PACE Programs (Program of All-Inclusive Care for the Elderly): Who Qualifies and What’s Covered

The Program of All-Inclusive Care for the Elderly (PACE) is a federal–state program that lets clinically frail older adults get comprehensive medical, social, and long-term care while living at home or in the community rather than in a nursing facility.

PACE organizations coordinate everything from primary care and prescription drugs to transportation, home care, and nursing home care when needed—under one integrated plan and team. As of September 2025, PACE operates through more than 188 programs across 33 states and Washington, D.C., reflecting steady national growth.

PACE is uniquely capitated and integrated: programs receive fixed monthly payments to cover all Medicare- and Medicaid-covered services, plus other medically necessary services that an enrollee’s care team approves.

This integrated financing and care model aims to keep participants safer at home, reduce avoidable hospitalizations, and simplify benefits by making the PACE organization your single point of accountability for care. 

Who Qualifies For PACE

To join PACE, you must meet all of the following core eligibility rules at the time you enroll:

• Age: 55 or older.
• Clinical Need: Certified by your state as needing a nursing home level of care (NHLOC).
• Residence: Live in the service area of a PACE organization.
• Safety: Be able to live safely in the community with support from PACE services.

Enrollment is voluntary, and if you qualify you can enroll even if you don’t have Medicare or Medicaid (you can self-pay). Participants can leave at any time and for any reason; PACE must continue services until the disenrollment date, and you must keep using PACE providers and paying any premiums until then.

Key Takeaway: Eligibility hinges on clinical level of care and local availability, not just age. If there’s no PACE in your county, you cannot enroll until a program serves your area.

What PACE Covers (It’s More Than You Think)

PACE covers everything Medicare and Medicaid cover, plus any other medically necessary services your interdisciplinary team (IDT) approves to maintain or improve your health.

Typical benefits include: primary care, specialist visits, hospital and emergency care, home care, adult day health at a PACE center, physical/occupational therapy, dental, vision/hearing, meals/nutrition counseling, social work, and transportation to medical appointments and the PACE center. 

Prescription drugs (Part D) are built into PACE; if you try to join a separate drug plan, you’ll be disenrolled from PACE. 

PACE services are delivered and coordinated by an Interdisciplinary Team—at minimum including a primary care provider, registered nurse, master’s-level social worker, PT/OT, dietitian, recreational therapy/activity, home-care coordinator, center manager, personal care aide representative, and driver—who assess, plan, and adjust your care regularly. 

Good To Know: Nursing home care is included whenever the team determines it’s necessary. Emergency and urgently needed care are covered; out-of-area urgent/emergency services can be reimbursed under program rules. 

PACE At A Glance (Eligibility, Coverage, Costs)

Category	What To Know (2025)
Who Qualifies	55+, nursing home level of care, live in a PACE service area, can live safely in the community with PACE supports.
Coverage Scope	All Medicare & Medicaid services + any other medically necessary services your IDT approves (e.g., Part D drugs, home care, transportation, adult day health, dental/vision/hearing).
Network Rules	You use PACE network providers; enrolling in a separate Part D plan causes PACE disenrollment.
Costs (Medicaid Eligible)	No monthly premium for the long-term care portion.
Costs (Medicare-Only)	You pay a monthly premium for the long-term care portion + a Part D premium through PACE; no deductibles or copays for approved services.
Financing Model	PACE is capitation-based: programs receive fixed monthly payments (Medicare & Medicaid for duals) to cover comprehensive care.
Where Available	More than 188 programs in 33 states + DC (availability is local by service area).
Disenrollment	You can leave anytime; program continues services and you continue using PACE providers until disenrollment takes effect.

How PACE Works Day-To-Day

1. Assessment & Care Plan: After enrollment, the IDT completes a full assessment across medical, functional, and social domains. They create a single care plan tailored to your goals and update it routinely or when your health changes.
2. PACE Center & Home Supports: Most participants regularly attend an adult day health center for primary care, therapies, activities, and meals, while also receiving home-based services as needed. Transportation is coordinated by the program.
3. Medication & Specialists: Your medications come through PACE (Part D built-in). The team coordinates specialist visits, imaging, and hospital transitions.
4. 24/7 Coverage: PACE manages urgent needs and post-acute transitions. In 2025, CMS finalized tighter timelines for PACE organizations to review recommendations and schedule services, including 24-hour pharmacy scheduling for new medication orders and seven-day scheduling for other approved services.

