PACE Program Explained: Medicare's All-Inclusive Care Option for Seniors

What Is the PACE Program?

The Program of All-Inclusive Care for the Elderly, better known as PACE, is a joint Medicare and Medicaid program designed to help frail older adults get comprehensive care while continuing to live in the community. The PACE model of care is designed to help older adults remain in their home in the community for as long as possible, providing both medical and social services as a welcome alternative to nursing home care for many older adults.

Unlike a standalone Medicare plan, PACE acts as a single, wraparound program. PACE bundles all of a frail older adult's Medicare and Medicaid care into one plan so they can stay home instead of entering a nursing facility. PACE is a permanent Medicare and Medicaid benefit, authorized by Congress in the Balanced Budget Act.

In 2026, PACE has reached a real inflection point in size and reach. There are 204 PACE programs serving more than 96,400 participants in 33 states and the District of Columbia.

Who Qualifies for PACE?

PACE has strict eligibility rules because it's specifically designed for people who would otherwise qualify for a nursing home. PACE is open to adults 55 and older who are certified by their state as needing a nursing-home level of care but can still live safely at home with support.

To enroll in PACE, you generally must meet all four of these criteria:

• Be age 55 or older
• Be certified by your state as needing a nursing-home level of care
• Live in a PACE service area (usually within a defined ZIP code radius of a PACE center)
• Be able to live safely in the community with the help PACE provides at the time of enrollment

Most of the participants who are in PACE are dually eligible for both Medicare and Medicaid, but you do not have to be on Medicaid to enroll. If you're only on Medicare or you pay privately, you can still qualify as long as you meet the clinical and geographic tests.

What Services Does PACE Cover?

The scope of PACE coverage is broader than almost any other Medicare option. The program provides all the care and services covered by Medicare and Medicaid, as authorized by the interdisciplinary team, as well as additional medically-necessary care and services not covered by Medicare and Medicaid.

Here's what a typical PACE participant receives:

Medicare says PACE may cover primary care and doctor/nursing services, prescription drugs, adult day primary care (including meals and recreational therapy), home care / personal care support services, transportation to and from the PACE center and medical appointments, and physical therapy, occupational therapy, and speech therapy.

The Interdisciplinary Care Team Model

What truly sets PACE apart is how care is delivered. Instead of juggling separate doctors, therapists, pharmacists, and case managers, each participant is assigned to an interdisciplinary team (IDT) that meets regularly to plan and adjust their care.

A typical PACE team includes:

• Primary care physician
• Registered nurse
• Social worker
• Physical, occupational, and recreational therapists
• Dietitian
• Home care coordinator
• PACE center aides and driver

Each PACE participant receives customized care that is planned and delivered by a coordinated, interdisciplinary team, which meets frequently to review changes in the participant's health, medications, and living situation.

This model is a big reason PACE gets strong outcome numbers. A new study led by the U.S. Department of Health and Human Services (HHS) and conducted by RTI International confirms that the Program of All-Inclusive Care for the Elderly (PACE) delivers superior health outcomes for dually eligible seniors compared to those not enrolled.

How PACE Is Funded and What It Costs

PACE uses a capitation model, meaning Medicare and Medicaid each pay the PACE organization a fixed monthly amount for each enrollee, regardless of how much care that person actually uses. That predictable payment gives the PACE team flexibility to spend on whatever the participant truly needs, from a wheelchair ramp to a hospital stay.

For participants, what you pay depends entirely on which programs you qualify for.

Dual-eligible participants (both Medicare and Medicaid) pay $0 monthly premium for PACE, with no deductibles, no copays, and no coinsurance on approved care. Private-pay participants who qualify medically but not financially pay $4,000-$7,000 per month.

If you have Medicare but not Medicaid, you pay a monthly premium for the long-term-care portion of PACE, the part Medicaid would otherwise cover, and you keep paying your standard Part B premium.

PACE vs. Medicare Advantage vs. Original Medicare

PACE is not a replacement for a normal Medicare plan for most seniors. It's a specialized option that fully takes over your Medicare and Medicaid benefits once you enroll.

