PACE — Programs of All-inclusive Care for the Elderly — is a comprehensive, community-based alternative to nursing home placement. It serves frail seniors who need nursing-home-level care but want to keep living at home for as long as possible. PACE participants receive all their medical care, prescription drugs, transportation, meals, adult day services, and home care through a single PACE organization that coordinates everything.
There are around 175 PACE programs operating in 33 states, serving roughly 80,000 participants. PACE is one of the most generous (and least well-known) options for low-income seniors who need substantial daily help but want to avoid moving into a nursing home.
How PACE Works
Each PACE organization operates a PACE center — typically including an adult day program, a clinic with primary care doctors and nurses, a rehab gym, and a kitchen — plus a network of contracted services (hospitals, specialists, nursing homes for short stays). When you enroll, your care team manages everything: scheduling appointments, arranging transportation to the PACE center and to outside specialists, providing in-home care, supplying medical equipment, and coordinating any necessary hospitalization.
The PACE team includes:
- Primary care physician (often a geriatrician)
- Nurse and nurse practitioner
- Social worker
- Physical, occupational, and speech therapists
- Home care coordinator
- Dietitian
- Recreational therapist
- PACE center manager and drivers
The team meets regularly to review each participant’s care plan and adjust services as needs change. Most participants attend the PACE day center one to several days a week, where they receive medical care, therapy, meals, and social activities. The rest of the time they live at home (or in the home of a family caregiver), supported by PACE-arranged home care, meal delivery, and transportation.
What PACE Covers
PACE covers everything Medicare and Medicaid cover — plus a lot more. There are no deductibles, copays, or coinsurance on covered services. Covered care includes:
- Primary care and specialist visits
- Hospital and emergency care
- All prescription drugs (with no Part D donut hole)
- Adult day services at the PACE center
- Home health care and personal care
- Physical, occupational, speech, and recreational therapy
- Medical equipment (walkers, wheelchairs, hospital beds, oxygen)
- Dentures, glasses, hearing aids
- Dental and vision care
- Nursing facility care (when needed)
- Meals and nutritional counseling
- Transportation to and from the PACE center and to medical appointments
- Caregiver education and support
If you enroll in PACE, your PACE organization becomes your sole care coordinator. You must use PACE-affiliated providers (with limited emergency exceptions). You can’t simultaneously be enrolled in Medicare Advantage, regular Medicare Part D, or another Medicare-Medicaid plan.
Who Qualifies
To enroll in PACE, you must:
- Be age 55 or older
- Live in a PACE service area — these are defined by zip code; PACE doesn’t cover all states or all areas within a state
- Meet your state’s nursing home level-of-care criteria — typically meaning you need help with multiple activities of daily living (bathing, dressing, transferring, eating, toileting) or have cognitive impairment
- Be able to live safely in the community with PACE services at the time of enrollment
PACE assesses every applicant and develops a plan to determine whether community living is feasible. If you can’t be served safely at home even with PACE-level support, you may not be eligible.
What PACE Costs
How much you pay depends on whether you qualify for Medicaid:
- Dual-eligible (Medicare + Medicaid) — most PACE participants. You pay nothing for PACE services. Medicaid pays the PACE organization a fixed monthly amount, and Medicare pays its own monthly capitated rate
- Medicare only (no Medicaid) — you pay a monthly “premium” equivalent to Medicaid’s contribution, often $3,500–$5,000+ per month depending on the state. Most non-dual participants don’t sign up for this reason — at that price, regular Medicare plus paid help is often cheaper
- Private pay (no Medicare or Medicaid) — rare. You pay the full PACE rate, which is typically $7,000+ per month
If you have Medicare but not Medicaid, ask your state Medicaid agency whether you qualify based on the more generous income/asset limits available for community-based long-term care. Some states allow you to “spend down” excess income on medical expenses to qualify. Medicaid eligibility is more complex than headline income limits suggest.
PACE vs. Other Options
- PACE vs. nursing home — PACE participants stay in the community, often a key personal preference. Costs to the participant are typically lower (or zero) than long-term nursing home care, which can run $100,000+ per year
- PACE vs. Medicaid HCBS waivers — both keep you in the community, but PACE is fully integrated (one team manages everything) while HCBS waivers piece together services from multiple providers. PACE has stricter geographic limits
- PACE vs. Medicare Advantage — Medicare Advantage may add some non-medical benefits, but doesn’t include nursing-home-level long-term care. PACE is for people who would otherwise need a nursing home
How to Find a PACE Program
- npaonline.org — National PACE Association’s directory; search by state and zip code
- medicare.gov/pace — federal Medicare information page; includes a directory and eligibility quiz
- Call 1-800-MEDICARE — Medicare reps can help locate PACE programs in your area
- Your state Medicaid office — can confirm whether PACE is available in your area and help with the dual-eligibility application
When you contact a PACE organization, ask about wait times, assessment scheduling, and which conditions and care needs they handle particularly well. PACE programs vary in size and specialty focus.
Educational only. PACE availability, costs, and Medicaid eligibility rules vary by state and PACE organization. Confirm current details with the PACE organization directly or with your state Medicaid office.