5 Top Questions about Pace Medicare 2019
1.What is PACE?
Medicaid defines PACE as a program that:
“Provides comprehensive medical and social services to certain frail, community-dwelling elderly individuals, most of whom are eligible for Medicare and Medicaid benefits.
An interdisciplinary team of health professionals provides PACE participants with coordinated care.”
The PACE program allows patients who require a nursing home level of care to live at home and the caregiver to get paid for caring for their loved one at home.
PACE Programs and Assisted Living
PACE programs do not pay for assisted living in a traditional sense, but persons residing in assisted living communities can still receive care services paid for by PACE. To clarify, a PACE program would treat an individual residing in an assisted living community the same as a person living at home. PACE would arrange daytime transportation to take the individual to and from an adult day care center. This could greatly reduce the amount of care services provided by the assisted living community (and therefore their fees). However, PACE will not pay for the room and board in assisted living.
What PACE provides to the patient?
PACE provides transportation to and from the center for the day care, doctor appointments, transportation to any specialists outside the center, or to diagnostic testing (i.e. MRI, CT scan centers, etc.,) complete with a CNA attendant to accompany them on the van or bus.
PACE covers dental and vision as well and all medicines.
Which States offer PACE Medicare?
You can use this PACE Plan Search to see if your state offers the PACE program. It’s important to note that even within states that offer the program, some zip codes are not eligible.
Who is eligible for PACE Medicare?
Program Eligibility:
To be eligible for PACE, an individual must:
- Be 55 years of age or older
- Live within the defined service area of the PACE Center
- Meet medical eligibility requirements as determined by CARES
- Be able to live safely in the community
- Be dually eligible for Medicaid and Medicare, or Medicaid only. There is also a private pay option with PACE, however this is not regulated by the State.
On average, Medicare and Medicaid pay PACE providers $76,728 a person a year, about $5,500 less than the average cost of a nursing home. And the money going to PACE covers all of the person’s health and social needs, unlike nursing home care, which doesn’t include hospitalizations and other expensive medical care.
5. How to apply for PACE
To find out if you’re eligible and if there’s a PACE program near you, search for PACE plans in your area, or call your Medicaid office.
6. How much does PACE cost?
If a senior has Medicaid, they won’t have to pay a monthly premium for the long-term care portion of the PACE benefit.
If a senior doesn’t qualify for Medicaid, but does have Medicare, they’ll pay a monthly premium to cover the long-term care portion of the PACE benefit and a premium for Medicare Part D drugs.
If a senior doesn’t have Medicare or Medicaid, they can pay for PACE privately.
With the PACE program, there are no co-pays, deductibles, or coverage gaps. But seniors may have to pay out-of-pocket for any care received outside the program that isn’t approved by their PACE healthcare team.
Mintco Financial Medicare Advisors WNY and Florida
If you have questions about Medicare Enrollment and Medicare Plans please contact us at
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