As people age, they may require more health care yet become less equipped to care for themselves. If this is true of one of your loved ones, it could be time to help them transition to a senior living community or nursing home. However, some people are uncomfortable with the idea of moving into a facility and may prefer to receive health care and social support nearby — or in their home.
Depending on their zip code, individuals in need of nursing home-level care may qualify for the Program of All-Inclusive Care for the Elderly, a Medicare and Medicaid program that supports older adults’ health and wellness while they continue to live at home and within the community, rather than a nursing home. PACE offers a wide array of services that can be individualized to your loved one’s needs and that may include a combination of meetings with doctors, physical therapists and occupational therapists as well as social gatherings, meals and enrichment activities.
If you’re considering whether PACE is a good fit for your loved one, start by familiarizing yourself with the program’s offerings, talking to your loved one and their doctor about their needs — and preferences — and checking to see if there is a PACE location near you.
[What Is a Skilled Nursing Facility vs. a Nursing Home?]
What Is PACE?
Like its name implies, PACE is a program that offers all-inclusive care to older adults. These offerings range from medical supports and services to social events and meals.
Most of PACE’s services are provided at a local PACE center, which serves patients who live within designated boundaries. However, in-home support services, such as having a PACE worker tend to a patient in their house or apartment, are common too. For patients coming to the center, PACE provides transportation for added safety and convenience.
PACE is unique in the way it centralizes its services in the PACE center and in how it allows nursing-home eligible older adults to continue to live at home.
“It’s all under one roof — literally under one pay center,” says Dr. Esiquio Casillas, chief medical officer for AltaMed Health Services Program for All-Inclusive Care for the Elderly, who is based in Los Angeles. “There’s a real benefit in co-location of all the services in one place, where normally if you’re in a traditional Medicare plan, it is really piecemeal.”
He adds that PACE is an attractive option for seniors who “don’t want to be permanently in a nursing home,” but require extra services to maintain their health and independence.
[Read: Senior Home Care: Services, Costs and Tips for Aging in Place]
PACE Coverage
PACE provides patients with medical, wellness and social services. Financially, it will cover all services already covered by Medicaid and Medicare, plus other services that your team decides will benefit your health.
PACE may cover services including:
— Doctor’s and dentist’s visits, including preventive care
— Therapy services, such as recreational, physical and occupational therapy
— Emergency services
— Home care
— Hospital care
— Nursing home care
— Imaging and diagnostic tests
— Meals and nutritional counseling
— Counseling
— Transportation to the PACE center for activities or medical appointments
Casillas says that patients who participate in PACE’s social offerings — including activities like arts and crafts or eating meals with other patients at the center — tend to feel more appreciative of and fulfilled by the program.
“They feel like it’s an extended part of their family because they go so often there,” Casillas says. “I do think that’s one of the unique ‘secret sauces’ of the program: Co-locating that socialization at the same place that they get their doctor visits really makes it a meaningful place for them.”
Socialization isn’t just a mood-booster either. Casillas says it can have huge impacts on patients’ mental, cognitive and physical well-being.
In 2023, former U.S. Surgeon General Vivek H. Murthy released an advisory on the health risks of social isolation, in which he highlights that loneliness and isolation have “comparable levels of risk to health and premature death,” and says that, among older adults, social isolation can have a greater effect on hypertension risk than other major clinical risk factors, such as diabetes.
“There’s a whole new awareness of social isolation causing a lot of risk to frail seniors,” Casillas says.
How Much Does PACE Cost?
How much you pay for PACE will depend on what health plan you’re enrolled in before you join.
For instance, if you are on Medicaid or a combination of Medicaid and Medicare with no share of the cost, you won’t pay extra for PACE. If you are on Medicaid or a combination of Medicaid and Medicare with share of the cost, you will pay your share of the cost but not otherwise pay extra for PACE.
If you only have Medicare, you will have to pay a little extra for PACE — you will need to pay monthly premiums for PACE’s long-term care services and for Medicare Part D drugs.
If you are not on Medicaid or Medicare, you will have to pay for PACE yourself out of pocket. According to the American Council on Aging, the average monthly premium can range from $4,000 to $5,000.
Does PACE have income limits?
There are no income limits for joining PACE. However, there are income limits for joining Medicaid, which can influence how much you pay for PACE. Exact limits can vary based on the state you live in and may change over time.
Who Is Eligible for PACE?
Adults must meet the following requirements to be eligible for PACE:
— Be age 55 or older
— Be certified by their state as needing a nursing-home level of care, which may require them to display certain chronic conditions and/or dysfunctional limitations, such as having trouble walking or opening medications by themselves
— Be able to safely live in their community (with PACE’s assistance)
— Be located within a PACE service area
— Not be enrolled in certain other programs including hospice services
PACE Enrollment Timeline
PACE offers enrollment opportunities on a monthly basis. This sign-up structure may increase accessibility for some patients, especially if they’ve struggled to meet annual enrollment deadlines with other health plans. Despite this, PACE enrollment isn’t always quick or easy.
Because patients must be certified as nursing-home eligible before they can join the program, Casillas says prospective enrollees typically undergo a few weeks of waiting before starting PACE. This waiting period can consist of clinical assessments from state workers and visits from PACE team members. In some places, PACE programs may also have a waitlist, which may delay enrollment.
Barriers to PACE
Certain barriers may prevent your loved one from joining PACE, even if you feel they are eligible for the program. A big one is location.
PACE is not currently available in every state or in every zip code within the states it serves. And — due to restrictions such as time limits for how long patients can be in transportation vehicles — PACE service areas can be tightly limited to neighborhoods around the center. As of March 2025, there are 184 PACE organizations across the country, which operate in 33 states and the District of Columbia.
How to Know If PACE Is Right for You?
If your loved one is unsure whether or not to enroll in PACE, consider having an open conversation about their health needs and visiting a nearby center.
“Ask if they are overwhelmed having to coordinate all of their many appointments and if they are more interested in receiving all of their services through one site,” suggests Monica Macias-Garcia, director of PACE at CalOptima Health in Orange, California. “Someone who prefers to manage their own care and who doesn’t have a lot of chronic illnesses may not benefit as much from PACE.”
For those with lingering questions, Casillas says the best course of action is to visit a center near you to see services in person and in action.
“It’s good to be aware and to be exposed to that environment (to see) whether they feel like it’s something they fit into,” Casillas says. Encourage them to ask detailed questions about the value-added aspects — from a rehab and long-term care perspective — that may be beneficial for them, he says.
Casillas adds that some visitors may leave a visit feeling like it’s a place where they can fit into, whereas others may feel that they do not need such a high level of support. If your loved one feels that they do not need so much support, that could be a sign that PACE isn’t right for them at this point in time.
It could also be an opportunity for the two of you to have a conversation about what kind of support they may need down the line — and to think about whether or not joining PACE now could help them prepare to tackle future health declines.
“The family and patients should acknowledge some of the realistic, expected declines in the coming years,” Casillas says. “Anticipate those functional supports with caregivers or therapy that they may need.”
You’ll want to not only think about what these future needs are, but how much they cost. For instance, if your loved one is becoming increasingly reliant on rehab, they may be shelling out a lot of money on treatment copays with another health plan. If they join PACE, they will not have a copay for rehab.
Additionally, Casillas says it can help to remember that while some patients visit the PACE center multiple times a week, others come in more sparingly. With the guidance of their doctors, your loved one would be able to personalize their plan to fit their needs.
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