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What Is the Medicare Pace Program?

Sometimes, your health care needs might become too much for you to handle on your own. If this is the case for you, know that you aren’t alone, and that you have options outside of moving to an assisted living facility. With Medicare PACE, you can get the health care you need in your community, rather than going to a nursing home.

What Is Medicare PACE?

PACE stands for Program of All-Inclusive Care for the Elderly. It’s a little-known program that more than 40,000 people age 55 or older take part in. PACE provides in-home care, and can help you get in-depth medical and social services.

With PACE, you have an experienced team dedicated to focusing on you and your healthcare 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 ensure that the care that you get is top-notch.

Before you enroll, you should know that PACE might require you to use a PACE-preferred doctor. This is because these doctors are trained specially 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 aren’t limited to:

  • Adult day primary care
  • Dentistry
  • Home care
  • Hospital care
  • Emergency services
  • Physical therapy
  • Occupational therapy
  • Recreational therapy
  • Mental health services
  • Laboratory/ X-ray services
  • Meals
  • Medical specialty services
  • Nursing home care

PACE also covers your prescription medications. Keep in mind that if you enroll in a Medicare Part D Prescription Drug plan anyways, you’ll be disenrolled from PACE. In addition to your prescriptions, PACE also pays for some over-the-counter medications if your PACE team authorizes and includes them in your plan of care.

How Much Does Pace Cost?

Your financial situation and your qualification for Medicaid determines what you pay for PACE. If you have or qualify for Medicaid, you don’t have to pay a monthly premium for the long-term care portion of PACE. However, if you don’t qualify for Medicaid but have Medicare, you’ll have to pay a monthly premium. Additionally, you’ll have to pay a premium for prescription drug coverage.

When you receive treatment through PACE, there’s no copayment or deductible for drugs, services, or care approved by your personalized health care teams. It’s all covered under the program.

Who Is Eligible for PACE?

You’re 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 as stated by the state
  • Able to live safely in your community

PACE isn’t available in all states. If you think you’re eligible, you can search to see if there are programs available in your area on Medicare’s website. Medicare provides an easy-to-use tool to help you view PACE programs by state.

You can also call your local Medicaid office to determine if you’re eligible or for help finding PACE plans available in your area.

What If I Don’t Qualify for PACE?

If you don’t qualify for PACE but still need help with the costs left over from Original Medicare, you have options. A Medicare Supplement plan can help you control your expenses, and in general, has a broader doctor network than the PACE program. Medicare Supplement plans are standardized and categorized by coverage, so you have the option to choose the plan that will work best for your needs.

If you need the level of care that a nursing home offers, but aren’t ready to leave your own home, PACE may be the solution that you’re looking for. You’d receive treatment and support from a team of professionals that are dedicated to your mental and physical wellbeing. PACE may not be entirely free for you, but it can reduce your costs and significantly improve your quality of life.

Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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