Programs for All-inclusive Care of the Elderly (PACE) is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other care facility.
With PACE, the focus is on you — you have a team of health care professionals working with you and your family to make sure you get the coordinated care you need. Your team is experienced in caring for people like you. Usually they care for a small number of people, so they really get to know you.
When you enroll in PACE, you may be required to use a PACE-preferred doctor. These doctors are best suited to help you make health care decisions.
How does PACE work?
PACE organizations provide care and services in the home, the community, and the PACE center. They have contracts with many specialists and other providers in the community to make sure that you get the care you need. Many people in PACE get most of their care from staff employed by the PACE organization in the PACE center. PACE centers meet state and federal safety requirements.
Who can get PACE?
You can have either Medicare or Medicaid, or both, to join PACE. PACE is only available in some states that offer PACE under Medicaid. To qualify for PACE, you must:
- Be 55 or older
- Live in the service area of a PACE organization
- Need a nursing home-level of care (as certified by your state)
- Be able to live safely in the community with help from PACE
Note: You can leave a PACE program at any time.
What does PACE cover?
PACE provides all the care and services covered by Medicare and Medicaid if authorized by your health care team. If your health care team decides you need care and services that Medicare and Medicaid doesn’t cover, PACE may still cover them.
Here are some of the services PACE covers:
- Adult day primary care (including doctor and recreational therapy nursing services)
- Emergency services
- Home care
- Hospital care
- Laboratory/x-ray services
- Medical specialty services
- Nursing home care
- Nutritional counseling
- Occupational therapy
- Physical therapy
- Prescription drugs
Note: If you join a PACE program, you’ll get your Part D-covered drugs and all other necessary medication from the PACE program. You don’t need to join a separate Medicare Prescription Drug Plan. If you do, you’ll be disenrolled from your PACE health and prescription drug benefits.
Social services, including caregiver training, support groups, and respite care
Social work counseling
Transportation to the PACE center for activities or medical appointments, if medically necessary . You may also be able to get transportation to some medical appointments in the community.
How to apply for PACE
To find out if you’re eligible and if there’s a PACE program near you, search for PACE plans in your area, or call your Medicaid office.
What you pay for PACE depends on your financial situation
If you have Medicaid, you won’t pay a monthly premium for the long-term care portion of the PACE benefit.
If you don’t qualify for Medicaid but you have Medicare, you’ll be charged these:
- A monthly premium to cover the long-term care portion of the PACE benefit
- A premium for Medicare Part D drugs
There’s no deductible or copayment for any drug, service, or care approved by your health care team.
If you don’t have Medicare or Medicaid, you can pay for PACE privately.
If you need legal advice in managing an estate, trust, other elder law issue or veteran’s benefits, the Law Office of Scott C. Painter can help. We specialize in elder law issues ranging from nursing home planning, guardianship, wills, trusts, estates, veteran’s benefits, and other related legal matters. Attorney Scott Painter is CELA® certified under the National Elder Law Foundation (NELF).
A call to us is free, and the best advice is to act now to educate yourself about your options. Waiting to seek legal counsel may limit your options and be costly. Call now for your free consultation 610-378-5140 or visit https://painterelderlawpc.com/ for more information.