- PACE provides medical and social services for people with significant needs who want to continue living at home.
- The program is a combined effort between Medicare and Medicaid.
- People eligible for PACE are usually dual eligible for Medicare and Medicaid.
- To enroll in the program, you must meet specific criteria and live in a PACE service area.
The Program of All-Inclusive Care for the Elderly (PACE) offers support for people who wish to live at home but require a certain level of consistent medical care. Many of those enrolled in PACE are dual eligible for Medicare and Medicaid, and these organizations work together to offer this program.
PACE covers several services, as long as you live within one of its service areas and meet specific criteria to qualify. Keep reading to find out what services are covered, how to qualify, and more.
PACE was created for people who need help managing their health but live in a private residence rather than in a skilled nursing facility. You must have certain needs to qualify for the program, and most PACE participants are already dual eligible for both Medicare and Medicaid.
Medicare and Medicaid work together to offer PACE services, which are provided across the country by local care teams. The PACE team assesses your needs that can be met within your own community.
PACE is a public program that can help you get the medical and social support you need without a lot of extra costs and without leaving home. The program covers all the services available under Medicare and Medicaid — and more.
A few examples of these services include:
- adult day care
- dental care
- help with meals and nutrition
- home care
- occupational and physical therapy
- prescription medications
- social services and social work counseling
A specialized team of professionals is brought together to provide the necessary services for your care. This team may include a:
- home care liaison
- occupational therapist
- PACE center supervisor
- personal caregiver
- physical therapist
- primary care physician
- recreational therapist
- social worker
Services are mainly provided at adult day health centers that participate in the PACE program. Those services are supplemented by in-home care and other referral services. These are based on your needs and as directed by the PACE healthcare team.
When you need end-of-life care, the PACE program provides all your medical, prescription drug, and counseling services. The exception is if you elect to use hospice benefits.
At that point, you’re required to disenroll from the PACE program. You can choose to end your participation in the PACE program at any point for other reasons as well.
Enrollment in the PACE program is voluntary. If you’d like to enroll, you must meet specific criteria to be eligible. You must:
- be age 55 or older
- live in a PACE service area
- be certified by your state (through Medicaid) as needing nursing home–level care
- be able to continue living in the community safely with the help of PACE services
As long as you meet these criteria and want to enroll in the PACE program, you aren’t required to be enrolled in Medicare or Medicaid. Plus, there are no financial criteria considered in determining your eligibility for a PACE program.
To enroll in a PACE program, however, you can’t already be enrolled in any of the following:
- a Medicare Advantage (Part C) plan
- a Medicare prepayment plan
- a Medicare prescription drug plan
- hospice services
- certain other programs
There is a monthly premium that covers the long-term care portion of the PACE benefit.
If you don’t have Medicare or Medicaid, you’ll be responsible for paying this premium. The premium amount will depend on the services you need and your PACE service area.
If you don’t qualify for Medicaid, you’ll also pay a premium for your Medicare Part D medications. But you won’t have to pay any deductibles or copayments for services provided by your PACE care team.
To enroll in a PACE program, you have to meet the criteria mentioned above, plus any other requirements from your local program. If you decide to enroll, you must agree to provide medical and other personal information that’ll allow your care team to assess your needs and determine which services are required.
Once you sign an enrollment agreement for a PACE program, you’ll receive additional information on what the program covers, how to get services, and plans for emergency care.
When you’re enrolled in PACE, you don’t need to reenroll annually, as long as you continue to meet the program’s criteria. You can disenroll from the PACE program at any time.
It’s possible to be dropped from the program as well. Some of the reasons you may be dropped include:
- not paying your PACE premiums
- engaging in disruptive, dangerous, or threatening behaviors that could harm yourself or a caregiver
- moving outside of a PACE service area
- your PACE provider no longer being contracted by the state to provide care under the program
- no longer being eligible for services, as determined by the state
- PACE is a program for people who need extra medical services in their home or community.
- You’ll need to meet specific criteria to qualify, continue to prove these needs, and follow any rules set by your local program.
- If you qualify for Medicare or Medicaid, these agencies will help pay for the cost of PACE services.
- You can enroll or disenroll from PACE at any time, regardless of Medicare enrollment periods.
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