For seniors who need a nursing-home level of care but want to keep living at home, few programs are built around that goal as directly as PACE — the Program of All-Inclusive Care for the Elderly.
Here’s what it provides, who qualifies, what it costs, and how to enroll.
At a Glance
- What it is: A joint Medicare/Medicaid program combining medical care and daily support under one team
- Who qualifies: Age 55+, living in a PACE service area, meeting your state’s nursing-home-level-of-care standard
- Availability: Not everywhere — depends on local PACE organizations
- Big tradeoff: You give up your current doctor and other Medicare plans; PACE becomes your sole provider
- Cost: Often little to nothing if you have both Medicare and Medicaid
What Is PACE?
PACE provides comprehensive medical and social services to older adults who meet their state’s criteria for nursing-home-level care — but who can still live safely in the community with the right support.
Instead of juggling a primary care doctor, specialists, a pharmacy, and a home care agency separately, PACE participants get care through one interdisciplinary team, usually based out of a local PACE center.
The model started in San Francisco’s Chinatown–North Beach neighborhood in the 1970s and has since expanded to dozens of states — though it’s still not available everywhere, since each PACE organization only serves a defined local area.
How It Works Day to Day
Each PACE organization runs one or more PACE centers, typically including:
- A primary care clinic
- An adult day center
- Rehab therapy space (physical, occupational, speech therapy)
- Social and recreational activities
Participants attend the center on a schedule that fits their needs — sometimes several days a week — while still living at home the rest of the time. The care team, which typically includes physicians, nurses, social workers, therapists, dietitians, and personal care aides, meets regularly to coordinate everything.
What’s Included
One thing that sets PACE apart: it takes on full financial and clinical responsibility for nearly all of a participant’s care, rather than covering pieces separately. That typically includes:
- Primary and specialty medical care
- Prescription drugs
- Hospital care, when needed
- Nursing home care, if it becomes necessary
- Home care and personal care assistance
- Adult day care
- Transportation to the center and medical appointments
- Physical, occupational, and speech therapy
- Nutritional counseling and meals
- Social work services
- Dental, vision, and hearing services, in many programs
Because PACE providers are on the hook financially for all necessary care — including a hospital stay, if one happens — the program has a real incentive to invest in prevention and coordination that keeps people healthy and at home.
Who’s Eligible?
To qualify, you generally need to:
- Be age 55 or older
- Live in a PACE organization’s service area
- Meet your state’s standard for needing nursing-home-level care, based on an assessment
- Be able to live safely in the community with PACE’s help at the time you enroll
You don’t have to be dual-eligible for Medicare and Medicaid to qualify — though your cost and enrollment structure will differ depending on your coverage status.
What It Costs
- Eligible for both Medicare and Medicaid? You typically pay little to nothing out of pocket.
- Medicare only (no Medicaid)? You’ll generally pay a monthly premium for the Medicaid-covered portion of PACE, plus a Part D premium if you don’t already have drug coverage. There’s typically no deductible or copay for PACE-covered services either way.
- Neither Medicare nor Medicaid? Paying privately is possible in some cases, though less common.
Because the numbers vary, get a specific cost breakdown from the local PACE organization based on your own coverage.
Is It Available Where You Live?
Not necessarily. PACE organizations only operate in defined service areas, so availability depends heavily on your location. It’s expanded a lot but is still more concentrated in some states and regions than others.
Check Medicare.gov’s PACE locator tool or your state Medicaid office — new service areas are added over time.
How PACE Compares to Other Options
- Vs. a nursing home: PACE lets you stay home while still getting a comparable level of coordinated medical oversight.
- Vs. arranging home care privately: PACE consolidates everything — medical care, therapy, transportation, meals, social support — under one team and one point of contact, instead of piecing it together yourself.
- Vs. Medicaid HCBS waivers: These offer more a la carte support, without PACE’s single fully integrated team.
- Vs. assisted living: Assisted living provides housing plus some services, but generally not the same depth of ongoing medical coordination.
PACE isn’t a fit for everyone. You need to be willing and able to attend the center on a regular schedule, and enrolling means switching your primary care to the PACE team.
How to Apply
There’s no single national application — enrollment happens directly through the PACE organization serving your area.
- Find the PACE organization near you. Use Medicare.gov’s locator tool or contact your state Medicaid office.
- Contact them directly. An intake or enrollment coordinator will walk you through eligibility and next steps.
- Complete a level-of-care assessment. Usually done in person by a nurse or team member, to confirm you meet your state’s nursing-home-level-of-care standard and can be safely supported at home.
- Provide documentation. Proof of age, residency in the service area, and current Medicare/Medicaid coverage.
- Meet the care team. Many organizations have the team meet with you (and family, if involved) to review your health needs before finalizing enrollment.
- Sign enrollment agreements. This includes agreeing to get all primary and specialty care through PACE, and disenrolling from any current Medicare Advantage, Part D, or Medicaid managed care plan.
- Begin care. Most organizations start quickly, with a full health assessment and an initial care plan.
Because enrolling means giving up your current Medicare Advantage or Part D plan, use that first intake conversation to ask specifically about your current medications, specialists, and any ongoing treatments — so the team can confirm continuity of care before you commit. Some PACE programs also have limited enrollment capacity, so ask about current wait times when you first reach out.
Frequently Asked Questions
Can I keep my own doctor? No. PACE requires you to get primary care through its interdisciplinary team, since the model depends on that team managing all aspects of your care.
What if I need a nursing home stay while enrolled? PACE covers it. Many participants who need temporary nursing home care during a health crisis return home and resume regular PACE services once stabilized.
Can I leave PACE if it’s not working out? Yes. Enrollment is voluntary — you can disenroll at any time and return to standard Medicare and Medicaid coverage.
Is PACE the same as hospice? No. It’s a comprehensive care and coordination program, not end-of-life care specifically — though PACE teams do coordinate hospice and palliative care for participants who need it.
The Bottom Line
PACE offers one of the most comprehensive models available for seniors who qualify for nursing-home-level care but want to stay home — combining medical care, therapy, transportation, and social support under one coordinated team. Since availability depends on your location and the details vary by coverage status, checking Medicare.gov’s locator tool or your state Medicaid office is the fastest way to find out if it’s an option for you.
By Henry Rojas –