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
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 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
- 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.
- 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.
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.
In Virginia, you can also 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 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.