Medicare PACE is not a source of funds for paying for senior care. Rather, it is an optional program that covers all of a participating senior’s medical needs as well as some personal care. The program is open to both Medicare and Medicaid beneficiaries. It provides comprehensive medical and social services at home, adult day health centers, and inpatient facilities as an alternative for those who would otherwise need nursing home care.
All of a patient’s medical needs are determined and provided by a set group of medical service providers. This includes medications and medically-necessary transportation.
This model of care is sometimes referred to as Managed Care at Home, and in certain states, PACE Programs are called LIFE Programs. PACE is an acronym for Programs of All-inclusive Care for the Elderly, and LIFE is an acronym for Living Independence for the Elderly.
Pros & Cons of Medicare PACE and LIFE Programs
PACE programs are intended for families that wish to have the care recipient live at home instead of in a skilled nursing home / facility. Participating families are expected to provide some personal care themselves and not rely entirely on the program for 24-hour care. But if a PACE program can no longer safely support the care of an enrolled participant at home or in adult day care, the program will pay for care in a skilled nursing home.
PACE programs are a very good option for families that are able to provide some level of care. Unfortunately, as of July 2022, PACE programs were not available nationwide. Currently, there are PACE / LIFE Programs at 273 locations spread through 30 states. Another drawback to this program is that seniors must give up their primary care physician to enroll in the program. Finally, in some areas it can take many months to apply and have the application processed before enrollment.
Did You Know? Almost 50% of individuals enrolled in PACE have a diagnosis of dementia?
States with PACE/LIFE Programs
The following is a list of states with PACE / LIFE programs. Of the states that do have PACE / LIFE programs, each of these states has at least one such program. That said, there may not be programs available statewide.
States with PACE / LIFE Programs
- Alabama
- Arkansas
- California
- Colorado
- Delaware
- Florida
- Indiana
- Iowa
- Kansas
- Louisiana
- Maryland
- Massachusetts
- Michigan
- Nebraska
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- Tennessee
- Texas
- Virginia
- Washington
- Wisconsin
Program Benefits and Services
PACE/LIFE Programs are designed to provide all of a participating senior’s medical and personal care needs.
Program benefits come only in the form of medical and care services. Seniors do not receive cash payments. Benefits are determined on a case-by-case basis, are provided by a dedicated team of healthcare professionals, and can include any of the following.
- Adult Day Care / Adult Day Health
- Audiology
- Cardiology
- Chores
- Dentistry
- Durable Medical Equipment (Wheelchairs, walkers, hospital beds)
- Emergency Services
- Home Care
- Hospital Care
- Laboratory/X-ray Services/Radiology
- Meals
- Medical Transportation/Non-Medical Transportation
- Nursing Home Care
- Nutritional Counseling
- Optometry
- Outpatient Surgery
- Personal Care
- Physical Therapy
- Podiatry
- Prescription Drugs / Medications
- Primary Care
- Recreational Therapy
- Respite Care
- Rheumatology
- Skilled Nursing
- Social Services
- Social Work Counseling
- Women’s Services
PACE Programs and Assisted Living
PACE programs do not pay for assisted living in a traditional sense. But persons residing in assisted living communities can still receive care services paid for by PACE. To clarify, a PACE program would treat an individual residing in an assisted living community the same as a person living at home. PACE would arrange daytime transportation to take the individual to and from an adult day care center. This could greatly reduce the amount of care services provided by the assisted living community (and thus their fees). However, PACE will not pay for the room and board in assisted living.
Program Costs
PACE/LIFE Programs are possibly the most cost-effective form of long-term care available in the U.S.
PACE / LIFE programs receive monthly payments from Medicare or Medicaid. Participating seniors do not make payments to the PACE program. If a participant qualifies for Medicaid, there is no monthly premium for long term care. Seniors that are not Medicaid eligible, but have Medicare, will pay a monthly premium, but do not have deductibles or copayments. For persons who do not have Medicaid or Medicare, benefits and services are still available via private pay.
How to Apply for PACE / LIFE Programs
Persons can apply for the PACE or LIFE Program with the individual, regional PACE providers. Click here for a list. For more information about PACE Policy, please visit the National PACE Association website.
While there are many positives to these programs, an unfortunate reality is the application process can require patience and perseverance. For some programs in certain areas, the application and approval process can take as long as nine months. This is by no means the case everywhere, but applicants and their families should be aware of this possibility.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
