.
| 🌎 Region | States with PACE | Notes |
|---|---|---|
| Northeast | MA, NY, NJ, PA, RI, DE | PA calls it “LIFE” (Living Independence for the Elderly) |
| Southeast | FL, NC, SC, VA, KY, TN, AL, AR, LA | Growing rapidly |
| Midwest | OH, IN, IL, MI, MO, WI, IA, KS, NE, ND | Illinois is the latest state to offer PACE with OSF PACE in Peoria |
| Southwest | TX, OK, NM | Limited geographic areas |
| West | CA, CO, OR, WA | California has most programs |
| DC | District of Columbia | Available citywide |
States WITHOUT PACE: Alaska, Arizona, Connecticut, Georgia, Hawaii, Idaho, Maine, Minnesota, Mississippi, Montana, Nevada, New Hampshire, South Dakota, Utah, Vermont, West Virginia, Wyoming
Contact Information:
- 🌐 Find a PACE Program: npaonline.org/find-a-pace-program
- 📞 Medicare Locator: medicare.gov/plan-compare (search PACE)
- 📍 National PACE Association: 675 N Washington St, Ste 300, Alexandria, VA 22314
📝 How to Enroll: The Step-by-Step Process
To enroll in PACE, you must contact a PACE organization that serves the area where you live. The PACE organization will guide you through the assessment and enrollment process. Enrollment in PACE is voluntary.
| Step | What Happens | Timeline | 💡 Tip |
|---|---|---|---|
| 1. Contact PACE | Call or visit local PACE organization | Day 1 | Use npaonline.org/find-a-pace-program |
| 2. Eligibility Screening | Basic questions about age, location, care needs | Same day | Be honest about limitations |
| 3. In-Home Assessment | Members of your local PACE program will meet with you (and your caregivers, if applicable) in person to assess your health, social service needs, and existing benefits | Within 1-2 weeks | Include family members |
| 4. Center Visit | At the Center, you will meet with Interdisciplinary Team members for your individual assessments. You’ll be introduced to your Care Team. Transportation is provided. | After home assessment | Lunch included |
| 5. Sign Enrollment Agreement | If an individual elects PACE, an Enrollment Agreement is signed | Same day as approval | Ask all questions first |
| 6. Effective Date | A participant’s PACE enrollment is effective the first day of the calendar month following the date the PACE organization receives the signed enrollment agreement | 1st of next month | Coverage starts immediately |
| 7. Care Plan Development | The Interdisciplinary Team has 30 days from enrollment to complete and review with you, your plan of care | Within 30 days | Participate actively |
If you’re denied enrollment, your local PACE program must give you a written reason why and suggest other options for care.
💬 Comment 1: “Do I have to give up my own doctor?”
Short Answer: ⚠️ Yes—but here’s why it might be worth it.
Important: You must use PACE healthcare providers. You cannot keep your own doctor.
| Concern | PACE Reality | Why It Works |
|---|---|---|
| “I love my doctor” | PACE doctors specialize in elderly care | The interdisciplinary team is required to provide all services covered by traditional Medicare but may also offer additional services at its discretion |
| “My doctor knows my history” | PACE team reviews all records | Comprehensive assessment at enrollment |
| “I don’t want to start over” | PACE model fosters continuous collaboration among participants, their families and caregivers, primary care physicians, the entire PACE staff | Coordinated, not fragmented |
“Every geriatrician loves this model,” says Dr. Mark Lachs, co-chief of geriatrics and palliative medicine at Weill Cornell Medicine.
💬 Comment 2: “What if I need to go to the hospital?”
Short Answer: ✅ PACE covers it—and continues managing your care.
If the participant needs to be admitted to a hospital or a nursing home, the interdisciplinary team will continue to supervise the treatment and care of the participant.
| Situation | What PACE Does | Cost to You |
|---|---|---|
| Emergency | Covered 100% | $0 |
| Planned Surgery | Team coordinates | $0 |
| Short-term Nursing Home | The PACE plan has the flexibility to directly pay for the SNF stay of a PACE enrollee even without a prior hospital stay | $0 |
| Long-term Nursing Home | Covered when necessary | $0 |
The average PACE participant has less than 1 Emergency Room visit per year.
💬 Comment 3: “I live in assisted living. Can I still use PACE?”
Short Answer: ✅ Yes—with important details.
If you are a resident in a Residential Care Facility for the Elderly, you can simultaneously be a participant in PACE. While PACE will not cover the costs of your room and board in the RCFE, it may pay for medical costs.
| Living Situation | PACE Coverage | What You Pay |
|---|---|---|
| Own Home | Full coverage | $0 (with Medicaid) |
| With Family | Full coverage | $0 (with Medicaid) |
| Assisted Living | Medical costs covered | Room & board yourself |
| Nursing Home | Full coverage | If you live in supportive housing (assisted living or nursing home), there is a co-pay to that facility |
💬 Comment 4: “What happens to my Medicare and Medicaid if I join PACE?”
Short Answer: ⚠️ PACE becomes your ONLY source of coverage.
