The PACE provides medical and social services for people with significant needs who want to continue living at home. It’s a combined effort between Medicare and Medicaid.
The Program of All-Inclusive Care for the Elderly (PACE) offers support for people who wish to live at home but require a certain level of consistent medical care. Many of those enrolled in PACE are eligible for both Medicare and Medicaid, and these organizations work together to offer this program.
PACE covers several services as long as you live within one of its service areas and meet specific criteria to qualify. Keep reading to discover what services are covered, how to qualify, and more.
What is the PACE program?
PACE was created for people who need help managing their health but live in a private residence rather than a skilled nursing facility. You must have specific needs to qualify for the program, and most PACE participants are already dual eligible for both Medicare and Medicaid.
Medicare and Medicaid work together to offer PACE services, which are provided across the country by local care teams. The PACE team assesses the needs that can be met within your community.
PACE is a public program that can help you get the medical and social support you need without a lot of extra costs and without leaving home. The program covers all the services available under Medicare and Medicaid — and more.
A few examples of these services include:
- adult day care
- dental care
- help with meals and nutrition
- home care
- occupational and physical therapy
- prescription medications
- social services and social work counseling
- transportation
A specialized team of professionals is brought together to provide the necessary services for your care. This team may include the following:
- dietitian
- driver
- home care liaison
- nurse
- occupational therapist
- PACE center supervisor
- personal caregiver
- physical therapist
- primary care physician
- recreational therapist
- social worker
Services are mainly provided at adult day health centers participating in the PACE program. Those services are supplemented by in-home care and other referral services. These are based on your needs and as directed by the PACE healthcare team.
When you need end-of-life care, the PACE program provides medical, prescription drug, and counseling services. The exception is if you elect to use hospice benefits.
At that point, you’re required to disenroll from the PACE program. You can choose to end your participation in the PACE program at any time for other reasons as well.
Am I eligible for this program?
Enrollment in the PACE program is voluntary. If you’d like to enroll, you must meet specific criteria to be eligible. You must:
- be age 55 or older
- live in a PACE service area
- be certified by your state (through Medicaid) as needing nursing home–level care
- be able to continue living in the community safely with the help of PACE services
As long as you meet these criteria and want to enroll in the PACE program, you aren’t required to be enrolled in Medicare or Medicaid. Plus, financial criteria are not considered when determining your eligibility for a PACE program.
To enroll in a PACE program, however, you can’t already be enrolled in any of the following:
- a Medicare Advantage (Part C) plan
- a Medicare prepayment plan
- a Medicare prescription drug plan
- hospice services
- certain other programs
How much does the PACE program cost?
A monthly premium covers the long-term care portion of the PACE benefit.
You’ll be responsible for paying this premium if you don’t have Medicare or Medicaid. The premium amount will depend on the services you need and your PACE service area.
If you don’t qualify for Medicaid, you’ll also pay a premium for your Medicare Part D medications. But you won’t have to pay any deductibles or copayments for services your PACE care team provides.
How do I enroll?
To enroll in a PACE program, you must meet the criteria mentioned above and any other requirements from your local program. If you decide to enroll, you must agree to provide medical and other personal information that’ll allow your care team to assess your needs and determine which services are required.
Once you sign an enrollment agreement for a PACE program, you’ll receive additional information on what the program covers, how to get services, and plans for emergency care.
When enrolled in PACE, you don’t need to reenroll annually as long as you meet the program’s criteria. You can disenroll from the PACE program at any time.
It’s possible to be dropped from the program as well. Some of the reasons you may be dropped include:
- not paying your PACE premiums
- engaging in disruptive, dangerous, or threatening behaviors that could harm yourself or a caregiver
- moving outside of a PACE service area
- the state no longer contracts your PACE provider to provide care under the program
- you are no longer eligible for services, as determined by the state
Takeaway
PACE is a program for people who need extra medical services in their home or community. You’ll need to meet specific criteria to qualify, continue to prove these needs, and follow any rules set by your local program.
If you qualify for Medicare or Medicaid, these agencies will help pay for the cost of PACE services. You can enroll or disenroll from PACE at any time, regardless of Medicare enrollment periods.-=[‘;