Part of growing older is realizing that we someday may need help completing the activities of daily living—the basic, yet crucial, tasks required to maintain our independence. Things like bathing, getting dressed, making our own meals, and getting into and out of bed.

At the same time, we also may face a growing list of health concerns that need close attention, coordination, and the ability to frequently travel to and from the doctor’s office or hospital to address. Concerns like diabetes, kidney, and heart disease; taking and keeping track of multiple prescription drugs; surgeries; cognitive decline; and other physical and mental health needs.

“In situations where these things become challenging or impossible to manage on our own, we—and the caregivers we may have in our lives—automatically assume that going into nursing care may be the only option,” explained Ryan Ramsey, Associate Director of Health Coverage and Benefits at NCOA.

But what if there were a way to get all of these needs met right in your own home instead? 

That's where the Program of All-Inclusive Care for the Elderly, also known as PACE, comes in. Whether you or someone under your care is enrolled in a benefit program like Medicare or not, PACE is an option for older adults who require wraparound services that meet all of their daily needs while remaining in their community.

What is a Program of All-Inclusive Care for the Elderly (PACE)?

PACE is a care program covering a variety of needs for older adults who may otherwise be enrolled in nursing home care.¹ A variety of public and private nonprofit organizations offer PACE programs, and The Centers for Medicare and Medicaid Services (CMS) regulate them. In addition to regular meals, transportation and social services, PACE programs provide a comprehensive set of physical health and medical services for older adults who live at home or attend adult day health centers. These include, but aren't limited to, the following:² 

• Dental care
• Emergency services
• Hospital care
• Laboratory work
• Nutrition counseling
• Occupational therapy
• Physical therapy
• Prescription drugs
• Primary care nurses and doctors
• Recreational therapy
• Specialty care
• X-rays

Who is eligible for PACE?

Older adults qualify for PACE if they meet all of the following requirements:¹

• Are age 55 or older
• Live near a PACE program in their state
• Are eligible for nursing home care (according to their state’s Medicaid agency)
• Are living safely in their community

It's important to know that being enrolled in Medicare or Medicaid isn't reqired in order to be eligible for PACE services. However, people who are enrolled in Medicare, Medicaid, or both may not use the following programs if they choose to participate in PACE:³

• Medicaid Home and Community Based Services (HCBS) 1915(c) waivers
• Medicaid prepayment plan
• Medicare Advantage
• Medicare Hospice Benefit
• Medicare prescription drug plan other than Medicare Part D

Once someone joins PACE, the program will provide all of their Medicare- and Medicaid- covered services.⁴ Currently, PACE plans are only available for Medicaid recipients in 33 states and the District of Columbia.⁵ There are 194 PACE programs in the U.S., with 87,750 participants.⁶ PACE programs commonly distinguish themselves by the people they serve; for example, a Dual Eligible PACE or a Medicare Only PACE. Use Medicare’s search tool to find a PACE program near you.    

How do I enroll in PACE?

There are limited spaces available in PACE programs, and teh enrollment process depends on where you live. In general, you can expect that 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.³ This helps PACE staff determine whether you meet your state’s criteria for nursing home care and can safely live in your community. Your assessment also helps PACE staff develop a personalized care plan and figure out how you will pay for services. Participants are free to leave the PACE program at any time.⁴

If you’re denied enrollment, your local PACE program must give you a written reason why and suggest other options for care.³

How much does PACE cost?

The average cost of PACE care can be $4,000 to $5,000 a month for older adults who aren’t enrolled in Medicare or Medicaid.⁷ However, if you’re enrolled in Medicare, then Medicare will pay the costs of its covered services under PACE.⁸

Medicare recipients who are not enrolled in Medicaid are responsible for paying monthly premiums to cover the long-term care part of PACE services as well as and a premium for Medicare Part D drug prescriptions.¹ (Note that you do not need to join a separate Part D drug plan; if you participate in PACE, you will get all of your prescription medications covered by Part D through the program).⁸

Medicaid enrollees will pay either a small monthly fee or nothing at all for PACE’s long-term care benefit.⁸

And if you're not enrolled in Medicare or Medicaid at all, you do have the option to pay for PACE out of pocket.¹

Sources

1. Medicare.gov. PACE. Found on the Internet at https://www.medicare.gov/health-drug-plans/health-plans/your-coverage-options/other-medicare-health-plans/PACE

2. Medicaid.gov. Programs of All-Inclusive Care for the Elderly Benefits. Found on the Internet at https://www.medicaid.gov/medicaid/long-term-services-supports/pace/programs-all-inclusive-care-elderly-benefits/index.html

3. CMS.gov. Programs of All-Inclusive Care for the Elderly (PACE) Chapter 4 – Enrollment and Disenrollment Table of Contents (Rev. 3, Issued: 12-05-23). Found on the Internet at https://www.cms.gov/files/document/pace-chapter-4-12-05-23.pdf

4. Medicaid.gov. Program of All-Inclusive Care for the Elderly. Found on the Internet at https://www.medicaid.gov/medicaid/long-term-services-supports/program-all-inclusive-care-elderly/index.html

5. Medicare.gov. Find a PACE Plan in your area. Found on the Internet at https://www.medicare.gov/plan-compare/#/pace?year=2025&lang=en

6. National Pace Association. Find a PACE Program Near You. Found on the Internet at https://www.npaonline.org/find-a-pace-program

7. MedicaidPlanningAssistance.org. PACE Programs as an Alternative to Nursing Homes for Medicaid Beneficiaries. Found on the Internet at https://www.medicaidplanningassistance.org/medicare-pace-programs/

8. CMS.gov. Quick Facts about Programs of All-inclusive Care for the Elderly (PACE). Found on the Internet at https://www.cms.gov/medicare/health-plans/pace/downloads/externalfactsheet.pdf