What is a pace plan for the elderly? Understanding the Program of All-Inclusive Care

Over 90% of older adults want to remain in their homes for as long as possible, yet many face complex health needs that make this challenging. The Program of All-Inclusive Care for the Elderly (PACE) is a comprehensive solution designed to empower eligible seniors by coordinating their medical and social services to help them live safely in the community. This model represents a shift from traditional healthcare by providing a holistic, team-based approach to senior care.

Quick Summary

The Program of All-Inclusive Care for the Elderly (PACE) is a managed care program for frail seniors, combining all necessary medical and social services into a single, coordinated system run by an interdisciplinary team. It helps eligible individuals, who otherwise would require a nursing home, to remain independent in their community.

Key Points

• Holistic and Integrated Care: The PACE program provides a comprehensive range of medical, social, and long-term care services consolidated under a single managed plan.

• Interdisciplinary Team: A dedicated team of healthcare professionals assesses individual needs and coordinates all aspects of a participant's care, from primary medical to emotional support.

• Aging in Place: By delivering services in the community and at a day center, PACE helps seniors who require a nursing home level of care remain independent and in their homes.

• Consolidated Costs: For eligible participants, particularly those with both Medicare and Medicaid, PACE can significantly reduce or eliminate costs like premiums, copayments, and deductibles for authorized services.

• Geographic and Provider Limits: A drawback of PACE is that participants must use the program's network of providers and live within a specific service area, limiting flexibility.

What is a PACE Plan for the Elderly?

The Program of All-Inclusive Care for the Elderly (PACE) is a state and federal program providing comprehensive care to individuals 55 or older who need nursing home-level care but can live in the community. It consolidates all necessary services under one provider.

The Interdisciplinary Team (IDT) Approach

A core part of PACE is the interdisciplinary team (IDT). This team develops a personalized care plan for each participant. The IDT includes various healthcare professionals.

Services Covered by PACE

PACE covers medically necessary services approved by the IDT, including those usually covered by Medicare and Medicaid, removing the need for separate plans like Medicare Part D. Services may include adult day care, home care, emergency services, prescription drugs, dental, vision, hearing, hospitalization, therapies, and transportation.

PACE vs. Traditional Medicare/Medicare Advantage

A table comparing PACE, Traditional Medicare, and Medicare Advantage regarding care coordination, provider choice, services covered, cost-sharing, and purpose is available from {Link: CMS https://www.cms.gov/medicare/health-plans/pace/downloads/externalfactsheet.pdf}.

Who is Eligible for a PACE Plan?

Eligibility requires being 55+, living in a PACE service area, needing nursing home-level care as certified by the state, being able to live safely in the community with PACE services, and agreeing to get all care exclusively through the PACE organization.

The Cost of a PACE Plan

Costs vary by eligibility. Those with both Medicare and Medicaid usually have no monthly premium for long-term care and no deductibles or copayments for authorized services. Participants with only Medicare pay a monthly premium for long-term care and prescription drugs but no deductibles, copayments, or coinsurance for authorized care. Those without Medicare or Medicaid can pay privately.

How to Find and Enroll in a PACE Program

Check for local programs as enrollment is voluntary, and participants can disenroll anytime. The National PACE Association website is a resource for finding programs.

The Benefits of Joining a PACE Program

PACE provides personalized, comprehensive care that supports community independence. It simplifies care management and supports caregivers. PACE participants may have better health outcomes, including fewer hospital and emergency visits.

Frequently Asked Questions

What is the primary goal of a PACE plan?

The primary goal of a PACE plan is to enable frail seniors who meet state eligibility for nursing home care to remain safely in their own communities by providing all necessary medical and social support services.

Do I have to be on both Medicare and Medicaid to join PACE?

No, you do not. Individuals can enroll in PACE if they have Medicare only, Medicaid only, or are dually eligible for both. Those without either can also pay privately.

Does a PACE plan cover hospital stays?

Yes, a PACE plan covers hospital care, including inpatient and emergency services, if deemed medically necessary by the interdisciplinary care team. This is a core part of its comprehensive coverage.

What happens to my other insurance plans if I join PACE?

If you enroll in a PACE plan, it becomes your sole source of medical and long-term care services. You will be unenrolled from other Medicare or Medicaid plans, including any Medicare Part D prescription drug plan.

Is transportation to medical appointments included in PACE?

Yes, transportation to the PACE center and all medically necessary appointments in the community is a covered service provided by the program.

What if I need care that is not typically covered by Medicare or Medicaid?

The interdisciplinary team has the authority to approve and provide any additional medically necessary services, beyond standard Medicare and Medicaid coverage, to help maintain your health and well-being in the community.

Can family members be involved in the care plan?

Yes, family members and other caregivers are an integral part of the care team. The PACE program actively involves and supports them by offering education, training, and respite services.