Family Planning
PACE Programs: A Family Guide to Medicare and Medicaid Community Care
Published June 1, 2026
A plain-language guide to PACE programs, who may qualify, what services may be included, costs, tradeoffs, and questions families should ask before enrolling.
When an older adult starts needing help every day, families often feel pushed toward two choices: patch together home care one shift at a time, or start looking at assisted living or nursing home care. There is another option in some communities that many families never hear about until late in the process: the Program of All-Inclusive Care for the Elderly, usually called PACE.
PACE is not available everywhere, and it is not the right fit for every household. But for an older adult who needs a high level of support and still wants to live in the community, it can be worth understanding before a crisis forces a rushed decision. This guide explains what PACE is, who may qualify, how the care model works, what questions families should ask, and how to compare it with home care, adult day services, assisted living, and nursing facility care. It is educational information only, not medical, legal, financial, or benefits advice.
What PACE is
PACE is a Medicare and Medicaid program designed for eligible older adults who need nursing-home-level care but can live safely in the community with the support of the program. Medicare describes PACE as a comprehensive medical and social services program that coordinates care through a team of health professionals. The goal is to help participants get the services they need while continuing to live at home, with family, or in another community setting instead of moving directly into a nursing home.
The important word is comprehensive. A PACE organization is responsible for arranging and coordinating a participant's covered care. That can include primary care, prescription drugs, therapy, transportation, meals at the PACE center, social work, home care, hospital care, emergency services, dental care, nursing facility care when needed, and other services the PACE team determines are necessary. Medicaid.gov's PACE benefits overview explains that services are commonly provided through an adult day health center and supplemented by in-home and referral services based on the participant's needs.
Because PACE combines medical care, long-term services, social support, and transportation, it can feel different from a traditional insurance plan. Families are not only choosing a payment arrangement. They are choosing a care model and a local organization that will become central to the older adult's daily support.
Who may qualify
Medicare lists four basic eligibility conditions for PACE. A person must be at least 55, live in the service area of a PACE organization, need a nursing-home level of care as certified by the state, and be able to live safely in the community with help from PACE. The program is only available in states that offer PACE under Medicaid, and even within those states, enrollment depends on whether a PACE organization serves the person's address.
That means the first practical question is location. A family may read about PACE and find that the nearest program does not serve their county or ZIP code. Another family may have a PACE center nearby, but the older adult may not meet the state level-of-care standard yet. A third family may qualify medically but need to think carefully about whether the program's center schedule, provider network, and transportation model fit the person's daily life.
PACE is most often discussed for people who are eligible for both Medicare and Medicaid, but Medicare.gov also explains that people with Medicare who do not qualify for Medicaid may be able to enroll and pay premiums for the long-term-care and Part D portions of the benefit. People without Medicare or Medicaid may be able to pay privately. Exact costs and eligibility depend on the local program and the person's coverage.
How the care team works
A central feature of PACE is the interdisciplinary team. Medicaid.gov describes a team that may include a primary care provider, registered nurse, social worker, physical therapist, occupational therapist, recreational therapist or activity coordinator, dietitian, PACE center manager, home care coordinator, personal care attendant representative, and driver representative. The team assesses the participant's needs, develops a care plan, and coordinates services.
For families, this team structure can be one of the biggest advantages. Instead of a daughter calling the primary care office, home care agency, pharmacy, physical therapist, transportation service, and Medicaid office separately, the PACE organization is intended to coordinate those pieces around one plan of care. That does not remove every burden from the family, but it can reduce the amount of fragmented coordination that often exhausts caregivers.
It also changes how decisions are made. Services are not simply ordered by family preference. The PACE team determines what is needed to improve and maintain the participant's health and safety. That can be reassuring when the team is responsive and transparent. It can also be frustrating if the family expects unlimited services or wants providers outside the PACE network. Before enrolling, ask how the team handles care-plan changes, urgent needs, service denials, appeals, and family communication.
What PACE may cover
PACE may cover a wide range of medical and support services. Medicare's PACE page lists examples such as adult day primary care, dentistry, emergency services, home care, hospital care, lab and X-ray services, medical specialty services, mental health counseling, nursing home care, nutritional counseling, occupational therapy, personal care, physical therapy, prescription drugs, preventive care, primary care, social services, speech therapy, and transportation to and from the PACE center and medical appointments.
The services that matter most for one family may be different from another. A person with limited mobility may care most about transportation, therapy, medication management, and help bathing. A person with dementia may need supervision, structured activity, caregiver coaching, and a plan for wandering risk. Someone with several chronic conditions may need close primary care follow-up, lab work, medication changes, and coordination after hospital visits.
Families should ask the local PACE organization to describe a typical week for someone with similar needs. How many days might the participant go to the center? What happens on days at home? Who helps with bathing, dressing, meals, or medication reminders? Is evening or weekend help available? How are dental, vision, hearing, podiatry, mental health, and specialty appointments handled? What transportation is included, and how much notice is needed?