What PACE Costs (And Why Many Pay Little Or Nothing)

PACE simplifies costs by bundling all covered care. The basics for 2025:

• If you have Medicaid (or Medicare + Medicaid), you typically pay no monthly premium for the long-term care portion of PACE. Some states may apply a Medicaid share of cost for certain individuals, but copays and deductibles do not apply for services the team approves. 
• If you have Medicare only, you’ll pay a monthly premium for the long-term care portion plus a Part D premium through PACE; again, there are no copays or deductibles for approved services. 
• If you have neither Medicare nor Medicaid, you can self-pay a program-set monthly amount to get the full PACE benefit package.

Behind the scenes, PACE is financed by monthly capitation: for dually eligible participants, programs receive two payments (Medicare + Medicaid) and take on the full financial risk for your care.

This value-based design is intended to align incentives around prevention, coordination, and home-based supports rather than fee-for-service volume. 

2025 Policy Updates You Should Know

• Final Rule, Effective 2025 Coverage: CMS’s 2024 Final Rule (effective June 3, 2024, applying to coverage beginning Jan. 1, 2025) tightened application review standards, added immunization requirements for staff with direct participant contact, and set deadlines for how quickly PACE must review hospital/ED/urgent recommendations and schedule services (e.g., review hospital/ED recommendations within 48 hours of discharge). It also updated the grievance process and timelines.
• Medicaid Capitation Guidance (Effective Jan. 1, 2025): CMS released an updated PACE Medicaid Capitation Rate Setting Guide to help states and actuaries set sound, documented rates—part of ongoing standardization as PACE expands. 

PACE Vs. Other Medicare Options (In Plain English)

• PACE vs. Medicare Advantage (MA): MA plans cover Medicare benefits and may add extras, but don’t include Medicaid long-term services in the same fully integrated way. PACE integrates medical, behavioral, social, and long-term care under one accountable program and includes Part D—with no copays/deductibles for approved services. Note: You can’t keep a separate Part D or MA plan while in PACE.
• PACE vs. Traditional Medicare + Medicaid Waivers: Traditional arrangements often mean multiple providers, separate authorizations, and cost-sharing rules. PACE consolidates care decisions and financing under your IDT, with responsibility to deliver the services you need. 

How To Enroll (And When You Can Start)

1. Check Local Availability: Confirm that your home address is inside a PACE service area (availability is county/ZIP based). 
2. Clinical Screen: The state (or its designee) must certify you meet nursing home level of care. 
3. PACE Intake & IDT Evaluation: The PACE team completes an in-person assessment and designs an initial plan. 
4. Enrollment & Start Date: Enrollment is voluntary and year-round; once enrolled, PACE becomes your sole source for Medicare and/or Medicaid services (except emergencies), and you must use PACE network providers. You may disenroll at any time (effective the first day of the following month).

What PACE Doesn’t Cover (Practically Speaking)

• Out-of-network services you get without PACE authorization (non-emergency) are generally not covered.
• Separate Part D plans are not allowed—enrolling in one will disenroll you from PACE.
• Room and board costs in a nursing facility may be handled by Medicaid if you’re eligible; otherwise, you could face private-pay obligations—discuss specifics with the local PACE program.

Real-World Fit: Who Benefits Most

PACE is often a good match if you or a loved one is 55+, has multiple chronic conditions or functional limitations, prefers to remain at home, and would benefit from frequent touchpoints at a day center plus coordinated home supports.

PACE’s transportation, medication management, therapy, respite, and social engagement can reduce caregiver strain and improve safety—while the no-copay model (for approved services) removes financial surprises. As of September 2025, the sector’s continued growth signals that more communities are gaining access. 

PACE is one of the most comprehensive, person-centered options for older adults who meet nursing home level of care yet want to remain at home with intense supports.

In 2025, with more than 188 programs operating in 33 states + DC, and with new CMS rules reinforcing timeliness and quality, PACE offers all-inclusive benefits, integrated care planning, and predictable costs—often no premiums for the long-term care portion if you’re Medicaid-eligible, and no copays/deductibles for approved services.

If PACE serves your area and you meet the criteria, it’s worth a serious look for safety, independence, and coordination under one roof.

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