What is a PACE Plan?

Medicaid PACE

If you're eligible for Medicare and Medicaid, you may qualify for PACE

If you are eligible for both Medicare and Medicaid health care coverage (also known as dual-eligible) then you may be able to qualify for the Programs of All Inclusive Care for the Elder – also known simply as PACE – plan. PACE is a program of managed care benefits that features a comprehensive medical and social delivery system.

This program’s services include, but are not limited to, all Medicare and Medicaid services, including hospitalization. In addition, there are also some added items that must be provided by PACE, such as social services, restorative therapies, personal care, nutritional counseling, supportive services, recreational therapy, and even meals.

What are Medicare PACE Plans and How Do They Work?

The Programs of All Inclusive Care for the Elderly (PACE) offers coverage for a wide range of services. These include visits to a doctor and / or other health care practitioners, prescription medications, home health care, hospital visits, transportation, and even a stay in a nursing home facility if needed.

Because comprehensive care is provided to PACE participants, those who require end-of-life care such as hospice will typically be eligible to receive the appropriate medical, pharmaceutical, and psychosocial services through the PACE program.

However, if a PACE enrollee wishes to receive end-of-life care through a certified hospice facility, then he or she will need to dis-enroll from the PACE program. In this case, though, the PACE organization would still work with the individual’s state administering agency, as well as the Centers for Medicare and Medicaid Services, in order to facilitate the election of the hospice benefit.

How Much Does It Cost to Join a PACE Plan?

If you are already enrolled in Medicaid, then you won’t be required to pay a monthly premium for the long-term care portion of the PACE program. If, however, you are enrolled in Medicare, but not in Medicaid, you will be charged a monthly premium for your PACE long-term care services. You will also be charged a premium for Medicare Part D prescription drug benefits.

In any case, however, for those who are enrolled in the PACE program, there are no deductibles or copayments that are required for any service, prescription medication, or care that is approved for you by the PACE team of health care professionals.

Do You Qualify for the Programs of All Inclusive Care for the Elderly?

In order to qualify for a PACE plan, it is required that you meet the following conditions:

  1. You are age 55 or older
  2. You reside in the service area of a PACE organization (this means that you live within a geographic area where a health insurance plan accepts members)
  3. It is certified by your state that you require a nursing home level of care, and
  4. At the time you enroll in the PACE plan, you are able to safely reside in the community with the assistance of PACE plan services.5

Want to Learn More About the PACE Health Care Program?

If you have any additional questions regarding the Programs of All Inclusive Care for the Elderly and/or if you would like to find out if you qualify, and how to apply for these benefits, you can contact Medicare directly by phone, toll-free at 1-800-633-4227 (1-800-MEDICARE).

Sources

1. PACE Fact Sheet. https://www.cms.gov/Medicare/Health-Plans/pace/downloads/PACEFactSheet.pdf
2. Medicare and You 2018. https://www.medicare.gov/pubs/pdf/10050-Medicare-and-You.pdf