PACE Programs: The $0 Alternative to Nursing Homes

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 💚

Healthcare & Medicare