Understanding PACE Costs: It's Not One-Size-Fits-All
The cost of the Program of All-Inclusive Care for the Elderly (PACE) is determined by your eligibility for Medicare and Medicaid. This approach makes comprehensive care accessible for seniors needing a nursing home level of care but wanting to stay home. For most, this means no deductibles or copayments for approved services.
The Cost for Dually Eligible Participants (Medicare & Medicaid)
Most PACE participants qualify for both Medicare and Medicaid, resulting in minimal or no cost for core services.
- Monthly Premium: Dually eligible individuals typically do not pay a monthly premium for the long-term care benefit.
- Other Payments: While most services are covered, a co-pay may apply if residing in or moving to supportive housing like assisted living or a nursing home. Some states might require a "share of cost" fee if income exceeds the Medicaid limit, which varies by state.
The Cost for Medicare-Only Participants
If you have Medicare but not Medicaid, you will have monthly premiums.
- Monthly Premiums: You'll pay a monthly premium for the long-term care part of the PACE benefit and for Medicare drug coverage (Part D).
- Part B Premium: You are still responsible for your standard Medicare Part B premium.
- No Deductibles or Copayments: A key benefit is that you won't have deductibles or copayments for services or care approved by your PACE care team.
The Cost for Private Pay Participants
Private pay is an option if you meet other eligibility criteria (age 55+, needing a nursing home level of care, living safely in the service area) even without Medicare or Medicaid.
- Average Cost: Private pay costs can range from $4,000 to $5,000 or more per month, depending on the program and location.
- No Hidden Fees: Private pay covers all approved services with a single monthly premium.
What Does a PACE Program Cover?
PACE provides a wide range of integrated services to help you stay healthy and independent. Coverage typically includes, but is not limited to:
- Adult day primary care
- Dental care
- Emergency services
- Home care
- Hospital and nursing home care (if necessary)
- Laboratory and X-ray services
- Meals and nutrition counseling
- Medical specialty services
- Occupational and physical therapy
- Prescription drugs
- Social services and counseling
- Medically-necessary transportation
PACE vs. Other Care Options: A Cost Comparison
Comparing PACE costs to other senior care options helps illustrate its value. While costs vary individually, this table gives a general comparison.
| Feature | PACE | Home Health Aide (Private Pay) | Nursing Home (Private Room) |
|---|---|---|---|
| Cost Structure | All-inclusive monthly premium (variable by eligibility); no copays or deductibles for approved services. | Hourly rate, average ~$30/hour. Costs can exceed $6,000 per month. | Annual average over $100,000. Can have high entry fees and separate costs. |
| Coverage | All medically-necessary care, social services, and support, as determined by the care team. | Limited to services purchased, typically hourly care for activities of daily living (ADLs). | Room, board, and comprehensive on-site medical care. |
| Location | Primarily at home or at the PACE center, with transportation provided. | In your home. | At a residential facility. |
| Financial Risk | Minimal. No surprise costs for approved care. | High. Costs can fluctuate significantly with hours of care needed. | High, can deplete savings quickly. |
Making an Informed Decision
Choosing PACE requires evaluating your situation. A PACE team will assess your needs at home to create a personalized care plan and determine costs. The best way to get a clear estimate is to contact a local PACE provider.
For more information and to find a plan in your area, you can visit the official Medicare website Find a PACE Plan.
Understanding costs based on your Medicare and Medicaid eligibility helps in making an informed decision about long-term care.
