Background and Overview
The Program of All-Inclusive Care for the Elderly (PACE) was developed in the early 1970s, beginning as a pilot program in San Francisco aimed at providing an alternative to costly nursing home placements for older adults. Now operating nationally under the Centers for Medicare & Medicaid Services (CMS), PACE integrates medical, social, and long-term care services through a coordinated approach tailored to each participant’s needs.
How PACE Works
PACE is delivered through provider organizations called PACE programs or centers. An interdisciplinary team of healthcare professionals—including doctors, nurses, social workers, therapists, and nutritionists—assesses each participant and develops a personalized care plan. Participants typically attend a PACE center for services but can also receive home visits and transportation assistance.
PACE covers nearly all services that Medicare and Medicaid usually provide, plus extra supportive services not generally included in traditional plans, such as meals, social activities, and counseling. This holistic care model assists seniors in maintaining their health, preventing hospitalizations, and supporting daily living.
Eligibility Criteria
Seniors interested in joining PACE must meet several criteria:
- Be 55 years or older
- Live within a PACE program’s service area
- Be certified by their state as needing nursing home-level care
- Be able to safely live in the community with PACE support
Financial Benefits and Cost Structure
PACE offers financial predictability by bundling almost all healthcare and support services into one program with a fixed monthly premium. For Medicaid beneficiaries, costs may be minimal or none. Medicare enrollees generally pay standard Medicare premiums and cost-sharing. By reducing hospital visits and delaying or avoiding nursing home placement, PACE helps preserve seniors’ savings and assets.
This financial structure simplifies budgeting for seniors and their families, removing many unexpected healthcare costs common with traditional insurance.
Real-Life Example
Mrs. Johnson, an 82-year-old with diabetes and mobility challenges, benefits from PACE by receiving coordinated medical care, home nursing visits, medication management, meals, and transportation. This support allows her to live independently at home rather than moving to a nursing facility.
Tips for Seniors and Caregivers
- Verify if PACE programs operate in your state or local area, as availability is limited.
- Get a thorough care needs assessment early to understand eligibility.
- Explore combining PACE with Medicaid planning for comprehensive financial protection.
- Visit a PACE center to learn firsthand about services and costs.
Common Misconceptions
- PACE is only for low-income seniors: Income eligibility varies; many seniors qualify based on medical needs regardless of income.
- Participants lose control over their care: PACE emphasizes active involvement of participants in planning and decisions.
- PACE covers only medical services: It also covers social supports, meals, transportation, and counseling.
Frequently Asked Questions
Q: Does PACE cost anything?
A: Costs depend on income and coverage. Medicaid participants often pay little or nothing; Medicare enrollees pay standard premiums and coinsurance.
Q: Can PACE participants see their own doctors?
A: PACE prefers participants use their network for coordinated care, but some programs may allow outside providers.
Q: Can participants leave the program?
A: Yes, enrollment is voluntary and can be ended at any time.
Summary Table
| Feature | Details |
|---|---|
| Eligibility | 55+, nursing home level care need, local service area |
| Covered Services | Medical care, social supports, home care, transportation, meals, medications |
| Cost | Varies by Medicaid/Medicare eligibility; often low or no cost for Medicaid participants |
| Goal | Allow seniors to live safely and independently at home |
| Program Type | Funded by Medicare and Medicaid |
| Enrollment | Voluntary; participants can withdraw anytime |
Additional Resources
Understanding PACE can significantly impact financial and healthcare planning for seniors, offering a comprehensive, coordinated approach that promotes independence while managing costs effectively.
