Medicare and PACE: What you need to know

Living in Chicago, I’ve seen PACE vans all over my South Shore neighborhood. Coming from Rhode Island, I knew about PACE but I didn’t realize they were in so many states! So first off, what is PACE? 

PACE stands for Programs of All-Inclusive Care for the Elderly. It is a dual Medicare and Medicaid program that allows an individual to age in place, remaining at home and still receiving the care they need. Both medical professionals and paraprofessionals provide the care that individuals need. The cost and access to PACE depends on a person’s age, health conditions and finances. 

PACE can provide nursing-home quality care while living at home through the PACE Medicare program. PACE does this by working with a caregiver or family member to develop a customized care regimen. The services available include anything that Medicare and Medicaid will cover, plus a bit more. 

PACE fits with Medicare because it replaces original Medicare including Parts A inpatient hospital insurance and Part B outpatient insurance. PACE can also take the place of Advantage plans, the typical alternative to original Medicare. Although, someone with PACE is not eligible for Medigap - the Medicare supplement insurance. PACE also has Part D coverage. 

So, what does PACE cover? 

• Dentistry

• Lab tests

• Meals and nutrition counseling

• Social services

• Transportation to the PACE center and some medical appointments

• Social work counseling

• Emergency services

• Physical, recreational, and occupational therapy

• Primary care including doctor and nurse services

• Medical specialty services

• Hospital care

• Nursing home care

• Home care

• Preventative care

• Prescription drugs

A patient can stay on PACE despite their health status and if they do need to be moved into long-term care or nursing home, PACE will continue to coordinate care. 

So how much does this cost? 

There are two costs associated with the PACE service. One is for th PACE itself as a monthly long-term care premium and the other is a Part D premium. But they do have a adjustable model where patients pay based on their financial situation. However, it patients qualify for Medicaid, they will not pay the long-term care premium. If ineligible for Medicaid, but enrolled in medicare, a person would pay the long-term care premium, Part D premium and Part B premium for $148.50/month in 2021. 

PACE costs do not cover copayments or deductibles. If someone does not have Medicare or Medicaid, an individual can pay for PACE out of their pocket. 

Who is eligible? 

The best candidates have both Medicare and Medicaid and: 

• Live within a PACE center’s service area

• Be age 55 or older

• Be able to live at home with PACE assistance safely

• Have received state certification that they need nursing home level care

Where can you find PACE? 

PACE is available in 31 states! You can see if your state has PACE via this link.