Core Principles of the PACE Program
The Program of All-Inclusive Care for the Elderly (PACE) is founded on the principle of providing comprehensive, person-centered care to help frail seniors remain in their communities. A central component is the interdisciplinary team (IDT), which manages all aspects of a participant's care plan. This team typically includes a primary care physician, nurses, social workers, and various therapists who collaborate regularly to address the participant's medical and social needs. The PACE center serves as the main location for many services, offering medical care, therapies, meals, and social activities. PACE also provides in-home care and transportation to ensure participants can access necessary services and maintain independence.
Eligibility Requirements for Joining PACE
To enroll in PACE, individuals must generally be 55 or older, live within a PACE organization's service area, be certified by their state as needing nursing home-level care, and be able to live safely in the community with PACE support at the time of enrollment. PACE is not offered in all areas.
Comprehensive PACE Services and Benefits
PACE provides medically necessary services determined by the IDT, covering care typically included in Medicare and Medicaid, along with other needed support. Services often include medical care, therapies, home care, adult day health services, prescription drugs, hospital and nursing home care when needed, 24/7 emergency services, and transportation to appointments and the PACE center. Respite care for caregivers may also be provided.
Financial Aspects of the PACE Program
PACE uses a capitated funding model where the organization receives a set monthly payment from Medicare and Medicaid for each participant. Costs for participants depend on their eligibility for Medicare and Medicaid.
PACE Cost Comparison: Different Scenarios
| Enrollment Scenario | What You Pay | What You Don't Pay |
|---|---|---|
| Dual Eligible (Medicare & Medicaid) | Nothing for the long-term care portion. | Premiums for Medicare and Part D, deductibles, or copayments for approved services. |
| Medicare Only | A monthly premium for the long-term care portion and a premium for Medicare Part D drugs. | Deductibles or copayments for any service approved by the PACE team. |
| Private Pay (No Medicare or Medicaid) | Full monthly cost of the PACE program. | N/A |
This structure eliminates deductibles and copayments for approved care, distinguishing it from traditional Medicare and Medicaid.
PACE vs. Other Healthcare Options
A key difference of PACE is its integrated, team-based care model, unlike standard Medicare Advantage plans. PACE organizations are direct healthcare providers, while Medicare Advantage plans are typically insurers with a network. PACE's focus on coordinated, community-based long-term care and maximizing independence is more intensive. Participants receive comprehensive drug coverage through PACE and should not enroll in a separate Medicare Part D plan, which would result in disenrollment.
Conclusion
In summary, the Program of All-Inclusive Care for the Elderly (PACE) is a comprehensive healthcare model that aims to keep frail seniors in their homes and communities. It provides necessary medical and social care through an interdisciplinary team, a dedicated center, and a wide range of support services. Key features include capitated funding, specific eligibility criteria for those requiring a nursing home level of care, and an integrated system covering transportation and home care. PACE's proactive, coordinated approach offers a distinct alternative to institutional care.
Frequently Asked Questions
Can a PACE participant keep their regular doctor?
No, when you enroll in PACE, you must receive all your medical care, including primary care and specialist services, through the PACE organization or its authorized providers.
Is PACE available in every state?
No, PACE is not available in every state. It is offered in states that have elected to provide PACE services, and even within those states, only in specific areas where a PACE organization operates.
Can a family member be a caregiver in the PACE program?
Yes, PACE programs often include support for family members and other caregivers. This may involve training, support groups, and respite care.
What happens if I want to leave the PACE program?
Participants can disenroll from PACE at any time. Those with Medicare or Medicaid will receive help in transitioning back to their previous coverage.
Do I need to be eligible for both Medicare and Medicaid to join PACE?
No, you can join with Medicare, Medicaid, or pay privately, with costs varying based on eligibility.
Does PACE cover end-of-life care?
Yes, PACE covers end-of-life care, but electing the hospice benefit requires disenrollment from PACE.
What if I disagree with my care plan?
Participants have the right to file an appeal if they disagree with their individualized care plan.
How does PACE support preventive care?
PACE prioritizes preventive care to help participants live in the community longer. The IDT monitors health and provides proactive services.
What is the PACE center?
The PACE center is the main hub for services like primary care, therapies, meals, and social activities.
