PACE (Program of All-inclusive Care for the Elderly) 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. PACE is a community-based alternative to institutional long-term care. Rather than pay for services in institutions, Medicare and Medicaid funds the medically-necessary care and services - transportation, health care, home-health aides, etc. - to help program participants stay at home. The goal of the program is to keep people living at home as long as possible.
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 PACE participants 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. 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 (by the appropriate State agency)
- 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 healthcare team. If your healthcare team decides you need care and services that Medicare and Medicaid don'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*
- Preventive care
- 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.
*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.
How to apply for PACE
Contact Virginia's Department of Medical Assistance (Medicaid) program to find out if you qualify for a PACE program near you.
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 a monthly premium to cover the long-term care portion of the PACE benefit and a premium for Medicare Part D drugs.
There's no deductible or co-payment for any drug, service, or care approved by your healthcare team.
If you don't have Medicare or Medicaid, you can pay for PACE privately.
To see if there is a PACE Center near you, visit VirginiaNavigator and, type PACE in the 'What do you need?' box, and then either your 'Zip' or 'City/County'.