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PACE care guide
Last updated: 18 September 2026
PACE can be a strong option when an older adult needs nursing-home level care but may still live safely in the community with help. The tradeoff is important: PACE coordinates medical care, drugs, transportation, home support, and long-term care, but routine care usually must go through the PACE organization and its approved providers.
Bottom Line
PACE is often a good fit for someone age 55 or older who needs a high level of care and wants one team to manage most of it. It may be a poor fit for someone who strongly wants to keep outside doctors, spends long periods away from home, or needs only light help. Check the home ZIP code first, then ask the local program for its provider list, exact monthly cost, and earliest possible enrollment date.
Start Here
- Use the PACE program finder to see whether a program serves the exact home address.
- Ask whether the person appears to meet the four basic tests: age 55+, service area, state nursing-home level of care, and safe community living with PACE help.
- Before signing, get the provider list, premium quote, enrollment start date, drug-transfer plan, and appeal information in writing.
| Situation | PACE fit | First question |
|---|---|---|
| Needs several medical and daily-care services | Often strong | Can one PACE team cover the current needs? |
| Wants to keep outside doctors | Often weak | Are these doctors in your network? |
| Travels or lives elsewhere for months | Often weak | How is out-of-area care handled? |
| Leaving hospital or rehab soon | Worth checking quickly | What is the earliest start date? |
| Needs only light housekeeping | Usually too much | Would home-care services fit better? |
What Has Changed
- PACE has grown: the National PACE Association now lists 204 programs serving more than 97,000 participants in 33 states and the District of Columbia. The May version of this guide listed 202 programs and more than 93,600 participants.
- State resource links are newer: Medicaid.gov published an updated state PACE resource list in July 2026. This can help if the national finder does not clearly show the responsible state office.
The core federal eligibility, cost-sharing, enrollment, service-request, appeal, and voluntary disenrollment rules described below were rechecked for this update.
Urgent Help
PACE enrollment is not an emergency service. Call 911 for a medical emergency. If the person is leaving a hospital or rehab and may not be safe at home, ask the discharge planner to contact the local PACE program and other home-care options at the same time.
If there is no caregiver, food, transportation, or safe support today, contact the Eldercare Locator at 1-800-677-1116. It connects older adults and families with local aging services.
How PACE Works
PACE means Program of All-Inclusive Care for the Elderly. It is a Medicare and Medicaid care model for some people who need nursing-home level care but can still live safely in the community with help. Most participants have both Medicare and Medicaid, but the federal rules also allow enrollment paths for some people who do not have both.
PACE becomes the main system for covered care. A team coordinates primary care, specialists, medicines, therapy, transportation, home care, social services, and long-term care. Medicare says PACE can cover all Medicare- and Medicaid-covered care plus other services the PACE team decides are needed to improve or maintain health. The Medicaid PACE overview explains the same coordinated model.
PACE is not a grant or cash benefit. The program pays for or arranges approved care. If a participant later needs nursing-home care, PACE can arrange facility care as part of the benefit.
Who PACE Fits — and Who It Does Not
PACE may fit well when
- Falls, hospital visits, medicines, rides, therapy, and personal care are getting hard to coordinate.
- The person needs help with bathing, dressing, transfers, meals, toileting, or other daily tasks.
- A family caregiver is overwhelmed by many separate providers and agencies.
- The person is comfortable changing to PACE doctors and approved specialists.
- The family wants one care plan and one team responsible for coordination.
PACE may be a poor fit when
- The person strongly wants to keep doctors or hospitals that are outside the PACE network.
- The household spends long periods outside the PACE service area.
- The main need is companionship, housekeeping, or a few hours of help rather than nursing-home level care.
- The person wants to keep a separate Medicare Advantage or Part D plan instead of moving care into PACE.
If the main decision is where care should happen, compare home care vs assisted living and home care vs nursing home before choosing a path.
