PACE: All-in-One Care That Helps Seniors Stay Home
Many older adults who need daily help want to stay in their own homes, not move to a nursing home. PACE, the Program of All-Inclusive Care for the Elderly, is built for that. One team handles your doctor visits, therapy, medications, home care and rides, and for people with Medicaid there's no monthly premium. Here's who can join, what it covers, what it costs, and the trade-offs to understand before you sign up.
AT A GLANCE
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What PACE is
Medicare.gov describes PACE as a Medicare and/or Medicaid program of medical and social services, available in some states. It helps eligible older adults who need nursing home-level care meet those needs in the community, with coordinated care and support, instead of going to a nursing home or other care facility.
Medicaid.gov adds that most PACE participants are dually eligible for Medicare and Medicaid. It says that for most participants, the full service package lets them remain in the community rather than receive care in a nursing home.
The key idea is that one organization is responsible for all of your care. When you join, PACE becomes your single source of Medicare and Medicaid services. A team of health professionals plans your care and coordinates it around your medical, physical, social and emotional needs and preferences.
PACE covers all Medicare- and Medicaid-covered care and services, and anything else your PACE team decides you need to improve and maintain your health.
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Who can join
Medicare.gov lists four conditions. Federal rules at 42 CFR 460.150 set out the same requirements in more detail.
Requirement | What it means |
|---|---|
Age | You must be 55 or older |
Where you live | You must live in the service area of a PACE organization |
Level of care | The state must determine that you need the level of care the state Medicaid plan requires for nursing facility services |
Safety at home | At the time you enroll, you must be able to live in a community setting without putting your health or safety at risk |
Program conditions | A PACE program can add its own eligibility conditions, but these can't change the age, care-level or service-area rules |
You don't need Medicaid or Medicare to join
Under 42 CFR 460.150(d), PACE isn't limited to people on Medicare or Medicaid. You may have Medicare Part A, Part B, Medicaid, all of them, or none of them. What changes is how much you pay, which is covered below.
The state checks your care needs
Being 55 or older isn't enough. The state agency that runs PACE must assess you, even if you aren't eligible for Medicaid, to confirm you need a nursing facility level of care. PACE staff also assess whether you can be cared for safely in the community.
If you're turned down because living in the community would put your health or safety at risk, the PACE organization must tell you the reason in writing and refer you to other services as appropriate.
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What PACE covers
Your PACE team can approve any service you need to improve and maintain your health, so the list isn't fixed. Medicare.gov lists these as services PACE may cover:
Adult day primary care, including meals, special diets and recreational therapy
Primary care, including doctor and nursing services
Prescription drugs
Dentistry
Emergency services
Home care and personal care
Hospital care
Nursing home care when medically necessary
Lab work and X-rays
Medical specialty services
Mental health counseling
Nutritional counseling
Physical, occupational and speech therapy
Preventive care
Social services
Transportation to and from the PACE center and medical appointments
Your care team
Under 42 CFR 460.102, the interdisciplinary team must include people who fill at least these roles:
Primary care provider
Registered nurse
Master's-level social worker
Physical therapist
Occupational therapist
Recreational therapist or activity coordinator
Dietitian
PACE center manager
Home care coordinator
Personal care attendant, or their representative
Driver, or their representative
The PACE center
Every PACE organization must run at least one PACE center in or next to its service area. At a minimum, each center has to offer primary care and nursing, social services, physical and occupational therapy, personal care, nutritional counseling, recreational therapy and meals. Your team decides how often you go to the center, based on your needs and preferences.
Care isn't limited to the center. Federal rules require services in at least the PACE center, your home and inpatient facilities, around the clock, every day of the year.
How fast services must happen
42 CFR 460.98 sets deadlines for the PACE organization:
Service | Deadline |
|---|---|
Medications | Dispensing must be arranged no later than 24 hours after a primary care provider orders it |
Other team-approved services | Must be arranged or scheduled no later than 7 calendar days after the team or a team member approves it |
Routine or preventive care | Can take longer only if the organization documents it couldn't schedule the visit for reasons beyond its control, your condition hasn't changed, and the care is given as soon as your condition requires |
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What PACE costs
What you pay depends on whether you have Medicaid and which parts of Medicare you have.
