PACE Program
Program of All-inclusive Care for the Elderly — a comprehensive managed care program for dual-eligible Medicare/Medicaid seniors that integrates all medical and long-term care services through a single provider.
PACE (Program of All-inclusive Care for the Elderly) is a capitated managed care benefit that covers all Medicare and Medicaid services for participants who are 55+, certified by their state as needing nursing-home-level care, and able to live safely in the community. As of 2024, PACE serves approximately 68,000 participants in 32 states through 175 programs.
A PACE organization receives a monthly capitated payment from both Medicare and Medicaid for each participant (totaling $6,000–$10,000/month in most markets) and in return provides all needed care: primary and specialty medical care, prescription drugs, dental, vision, hearing, physical/occupational/speech therapy, adult day health center attendance, in-home care, and nursing facility placement if needed — all coordinated by an interdisciplinary team.
For families, PACE offers the security of comprehensive coverage with an experienced interdisciplinary care team managing all aspects of a frail elder's health. For dual-eligible participants (both Medicare and Medicaid), PACE costs nothing out-of-pocket beyond Medicare and Medicaid cost-sharing. Medicare-only participants who do not qualify for Medicaid pay a monthly premium for the long-term care component.
Real-World Example
An 82-year-old with congestive heart failure, diabetes, and moderate dementia enrolled in PACE; her PACE team coordinated all her medications, specialist visits, home health aide hours, adult day center attendance 4 days/week, and two SNF stays for acute episodes — under a single care plan with no separate billing or insurance claims.