Costs and tradeoffs
PACE can be financially helpful for people who qualify for Medicaid because Medicare.gov says Medicaid participants do not pay a monthly premium for PACE. Medicaid.gov also notes that PACE participants pay no deductibles, coinsurance, or other Medicare or Medicaid cost-sharing for approved services. For people with Medicare but not Medicaid, costs can include a monthly premium for the long-term-care portion of PACE and a premium for Part D drug coverage. Families should get written cost information from the local PACE organization before making a decision.
The tradeoff is that care generally flows through the PACE organization. If a participant has Medicare and joins PACE, Medicare says the participant gets Part D-covered drugs and other necessary medication from PACE. Joining a separate Medicare drug plan while in PACE can cause disenrollment from PACE. Families should also ask what happens to current doctors, specialists, pharmacies, home care aides, and therapists. Some relationships may be able to continue; others may not fit the PACE network or contract structure.
That is why PACE should not be evaluated only on premium cost. A good comparison includes access, continuity, transportation, caregiver relief, safety, the participant's preferences, and how quickly the program can respond when needs change.
PACE compared with other options
Compared with private home care, PACE may offer broader medical coordination, transportation, prescriptions, center-based services, and a team-based plan. Private home care may offer more control over schedule and caregiver selection, but families often have to coordinate medical care separately and pay privately unless another benefit applies.
Compared with adult day services, PACE is usually more medically integrated. Adult day programs can be valuable for meals, social activity, supervision, and caregiver respite, but they may not coordinate the full medical and long-term-care plan. PACE often includes an adult day health center as one part of a larger care model.
Compared with assisted living, PACE may allow a person to remain at home longer while receiving coordinated support. Assisted living may provide housing, meals, help with daily activities, and community life, but costs, medical coordination, memory care, and discharge rules vary widely by community and state. PACE does not replace housing; the participant still needs a safe place to live.
Compared with nursing facility care, PACE is designed for people who need nursing-home-level care but can still live safely in the community with PACE support. If a person's needs become too high for safe community living, the PACE team may arrange nursing facility care. Families should ask how the program handles temporary rehabilitation, respite, short nursing facility stays, and long-term placement if community care stops being safe.
Questions to ask before enrolling
Start with the basics: Does this PACE organization serve the older adult's address? How does the state determine nursing-home-level care? How long does eligibility review take? What documents are needed? If the person has Medicaid, confirm how enrollment affects current benefits. If the person has Medicare only, ask for a written explanation of premiums, drug coverage, and any other expected costs.
Then ask about daily life. What time does transportation arrive? How long is the ride to the center? How many days per week do participants usually attend? Can the person stay home on certain days? How are meals handled? What if the person refuses to attend the center, has anxiety, uses oxygen, has incontinence, or needs a wheelchair-accessible ride?
Ask about medical continuity. Which doctors and specialists are in network? Can the person keep a long-time primary care doctor or specialist? How are urgent calls handled after hours? What happens after an emergency room visit or hospital stay? How does the team communicate medication changes to family caregivers?
Ask about the home. Will someone assess fall risk, bathroom safety, meal access, medication setup, and caregiver availability? Can the program provide home care, personal care, durable medical equipment, therapy, or caregiver training? How often is the care plan reviewed?
Finally, ask about rights and appeals. CMS provides a PACE participant rights document, and families should understand how to make complaints, request services, appeal denials, and voluntarily disenroll if the program is not a good fit. A strong PACE organization should be able to explain these rights plainly.
When PACE may be worth a closer look
PACE may be worth exploring when an older adult has multiple medical conditions, needs help with daily activities, has transportation barriers, is frequently using emergency or hospital care, attends adult day care but needs more clinical coordination, or has a family caregiver who is running out of capacity. It may also be worth exploring after a hospital or rehab stay when the discharge plan assumes more home support than the family can realistically provide.
PACE may be a poor fit if the person strongly wants to keep doctors outside the PACE model, lives outside a service area, does not meet level-of-care criteria, cannot live safely in the community even with support, or needs a schedule the local program cannot provide. The best answer is local and personal. Families should talk with the PACE organization, the older adult's clinicians, Medicaid office or benefits counselor when relevant, and trusted family members before making changes.
A practical next step
If PACE sounds relevant, make a one-page snapshot before calling a program: age, address, Medicare and Medicaid status, diagnoses, medications, recent hospital stays, mobility limits, memory concerns, daily help needed, current doctors, current caregivers, and the main reason the current plan is not working. That makes the first conversation more productive and helps the family compare PACE with home care, assisted living, nursing facility care, or a blended plan.
The question is not whether PACE is better than every other option. The question is whether a local PACE organization can safely coordinate the right mix of medical care, daily support, transportation, prescriptions, and caregiver relief for this person at this stage of life. For some families, that conversation can open a path between doing everything alone at home and moving too quickly into facility care.