Who May Qualify
Medicare lists four basic federal conditions. The person must be at least 55, live in a PACE service area, need nursing-home level care as certified by the state, and be able to live safely in the community with PACE help. The exact nursing-home level-of-care test is set through the state Medicaid system, so details can differ by state.
The federal PACE enrollment rules require the state to assess level of care and the PACE organization to assess safe community living. Intake also includes home and PACE-center visits and an explanation of provider rules, premiums, Medicaid spenddown obligations, and post-eligibility treatment of income when those apply.
If Medicaid is part of the household’s plan, review Medicaid for seniors. If the person has both Medicare and Medicaid, the dual-eligible guide explains how the two programs can work together.
What Services PACE Can Include
PACE may include primary care, hospital care, prescription drugs, dental care, mental health counseling, home care, nursing-home care, personal care, physical and occupational therapy, speech therapy, social services, meals, nutrition counseling, and transportation. The federal PACE benefits page lists the full service categories.
The important word is approved. Routine care generally must be furnished or authorized by PACE. Medicare’s current PACE quick facts says participants must use providers in the PACE organization’s network.
Emergency care is different. CMS rules allow emergency services without prior PACE approval, including care from qualified emergency providers inside or outside the service area. Urgent out-of-area care is more restrictive and generally requires contact with PACE. This is one reason frequent travelers should ask detailed questions before enrolling.
PACE Compared With Other Care Options
| Option | Best fit | Main tradeoff |
|---|---|---|
| PACE | Needs nursing-home level care but may live safely in the community | Strong coordination, less provider freedom |
| Home care | Needs help at home but not a full PACE care system | Family may still coordinate medical care separately |
| Assisted living | Needs housing, meals, supervision, and daily support | Medical care is not automatically all-inclusive |
| Nursing home | Needs 24-hour facility care or cannot live safely in the community | Less independent community living |
For more detail, see assisted living for seniors. Families comparing paid home help can also review agencies vs independent caregivers.
How PACE Costs Work
Medicare says a person with Medicaid does not pay a monthly PACE premium. A Medicare participant without Medicaid may pay a monthly premium for the long-term care part of PACE plus a Part D drug premium. A person without Medicare or Medicaid may be able to enroll by paying privately. Ask the local program for the exact amount before signing.
For any drug, service, or care the PACE team approves, Medicare says there is no deductible, copayment, or coinsurance. That does not mean every participant has a zero monthly cost.
If the participant keeps Medicare Part B, the standard 2026 Part B premium is $202.90 per month; higher-income beneficiaries can pay more. Some people with limited income may get help through Medicare Savings Programs.
| Coverage | PACE premium | Ask before signing |
|---|---|---|
| Medicaid, with or without Medicare | No monthly PACE premium under Medicare’s rule | Does any state Medicaid spenddown or income rule apply? |
| Medicare without Medicaid | Monthly PACE and Part D premiums may apply | What is the full monthly total for this person? |
| No Medicare or Medicaid | Private-pay amount may apply | Does this local PACE accept private pay, and at what price? |
A care-cost estimate can help families compare alternatives before committing. The GFS senior care cost calculator provides a starting point for comparing home care and facility costs by area.
How Enrollment Works
- Check the service area. PACE is local. A program in the same state may not serve the home ZIP code.
- Complete intake. PACE staff review medical, functional, social, and financial information and explain the enrollment agreement.
- Complete assessments. The state determines nursing-home level of care. PACE decides whether the person can be supported safely in the community.
- Review the agreement. Check provider rules, premiums, drug coverage, transportation, after-hours care, and appeal rights.
- Confirm the start date. Under the current PACE start-date rule, enrollment begins on the first day of the calendar month after PACE receives the signed enrollment agreement.
If discharge from a hospital or rehab is close, do not assume PACE can start the same day. Ask what will cover medicines, rides, home care, equipment, and follow-up appointments before the PACE effective date.
How to Start Without Wasting Time
- Ask first: “Do you serve this exact address?”