The PACE program becomes the sole source of Medicaid and Medicare benefits for PACE participants.
| Program | What Happens | Important |
|---|---|---|
| Medicare Part A | Covered through PACE | Cannot use separately |
| Medicare Part B | Covered through PACE | Cannot use separately |
| Medicare Part D | You’ll get your Part-D covered drugs from the PACE program. If you join a separate Medicare drug plan while in PACE, you’ll be disenrolled from PACE. | Must use PACE pharmacy |
| Medicaid | Medicaid Home and Community Based Services (HCBS) 1915(c) waivers cannot be used with PACE | Either/or choice |
| Medicare Advantage | Must disenroll | Cannot have both |
| Medigap | A person cannot have a Medigap plan with PACE | No supplemental insurance needed |
💬 Comment 5: “How do I know if PACE is better than a nursing home?”
Short Answer: 📊 The data is overwhelming.
| Factor | PACE | Nursing Home | 🏆 Winner |
|---|---|---|---|
| Independence | 96% live at home | 0% at home | PACE |
| Cost to You | $0 with Medicaid | Varies; Medicaid covers | Tie |
| Depression | 80% no longer depressed after 9 months | High depression rates | PACE |
| COVID Risk | 1/3 the rate of cases and deaths | High outbreak risk | PACE |
| Hospitalization | 24% lower | Higher rates | PACE |
| Family Involvement | Active partnership | Limited visiting | PACE |
| Personalization | 11-member team | Staff rotates | PACE |
| Keep Your Home | ✅ Yes | ❌ No | PACE |
PACE participants also report improved quality of life as reflected in increased social interaction, less depression, and fewer worries after enrollment.
💬 Comment 6: “I don’t qualify for Medicaid. Can I still get PACE?”
Short Answer: ✅ Yes—but you’ll pay a monthly premium.
You can join PACE, even if you don’t have Medicare or Medicaid.
| Your Insurance | Monthly Cost | What’s Covered |
|---|---|---|
| Medicare Only | A PACE organization may charge a premium to a participant who is only eligible for Medicare | All services |
| Private Pay | $4,000 to $5,000 a month | All services |
| Neither | There is also a private pay option for participants who are not eligible for either Medicare or Medicaid | All services |
Not meeting the financial criteria does not mean one cannot become eligible for Medicaid, and therefore, a PACE Program. Medicaid offers multiple pathways to eligibility and Medicaid Planning Professionals can assist persons in meeting Medicaid’s requirements.
📞 Essential Contact Information
| 🏢 Resource | 📞 Contact | 🌐 Website | Best For |
|---|---|---|---|
| National PACE Association | 703-535-1565 | npaonline.org | Find programs, general info |
| Find a PACE Program | — | npaonline.org/find-a-pace-program | Search by zip code, state, county, or facility name |
| Medicare Plan Finder | 1-800-MEDICARE | medicare.gov/plan-compare | Compare PACE options |
| State Medicaid Office | Varies by state | medicaid.gov | Apply for Medicaid |
| PACE 4 Information Line | PACE 4: You can provide information about the PACE Program, locating services in your area, provide information regarding PACE if you are moving to a new state/area | pace4.org | Moving, transitions |
| Eldercare Locator | 1-800-677-1116 | eldercare.acl.gov | Local aging services |
Select PACE Providers by State:
| State | Major PACE Provider | Contact |
|---|---|---|
| California | AltaMed PACE – 16 centers serving more than 5,000 seniors each year | altamed.org/PACE |
| Colorado/PA/FL/VA/NM | InnovAge PACE | 844-211-6178 TTY:711 |
| Missouri | EverTrue PACE | 314-897-7223 |
| Missouri (KC) | PACE KC | 816-321-3300 / 833-672-2352 |
| Missouri (Springfield) | Jordan Valley Senior Care | 417-851-1550 / 833-278-1070 |
| Oregon/Washington | Providence PACE | providence.org/services/pace |
| Central California | Central Valley PACE | cvpace.org |
📊 Quick Recap: Why PACE Is the Best-Kept Secret in Senior Care 📝
- $0 Cost for Most 💰: 80.5% are dually eligible for Medicare and Medicaid—paying nothing
- Stay Home 🏠: 96% live at home despite being nursing home eligible
- All-Inclusive 📋: Doctor, drugs, dental, transportation, meals, therapy—everything covered
- Better Outcomes 📈: 24% lower hospitalization rate, 80% depression improvement
- No Copays/Deductibles ✅: No deductible or copayment for any drug, service, or care your health care team approves
- 11-Member Care Team 👥: Personalized care from professionals who know you
- Leave Anytime 🚪: Individuals can leave the program at any time and for any reason
- Available in 33 States 🗺️: 195 PACE programs serving 88,726 participants
- Saves Medicaid Money 💵: States pay PACE programs 12% less than nursing homes/HCBS
- Caregiver Relief ❤️: Caregiver high burden decreased from 48% to 17%
PACE has proven itself to be a cost-effective program for improving the last chapter of life for older patients and is continuing to expand nationwide.
According to a recent survey, about 70% of older adults say their preference for care as they age is to remain at home with support. PACE makes that possible.
Start here: npaonline.org/find-a-pace-program or call 1-800-MEDICARE 💚