Who is Eligible for the PACE Program?
PACE Overview:
- PACE is a joint Medicare and Medicaid program that provides a comprehensive range of services to older adults who need a nursing-home level of care but wish to stay in their homes or communities. The program aims to improve the quality of life for participants by offering personalized care and support.
Eligibility Criteria:
- Age: To qualify for PACE, you must be 55 years or older.
- Medical Need: You must be certified by your state as needing a nursing-home level of care. This certification involves an assessment of your medical and functional needs.
- Residence: You must live in a PACE service area. PACE programs are available in many, but not all, areas of the United States. Each PACE organization has specific service areas, so it is important to verify that you live within a covered area.
- Ability to Live Safely: You must be able to live safely in the community with the help of PACE services. The PACE program’s interdisciplinary team will assess whether the services they provide can meet your needs and keep you safe at home.
Services Provided by PACE:
- PACE offers a wide range of medical and social services, including primary and specialty medical care, nursing services, physical and occupational therapy, prescription drugs, nutritional counseling, meals, personal care, and transportation. These services are typically provided at PACE centers, in participants’ homes, or through affiliated providers.
Enrollment Process:
- To enroll in PACE, you must contact your local PACE organization. They will conduct an initial assessment to determine your eligibility and explain the services available. If you meet the eligibility criteria, you will work with the PACE team to develop a personalized care plan that addresses your specific needs.
Cost of PACE:
- PACE is funded by Medicare and Medicaid, and the costs depend on your eligibility for these programs. If you qualify for both Medicare and Medicaid, you will not pay PACE premiums. If you do not qualify for Medicaid, you will pay a monthly premium for the long-term care portion of PACE and a premium for Medicare Part D (prescription drug coverage). There are no deductibles or copayments for services approved by the PACE team.
Benefits of PACE:
- Comprehensive Care: PACE provides all the care and services covered by Medicare and Medicaid, as well as any additional medically necessary care.
- Personalized Care: Care plans are tailored to meet the specific needs of each participant, promoting independence and improving quality of life.
- Team Approach: An interdisciplinary team of healthcare professionals collaborates to develop and implement individualized care plans.
- Community-Based: PACE allows participants to remain in their homes and communities, avoiding the need for institutional care.
Additional Considerations:
- PACE programs emphasize preventive care and proactive management of chronic conditions, which can help reduce hospitalizations and improve overall health outcomes. The goal is to provide holistic care that addresses both medical and social needs.