- Ask whether the program is accepting new participants and how long the assessment process is taking.
- Request the current provider and hospital list before changing coverage.
- Ask for the complete monthly cost in writing.
- Tell the program about current doctors, home-care hours, equipment, dialysis, oxygen, therapy, and recent hospital stays.
- Confirm how prescriptions will transfer on the first day of enrollment.
For free Medicare counseling, use the SHIP locator or call 1-877-839-2675. A SHIP counselor can help a family compare PACE with other Medicare choices without selling a plan.
Document Checklist
- Medicare card and Medicaid card or notice, if applicable.
- Photo ID and proof of home address.
- Current medication list, including nonprescription medicines.
- Recent hospital, rehab, or nursing-facility discharge papers.
- List of doctors, specialists, pharmacies, and home-care agencies.
- Recent care notes showing falls, memory problems, mobility limits, or help needed with daily activities.
- Power of attorney, guardianship, health care proxy, or other representative papers when applicable.
- Recent denial letters, service-cut notices, or bills that may affect the care plan.
Reality Checks
- PACE is not everywhere. Availability can stop at a county or ZIP-code boundary.
- All-inclusive does not mean any provider. Routine care is tied to the PACE network and approvals.
- No copay does not mean no monthly cost. Medicare-only and private-pay participants can owe premiums.
- The start date matters. A signed agreement does not make PACE coverage begin immediately.
- Home is not guaranteed forever. PACE can support community living, but some participants later need facility care.
Common Mistakes to Avoid
- Signing before checking current doctors, hospitals, pharmacies, and specialists.
- Assuming PACE is simply adult day care rather than the main care system.
- Joining a separate Medicare drug plan after PACE starts. Medicare says that causes disenrollment from PACE.
- Paying an outside routine-care bill before asking whether PACE authorized the service.
- Waiting for a verbal answer after a service denial instead of asking for the written decision and appeal instructions.
Denied, Delayed, or Overwhelmed
If enrollment is denied
Ask whether the problem was the state level-of-care test, the safe-community-living test, or missing information. If PACE denies enrollment because community living would jeopardize health or safety, federal rules require a written reason and referral to alternative services.
If a service is denied or reduced
Ask for a service determination. Under current PACE service-request rules, the request must reach the interdisciplinary team as quickly as the person’s condition requires and no later than three calendar days. After the team receives it, the decision and notice are also due as quickly as the condition requires and no later than three calendar days, unless a permitted extension applies.
If the request is denied, partially denied, reduced, or terminated, use the PACE appeal rules. Standard appeals must be resolved as quickly as health requires and no later than 30 calendar days. An expedited appeal is available when delay could seriously jeopardize life, health, or the ability to regain or maintain maximum function; that decision is generally due within 72 hours, subject to a limited allowed extension.
If PACE misses the service-determination timing or fails to provide an approved service, federal rules treat that failure as an adverse decision that must move into the appeal process.
If you want to leave
A participant can leave PACE voluntarily at any time. Under the PACE disenrollment rule, the change is effective on the first day of the month after the organization receives the notice. Plan replacement coverage before the effective date.
Phone Scripts You Can Use
Checking local availability
“I’m calling about PACE for my family member. The ZIP code is [ZIP]. Do you serve this exact address, are you accepting new participants, and what is the first step for an eligibility assessment?”
Calling from hospital or rehab
“My family member may need nursing-home level care but hopes to return home safely. Can the discharge team send records to PACE now, and what is the earliest possible enrollment date?”
Asking about cost
“Before we sign, please give us the full monthly cost in writing, including the PACE premium, drug premium, Part B if it still applies, and any Medicaid spenddown or income rule for this person.”
After a service denial
“Please send the written reason for the decision and the appeal instructions. If waiting could seriously harm health or function, please tell me how to request an expedited appeal today.”
Official Help
- Medicare: call 1-800-MEDICARE at 1-800-633-4227. TTY: 1-877-486-2048.
