Stay Home Instead of a Nursing Home: The PACE Program

If you or a loved one is aging and needs the level of care that would normally require a nursing home, the Program of All-Inclusive Care for the Elderly (PACE) offers a powerful alternative: a comprehensive package of medical, social, and supportive services designed to keep you living safely in your own home and community for as long as possible. PACE covers everything—doctor visits, hospital care, prescription drugs, physical therapy, dental care, home health aides, adult day services, meals, transportation, and more—all coordinated by a single interdisciplinary care team that knows you personally.

For most PACE participants who qualify for both Medicare and Medicaid, the program costs nothing out of pocket. No copays. No deductibles. No surprise bills. Everything is included. The program currently operates through approximately 160 PACE organizations across 32 states, serving over 70,000 participants at more than 300 PACE centers. It is one of the most comprehensive benefit programs in the United States, yet most people who could benefit from it have never heard of it.

Opportunity Snapshot

What PACE Actually Covers

PACE is not a limited benefit that covers a few doctor visits. It is an all-inclusive care model that wraps around every aspect of a participant’s health and daily living needs. Here is what is typically included:

Medical care: Primary care physician visits, specialist referrals, hospital care (inpatient and outpatient), emergency services, laboratory and diagnostic services, and preventive care.

Prescription drugs: All medications are covered, usually dispensed through the PACE center’s pharmacy or delivered to your home. No separate Part D plan is needed, and there are no formulary restrictions in the traditional sense—if the care team determines you need a medication, it is covered.

Adult day health center: Most PACE participants attend the PACE center several days per week for socialization, supervised activities, exercise programs, meals, health monitoring, and therapy sessions. The center serves as the hub of the program and provides a safe, engaging environment during the day.

Home care: Personal care aides who help with bathing, dressing, grooming, meal preparation, and light housekeeping. The level of home care is tailored to your assessed needs and can range from a few hours per week to daily assistance.

Therapy services: Physical therapy, occupational therapy, speech therapy, and recreational therapy, provided at the PACE center, in your home, or at partner facilities.

Dental care: Preventive and restorative dental services including cleanings, fillings, extractions, and dentures. Dental care is notoriously difficult for seniors to access, and PACE’s inclusion of comprehensive dental services is a major advantage.

Transportation: Free door-to-door transportation to and from the PACE center, medical appointments, pharmacy visits, and other program-related activities. For participants who cannot drive or lack reliable transportation, this is often the most immediately valuable service.

Social services and counseling: Social workers who help with care planning, family support, benefit enrollment, housing issues, legal referrals, and emotional support. The social work team coordinates with the medical team to address the full picture of your needs.

Hospital and nursing facility care: If you need hospitalization or short-term nursing facility care, PACE covers it completely. The care team manages the transition and ensures continuity when you return home.

Home modifications: Minor modifications to your home to accommodate disabilities or safety concerns, such as grab bars, ramp installations, or bathroom modifications.

Meals and nutrition: Meals at the PACE center, home-delivered meals, and nutrition counseling from registered dietitians.

Who Qualifies for PACE

PACE eligibility is based on four criteria:

Age: You must be 55 years of age or older. While the program is called “Program of All-Inclusive Care for the Elderly,” the minimum age is 55, not 65. Adults in their late 50s with significant care needs can qualify.

Nursing-home eligibility: Your state must certify that you need a nursing-home level of care. This determination is made by a state assessment team and is based on your functional limitations, medical conditions, and care needs. Typically, this means you need help with multiple activities of daily living (bathing, dressing, eating, transferring, toileting) or have cognitive impairments that require supervision.

Service area residence: You must live within the service area of a PACE organization. PACE programs serve defined geographic areas, and you must reside within that area. Not all areas of the country have PACE programs yet, though the number is growing.

Community safety: At the time of enrollment, you must be able to live safely in the community with the support of PACE services. If your needs are so acute that you require 24-hour institutional care immediately, you may need to stabilize before enrolling. However, PACE serves very frail individuals—the average participant has seven or more medical conditions and needs help with three or more activities of daily living.

How Much PACE Costs

If you qualify for both Medicare and Medicaid (dual-eligible): You pay nothing. Medicare and Medicaid together cover the full PACE capitation payment. There are no copays, deductibles, or premiums for any PACE-covered service.

If you have Medicare but not Medicaid: You pay a monthly premium to the PACE organization equal to the Medicaid capitation rate for your state (this varies but is typically several thousand dollars per month). You may also owe a premium for PACE’s prescription drug coverage. While this sounds expensive, it covers absolutely everything—it replaces Medicare Advantage premiums, Medigap premiums, Part D premiums, and all out-of-pocket costs. For some individuals, the total cost may be comparable to or less than what they would pay for a combination of traditional Medicare, supplemental insurance, and long-term care services.

If you have neither Medicare nor Medicaid: You can still enroll in PACE, but you are responsible for the full cost of the program, which is substantial. This situation is rare, as most people aged 55+ who are nursing-home eligible qualify for at least one of these programs.

Medicaid spend-down: If your income is too high for Medicaid but you cannot afford the full PACE premium, you may qualify for Medicaid through a medically needy spend-down or special income level in your state. PACE social workers can help you navigate this process.

How PACE Works Day-to-Day

A typical week for a PACE participant might look like this:

Monday: A PACE van picks you up at 8:30 AM and takes you to the PACE center. You have breakfast, attend a physical therapy session, participate in a social activity, eat lunch, see a nurse for a blood pressure check, and are driven home by 3:00 PM.

