Quick Facts about Programs of All-Inclusive Care for the Elderly (PACE)
What are Programs of All-inclusive Care for the Elderly (PACE)?
PACE is a Medicare program and Medicaid state option that provides community-based care and services to people age 55 or older who otherwise would need a nursing home level of care. PACE was created as a way to provide you, your family, caregivers, and professional health care providers flexibility to meet your health care needs and to help you continue living in the community.
A team of health care professionals will give you the coordinated care you need. These professionals are also experts in working with older people. They will work together with you and your family (if appropriate) to develop your most effective plan of care.
PACE provides all the care and services covered by Medicare and Medicaid, as authorized by the health care team. They also cover additional medically-necessary care and services not covered by Medicare and Medicaid that the team may decide you need. PACE provides coverage for prescription drugs, doctor care, transportation, home care, checkups, hospital visits, and nursing home stays when necessary.
Who can join PACE?
You can join PACE if you meet the following conditions:
•You’re 55 years old or older.
•You live in the service area of a PACE organization.
•You’re certified by the state in which you live as needing a nursing home level of care.
•You would be able to live safely in the community if you get PACE services.
Note:You can leave a PACE program at any time.
PACE services include (but aren’t limited to) the following:
•Adult Day Care
•Primary Care (including doctor and nursing services)
•Medical Specialty Services
•Nursing Home Care
•Social Work Counseling
PACE also includes all other services that are available in your area and determined necessary by your team of health care professionals to improve and maintain your overall health.
What do I need to know about PACE?
PACE Provides Comprehensive Care
PACE uses Medicare and Medicaid funds to cover all of your medically-necessary care and services. You can have either Medicare or Medicaid, or both, to join PACE. You can also pay for PACE privately, if you do not have Medicare or Medicaid.
The Focus is on You
You have a team of health care professionals to help you make health care decisions. Your team is experienced in caring for people like you. Usually they care for a small number of people. That way, they get to know you, what your living situation is, and your preferences. You and your family participate as the team develops and updates your plan of care and your goals in the program. When you enroll in PACE, you may be required to use a PACE preferred physician. These physicians are best suited to help you make health care decisions.
PACE Covers Prescription Drugs
PACE organizations offer Medicare prescription drug coverage (Part D). If you join a PACE program, you’ll get your Part D-covered drugs and all other necessary medication from the PACE program.
Note:If you’re in a PACE program, you don’t need to join a separate Medicare drug plan. If you do, you will be disenrolled from your PACE health and prescription drug benefits.
What do I need to know about PACE? (continued)
PACE Supports Family Caregivers
PACE organizations support your family members and other caregivers with care giving training, support groups, and respite care to help families keep their loved ones in the community.
PACE Provides Services in the Community
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 and include adult day programs, primary care from physicians and nurses, activities, and occupational and physical therapy facilities.
Preventive Care is Covered and Encouraged
Every PACE organization is focused on helping you live in the community for as long as possible. To meet this goal, PACE organizations focus on preventive care.
PACE Provides Medical Transportation
PACE organizations provide all medically-necessary transportation to the PACE center for activities or medical appointments. You may also be able to get transportation to some medical appointments in the community.
What You Pay for PACE Depends on Your Financial Situation
If you have Medicaid, you will not have to 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 will be charged a monthly premium to cover the long-term care portion of the PACE benefit and a premium for Medicare Part D drugs. However, in PACE there is never a deductible or copayment for any drug, service, or care approved by the PACE team.
For more information about PACE:
•Visit www.npaonline.org. This Web site is sponsored by the National PACE Association and provides information about the PACE program and what’s covered.
•Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048