Some key differences:

• Provider choice. MA plans often allow participants to use providers outside their networks. PACE, on the other hand, must provide all care through its own network or through providers it has a direct contract with.
• Overlap with other coverage. PACE becomes your insurance provider when you enroll. It replaces your existing Medicare coverage, Medicare Advantage plan, Medigap plan or Medicare Part D prescription drug plan.
• Cost sharing. With Original Medicare you typically pay Part A/B deductibles and 20% coinsurance unless you carry a Medigap plan. With PACE, dual eligibles pay nothing for approved care.

If you want to keep broader provider choice, Original Medicare plus a Medigap plan may make more sense. If you want an all-in-one plan without the frailty requirement, Medicare Advantage may be a better fit.

Geographic Availability of PACE

PACE is not available everywhere, and this is one of its biggest limitations. As of 2026, there are 202 PACE programs operating in 33 states and the District of Columbia, and seventeen states have none at all; close to 92,000 people are enrolled in PACE nationwide.

States without any PACE program in 2026 include Alaska, Arizona, Connecticut, Georgia, Hawaii, Idaho, Maine, Minnesota, Mississippi, Montana, Nevada, New Hampshire, South Dakota, Utah, Vermont, West Virginia, and Wyoming.

Even in states that offer PACE, coverage is usually tied to specific counties or ZIP codes near a PACE center. To find a program near you, search the National PACE Association's "Find a PACE Program" directory or ask your State Health Insurance Assistance Program (SHIP) counselor.

Pros and Cons of PACE

The major downside of the PACE program is its limited availability. PACE is only available in select areas, and seniors are generally required to live within the service area.

On the plus side, the average cost for a PACE program is 13% less than state Medicaid programs compared to a similar population. Additionally, PACE participants had fewer hospitalizations, re-admissions, and emergency room visits.

Is PACE Right for Your Family?

PACE tends to be the right fit when a loved one:

• Is 55+ and has multiple chronic conditions or cognitive decline
• Needs nursing-home-level help but wants to stay at home
• Already qualifies for Medicaid (or is close to qualifying)
• Lives near a PACE center
• Has a caregiver who is overwhelmed managing appointments, medications, and services

It tends to be a poor fit when someone wants to keep their current specialists, travels or snowbirds for months at a time, or only needs light help. In those cases, a well-chosen Medicare Advantage plan or Original Medicare with a Medigap policy is usually more appropriate.

Before enrolling, it's smart to visit the PACE center in person, meet the interdisciplinary team, and ask exactly which of your loved one's current providers would be replaced.

Frequently Asked Questions

Does Medicare cover the PACE program?

Yes. Medicare pays the PACE organization a monthly capitation payment for each enrolled participant, covering all the Medicare Part A, Part B, and Part D services they need. For dual-eligible participants, Medicaid covers the remaining costs, and the participant pays nothing. For Medicare-only participants, you'll pay a monthly premium for the long-term-care portion that Medicaid would otherwise cover.

What's the difference between PACE and Medicare Advantage?

Both are managed-care alternatives to Original Medicare, but PACE is far more comprehensive. PACE requires a nursing-home level of care and includes long-term care, adult day services, meals, transportation, and home care, none of which are typically covered by Medicare Advantage. Medicare Advantage is open to most Medicare beneficiaries and gives you a private plan with a provider network, but doesn't include long-term care.

Can you keep your own doctor with PACE?

Usually no. Once you enroll in PACE, you generally must use PACE-employed or PACE-contracted providers for all non-emergency care. This is the biggest trade-off for the comprehensive coverage. Some participants can keep a specific specialist if the PACE team approves and contracts with that provider, but this is uncommon.

How do I find a PACE program near me?

The National PACE Association maintains an online directory at npaonline.org that lets you search by state and ZIP code. You can also call your State Health Insurance Assistance Program (SHIP), your state Medicaid office, or 1-800-MEDICARE for referrals. As of 2026, PACE operates in 33 states and D.C., so availability depends heavily on where you live.

What happens if a PACE participant needs to move to a nursing home?

PACE continues to cover their care even if nursing home placement becomes necessary. The PACE organization pays for the nursing home stay as part of the all-inclusive benefit, and the interdisciplinary team continues to manage the participant's medical care, medications, and coordination. This is one of the strongest features of PACE compared to other Medicare options, which generally do not cover long-term nursing home stays.