Sometimes, your health care needs might become too much for you to handle alone. If this is the case, know that you are not alone in this. Each year, many seniors begin needing extra care to get by day-to-day, but do not want to go to a nursing home or another similar care facility. Now, you don’t have to. Medicare offers a program called the Medicare PACE program, which allows you to get the health care you need in the community rather than going to a nursing home.
What Is Medicare PACE?
PACE stands for Program of All-Inclusive Care for the Elderly. It is a little-known program that more than 40,000 elders take part in. PACE provides in-home care for seniors. It is completely optional, but a great program for those needing in-depth medical and social services.
With PACE, you have an experienced team dedicated to focusing on you and your health care needs. These teams are composed of a primary care physician, a nurse, a social worker, a physical therapist, an occupational therapist, a recreational therapist or activity coordinator, a dietitian, a home care liaison, and other health care professionals. They work with you and your family to make sure the care that you get is superior. Because you get an entire team, they really get to know you and your specific needs.
PACE might require you to use a PACE-preferred doctor. This is because these doctors are trained specifically for comprehensive medical needs and are well-suited to help you make important health care decisions.
What Does Medicare PACE Cover?
PACE covers a variety of services. These services include, but are not limited to:
- Adult day primary care
- Home care
- Hospital care
- Emergency services
- Physical therapy
- Occupational therapy
- Recreational therapy
- Laboratory/ X-ray services
- Medical specialty services
- Nursing home care
PACE also covers prescription drugs. This means that any of the prescription drugs you need are partially covered under this program. If you want, you do not have to get prescription drug coverage through PACE and can still enroll in Medicare Part D for your coverage. If you choose to enroll in a prescription drug plan, you will be disenrolled from PACE.
PACE covers over-the-counter medications if your PACE team authorizes and includes them in your plan of care.
In addition to medications, PACE provides mental health services. This is included in the program as a way to create a complete package to restore and preserve your well-being. The program contracts mental health specialists to provide these services.
What Are the Income Limits for PACE?
Your financial situation and your qualification for Medicaid determines what you pay for PACE. If you have or qualify for Medicaid, you do not have to pay the monthly premium for the long-term care portion of PACE. However, if you don’t qualify for Medicaid but have Medicare, you will have to pay this monthly premium. Additionally, you will have to pay a premium for prescription drug coverage.
A great aspect about PACE is that there is not copayment or deductible for drugs, services, or care approved by your personalized health care teams. This is all covered under the program if you are eligible.
Who Is Eligible for PACE?
You are eligible for the PACE program if you are:
- 55 or older
- Living in the service area of a PACE center
- In need of a nursing home-level of care
- Able to live safely in the community
PACE might not be available in all states. Once you determine you are eligible, the next step is to find available programs in your area. You can do so by using this tool. Medicare provides this easy-to-use tool to help you quickly look up which programs, if any, you can participate in.
You can also call your local Medicaid office to find out if you are eligible or to search for more PACE plans available in your area.
What If I Don’t Qualify for PACE?
If you do not qualify for PACE but are still looking for a way you can have your copayments and deductibles covered, do not worry. You are still able to get these services covered by enrolling in a Medicare supplement plan.
Certain Medicare supplement plans will cover the portion of costs that Medicare does not cover, in addition to any copayments or deductibles. This is a great option if you need a lot of health care services.
We can help talk you through your PACE eligibility and the possibility of a Medicare supplement plan. To get help today, you can call us at (800) 310-2550 or get a free Medicare supplement quote online.