- State Medicaid: use the state Medicaid contacts for level-of-care and Medicaid questions.
- PACE rules: CMS keeps the current PACE manual with chapters on enrollment, services, rights, and appeals.
- Local aging help: Eldercare Locator can connect a family to the Area Agency on Aging and other services.
Backup Options if PACE Does Not Fit
No PACE program, a failed eligibility assessment, or a network mismatch does not mean there are no other choices.
- Home care: compare paid agency care and independent caregivers if the person can stay home without a full PACE model.
- Assisted living: if housing and daily support are the main problems, review ways to afford assisted living on a limited income.
- Medicaid home services: ask the state Medicaid office about home and community-based services, personal care, adult day services, respite, and other long-term supports.
- Nursing-home care: if the person cannot live safely in the community, ask the discharge planner, Medicaid office, or Area Agency on Aging about facility-care options.
The goal is not to force PACE to fit. It is to choose the care setting that matches the person’s medical needs, daily-care needs, provider preferences, location, and family capacity.
Resumen en Español
PACE es un programa de Medicare y Medicaid para algunas personas de 55 años o más que necesitan un nivel de cuidado parecido al de un hogar de ancianos, pero que todavía pueden vivir con seguridad en la comunidad con ayuda.
PACE puede coordinar médicos, medicinas, terapia, transporte, cuidado en el hogar y cuidado a largo plazo. La principal ventaja es tener un solo equipo. La principal desventaja es que la atención rutinaria normalmente debe pasar por PACE y sus proveedores aprobados.
Antes de inscribirse, confirme que PACE atiende la dirección exacta. Pida por escrito la lista de médicos y hospitales, el costo mensual, la fecha de inicio y las reglas para apelar. Si niegan o reducen un servicio, pida la decisión por escrito y las instrucciones de apelación.
Frequently Asked Questions
Is PACE only for people 65 and older?
No. The federal minimum age is 55. You must also live in a PACE service area, meet your state’s nursing-home level-of-care standard, and be able to live safely in the community with PACE help.
Does joining PACE mean changing doctors?
Usually, yes. PACE becomes the main source of Medicare and Medicaid services for enrolled participants. Routine care generally comes from the PACE network or providers PACE approves. Ask for the current provider list before enrolling.
Is PACE free?
Not for everyone. Medicare says people with Medicaid do not pay a monthly PACE premium. Medicare-only and private-pay participants can owe monthly premiums. Approved PACE care has no deductible, copayment, or coinsurance.
Does PACE cover prescription drugs?
Yes. PACE includes prescription drug coverage. If a Medicare participant joins a separate Medicare drug plan while enrolled in PACE, Medicare says the person will be disenrolled from PACE.
Can a person with dementia join PACE?
Possibly. Dementia by itself does not decide eligibility. The person still must meet the age, service-area, state level-of-care, and safe-community-living requirements.
What if PACE denies a service?
Ask for the written decision and appeal instructions. A participant can appeal a denial, reduction, or termination of a service. If delay could seriously harm health or function, ask for an expedited appeal.
Can a participant leave PACE?
Yes. A participant may voluntarily disenroll at any time. Under the current federal rule, voluntary disenrollment takes effect on the first day of the month after the PACE organization receives the notice.
Is PACE a good fit for frequent travelers?
Often not. Emergency care does not require prior PACE approval, but routine care is network-based and urgent out-of-area care generally requires contact with PACE. Long stays away from the service area can make coordination difficult.
About This Guide
Sources: This guide uses official federal, state, local, and other high-trust nonprofit and community sources linked in the article.
Editorial note
This guide is produced under the GFS Editorial Standards using official and other high-trust sources. GFS is not affiliated with a government agency and is not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Corrections
Despite careful checking, errors may occur. Email info@grantsforseniors.org with corrections.
Disclaimer
This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, funding, and availability can change. Confirm current details directly with the responsible official program before acting.
Last updated: 18 September 2026 · Next review: 18 January 2027
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