Your coverage | Monthly premium |
|---|---|
Medicaid only, or both Medicare and Medicaid | None. PACE can't charge you a premium. |
Medicare Part A and Part B, no Medicaid | Equal to the Medicaid capitation amount |
Medicare Part A only, no Medicaid | Medicaid capitation amount plus the Medicare Part B capitation rate |
Medicare Part B only, no Medicaid | Medicaid capitation amount plus the Medicare Part A capitation rate |
No Medicare or Medicaid | You can pay the PACE premium yourself |
Medicare.gov says people with Medicare but not Medicaid also pay a premium for Part D drugs. Either way, you won't have a deductible, copayment or coinsurance for any drug, service or care your PACE team approves.
A note for Medicaid members
No premium doesn't always mean you pay nothing. The enrollment agreement must explain that Medicaid members aren't liable for premiums but may owe any applicable Medicaid spenddown and any amount due under what's called post-eligibility treatment of income. States can apply that process to PACE the same way they do for home and community-based waiver services. Ask the PACE staff to explain both in dollars before you sign.
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The trade-offs to understand
PACE changes how you get care. These points come from the enrollment rules in 42 CFR 460.152 and 460.154.
One provider for everything. The PACE organization becomes your sole service provider. It guarantees access to services, but not to a specific provider.
Your other plans end. Joining PACE ends your enrollment in any other Medicare or Medicaid prepayment plan or optional benefit.
Drug plans. You get Part D drugs and other medication from PACE. Medicare.gov warns that joining a separate Medicare drug plan while in PACE disenrolls you from PACE.
Hospice. Electing another Medicare or Medicaid plan or optional benefit, including the hospice benefit, after joining counts as leaving PACE.
Moving or long trips. You must tell the PACE organization about a move or a long absence from the service area.
Not through Social Security. A Medicare participant can't enroll in or leave PACE at a Social Security office.
Before you enroll, PACE staff must visit your home at least once, and you visit the center at least once. They must explain the enrollment agreement, give you a list of their staff and contracted providers, and explain any premium, spenddown or post-eligibility income obligations.
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Staying in PACE, or leaving
Enrollment continues until death, regardless of changes in your health, unless you leave voluntarily or are disenrolled.
Yearly check. At least once a year, the state reviews whether you still need a nursing facility level of care. The state can permanently waive this review if your condition isn't expected to improve. If the state finds you no longer meet the standard, you may still be treated as eligible until the next annual review if you'd reasonably be expected to meet it again within 6 months without PACE.
Leaving on your own. You can leave at any time without giving a reason. It takes effect on the first day of the month after the PACE organization gets your notice. The organization can't steer you to leave because your health changed.
Being disenrolled. Reasons include:
Not paying a premium, spenddown or post-eligibility amount after a 30-day grace period
Disruptive or threatening behavior, as defined in the rules
Moving away, or being out of the service area for more than 30 consecutive days unless the organization agrees to a longer absence
No longer meeting the care-level standard and not being treated as eligible
The program's agreement ending, or the organization losing licenses or contracts it needs
A PACE organization can't disenroll you for missing appointments or not following medical advice if that behavior is related to a mental or physical condition, unless it puts your safety or others' safety at risk. The state must review any involuntary disenrollment before it takes effect. It takes effect on the first day of the next month that begins 30 days after the organization sends notice.
Your checklist
☐ Search Medicare.gov for PACE plans in your area, or call your Medicaid office
☐ Confirm the address you live at is inside the program's service area
☐ Ask for the state's level-of-care assessment
☐ Ask the PACE staff to explain any premium, spenddown or post-eligibility amount in writing
☐ List the doctors you see now and ask whether they're on the PACE provider list
☐ Hold off on joining any separate Medicare drug plan
WHAT TO DO THIS WEEK
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More help
Related guides
Official sources
Last checked: October 30, 2026. Program basics, covered services, costs and how to apply come from Medicare.gov and Medicaid.gov. Eligibility, the care team, service deadlines, premiums, enrollment and disenrollment come from 42 CFR 460.92, 460.98, 460.102, 460.150, 460.152, 460.154, 460.160, 460.162, 460.164, 460.184 and 460.186.
This is general information, not legal or medical advice. Your state and the PACE organization make the final decisions about eligibility and costs.
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