Tuesday: A home health aide comes to your home for two hours to help with bathing, laundry, and meal preparation.

Wednesday: Another day at the PACE center with an occupational therapy session, a visit with the PACE physician to adjust your medications, and a group exercise class.

Thursday: You stay home. A meals-on-wheels delivery brings a hot lunch. You have a telehealth check-in with the PACE nurse.

Friday: Back at the center for dental cleaning, social activities, and a meeting with your social worker to discuss upcoming home modifications.

The frequency and intensity of services vary based on your individual care plan, which is developed by the interdisciplinary team and updated regularly. Some participants attend the center five days per week; others come two or three days. The plan adapts as your needs change.

How to Enroll in PACE

Step 1: Find a PACE program near you. Use the Medicare PACE plan finder at medicare.gov or contact the National PACE Association at npaonline.org to search for programs by state and zip code. You can also call 1-800-MEDICARE (1-800-633-4227) for assistance.

Step 2: Contact the PACE organization. Call the program directly to express interest. They will explain their specific enrollment process, service area boundaries, and current availability.

Step 3: Complete an assessment. The PACE organization will conduct an in-home assessment and coordinate with the state to determine your nursing-home eligibility. This assessment evaluates your medical conditions, functional limitations, cognitive status, social support, and living environment.

Step 4: Tour the PACE center. Visit the center to see the facilities, meet staff, observe activities, and ask questions. This is your opportunity to determine whether PACE feels like the right fit.

Step 5: Enroll and develop your care plan. Once eligibility is confirmed and you decide to enroll, the interdisciplinary team develops your individualized care plan. Services typically begin within a few weeks of enrollment.

Step 6: Ongoing participation. PACE is an ongoing program with no fixed end date. You remain enrolled as long as you continue to meet eligibility criteria and choose to participate. The care team regularly reassesses your needs and adjusts services accordingly.

Key Considerations Before Enrolling

You must use PACE providers. When you enroll in PACE, you agree to receive all care through the PACE program. Your PACE physician becomes your primary care provider, and the program manages all specialist referrals and hospitalizations. This means you may need to change doctors. For some people, this is the biggest hesitation about enrolling. However, PACE physicians and teams develop deep knowledge of each participant, providing highly personalized care.

PACE replaces Medicare Advantage and Part D. If you are enrolled in a Medicare Advantage plan or standalone Part D prescription drug plan, you will disenroll from those when you join PACE. PACE covers everything those plans cover and more.

Not all areas have PACE programs. PACE is growing but is not yet available everywhere. Rural areas, in particular, have fewer PACE options, though the PACE Innovation Act and rural PACE grants are working to expand access.

Waitlists may exist. Some PACE programs have limited capacity and may maintain waitlists. If this is the case, get on the list early and explore interim services through your state’s Medicaid home and community-based services waivers.

Why PACE Matters

The alternative to PACE for most participants is institutional nursing home care, which costs an average of $8,000 to $10,000 per month in the United States. Nursing homes are appropriate for some individuals, but many frail seniors prefer to remain in their own homes and communities. PACE makes this possible by bringing comprehensive, coordinated services to participants wherever they are—at home, at the PACE center, or in a healthcare facility.

Research consistently shows that PACE participants have fewer hospitalizations, fewer emergency room visits, better functional outcomes, lower rates of depression, and higher satisfaction with care compared to similar populations in nursing homes or receiving fragmented community services. The program’s all-inclusive financing model eliminates the perverse incentives that fragment care in fee-for-service medicine, allowing the care team to focus entirely on what is best for each participant.

For family caregivers, PACE provides enormous relief. The program’s adult day services, home care, and transportation reduce the burden on family members who may be struggling to provide care while working or managing their own health challenges. The PACE social work team also supports caregivers directly with respite planning, counseling, and resource referrals.

Frequently Asked Questions

Can I leave PACE if I change my mind? Yes. You can disenroll from PACE at any time by notifying the PACE organization. Your disenrollment takes effect the first day of the month after you provide notice. You would then return to traditional Medicare, Medicare Advantage, or other coverage options.

What if I need a nursing home permanently? If your condition deteriorates to the point where you need permanent nursing home care, PACE covers it. You remain a PACE participant and the program pays for your nursing facility care.

Does PACE cover vision and hearing? Many PACE programs cover eye exams, glasses, hearing assessments, and hearing aids. Coverage varies by program, so ask your local PACE organization about specific benefits.

Can my spouse enroll in PACE too? Your spouse can enroll if they independently meet the eligibility criteria (age 55+, nursing-home eligible, living in the service area). Each person is enrolled separately.

Is PACE the same as Medicare Advantage? No. PACE is a separate Medicare program type that provides much more comprehensive services than typical Medicare Advantage plans, including long-term care services that Medicare Advantage does not cover.

Get Started

• Visit medicare.gov and search for PACE plans in your area
• Call 1-800-MEDICARE (1-800-633-4227) for help finding PACE programs
• Visit the National PACE Association at npaonline.org for program listings
• Contact your local Area Agency on Aging at 1-800-677-1116 for referrals

PACE is one of the most generous and comprehensive benefit programs available to older Americans, yet it remains one of the least known. If you or a loved one is struggling to manage multiple health conditions, needing help with daily activities, and hoping to avoid a nursing home, PACE may be exactly the solution you have been looking for.