PACE Programs: The All-Inclusive Care Option Most Families Have Never Heard Of

The Benefit Hiding in Plain Sight

When a parent starts needing nursing-home level care but says, plainly, that they want to stay in their own home, most families assume they face an impossible choice. Move Mom into skilled nursing against her wishes, or try to assemble round-the-clock help at home and pay for every hour of it out of pocket. There is a third path that has existed for decades and that most families have never heard named: PACE, the Program of All-Inclusive Care for the Elderly.

PACE is quietly growing. This spring, the PACE Organization of Rhode Island acquired two Cranston properties, the former Scandinavian Communities campus and the shuttered Cra-Mar Meadows nursing home, with plans to renovate one and convert the other into a 24-unit assisted living residence for older adults with dementia. It was a small local story, but it signals something larger. PACE organizations are expanding because the model works and demand is climbing.

Here is what PACE is, who it serves, what it covers, and the one significant trade-off every family should weigh before enrolling.

What PACE Actually Is

PACE is a benefit jointly funded by Medicare and Medicaid that bundles nearly all of a senior’s medical and supportive care into a single coordinated program. Instead of juggling a primary doctor, a cardiologist, a physical therapist, a pharmacy, a ride service, and a home aide as separate pieces, a PACE participant gets all of it managed by one interdisciplinary team working out of a local PACE center.

That team (doctors, nurses, therapists, social workers, dietitians, aides, and drivers) meets regularly to plan and adjust each participant’s care. The PACE center itself doubles as an adult day health hub, a place to get a checkup, receive therapy, share a meal, and join in social activities, then ride home on PACE transportation. The entire point is to let someone who would otherwise qualify for a nursing home go on living in their own home and community.

A care aide helping an older woman into a wheelchair-accessible van outside her home on a sunny morning.

The model is well established. According to the National PACE Association, nearly 200 PACE programs now serve more than 85,000 older adults across 33 states and Washington, D.C. The average participant is in their mid-70s, and the great majority are “dual eligible,” meaning they qualify for both Medicare and Medicaid.

Who Qualifies

Eligibility comes down to four boxes, all of which must be checked:

Age 55 or older. PACE is not limited to those 65 and up, which surprises many families. A 58-year-old with early-onset dementia or a disabling chronic illness can qualify.
Certified as needing nursing-home level care. Your state’s Medicaid agency has to determine that the person’s needs rise to the level that would otherwise justify a nursing home. This is a clinical assessment, not a formality.
Living in a PACE service area. Programs serve defined geographic zones, usually specific counties or ZIP codes around the PACE center. If no program reaches your area, PACE is simply not an option there yet.
Able to live safely in the community at enrollment. The team must agree that, with PACE support in place, the person can remain safely at home. PACE is built to prevent a nursing home move, not to be entered from crisis.

Because that second box is a Medicaid level-of-care determination, and because availability and rules vary meaningfully from state to state, confirm the specifics with the PACE program itself before assuming a parent does or does not qualify.

What PACE Covers

The “all-inclusive” in the name is close to literal. A single PACE enrollment typically covers:

Primary care and the PACE team’s own doctors and nurses
Specialty care, hospital stays, and emergency services
Prescription drugs
Physical, occupational, and recreational therapy
Adult day programming and social activities
In-home personal care and aide services
Meals and nutrition counseling
Dentistry, vision, hearing, and podiatry
Lab work and X-rays
Transportation to the PACE center and to medical appointments
Social work and family caregiver support
Skilled nursing and end-of-life care when the time comes

If the PACE team decides a participant needs something to stay healthy and safe, the program is generally expected to provide or arrange it, even services that traditional Medicare and Medicaid would not each cover on their own. Because PACE can wrap in home care and adult day services, it often fills exactly the gap that makes aging in place instead of moving to senior living feasible for a family. For a participant with dementia, the mix of day programming, supervision, and clinical oversight can resemble what a good memory care community provides, delivered while the person still sleeps in their own bed.

A physical therapist helping an older man do a seated resistance-band exercise in a bright therapy room.

What It Costs

This is where PACE becomes remarkable for the right household. For a participant who has both Medicare and Medicaid, which describes most people in the program, there is usually no premium, no deductible, and no copay for anything the PACE team approves. The two public programs cover the cost between them.

Someone who has Medicare but does not qualify for Medicaid pays a monthly premium covering the long-term-care portion of the benefit, plus a premium for prescription-drug coverage, but still owes no copays for approved services. A person with neither program can enroll and self-pay, though the full monthly cost of comprehensive care commonly runs in the $4,000 to $5,000 range or higher.

That structure is why PACE is so often described as a lifeline for dual-eligible seniors in particular. If your family is sorting through the wider menu of ways to fund care, our guide to paying for senior living puts PACE in context alongside Medicaid waivers, veterans benefits, and long-term care insurance.

The Trade-Off: One Network for Everything

PACE’s greatest strength, total coordination, is also its central limitation. When you enroll, the PACE program becomes your sole provider and coordinator of care. You receive services from PACE-employed and PACE-contracted providers, and you generally cannot see outside doctors or specialists unless the PACE team authorizes and arranges the visit. Non-emergency care obtained outside the network is typically not covered, which means the participant would have to pay for it themselves.

For a senior deeply attached to a longtime primary-care doctor, that can be a real loss, and it is the most common reason people hesitate. The counterweight is that everything, including transportation and prescriptions, is handled by one team that actually talks to itself, the opposite of the fragmented experience most families know. This is a personal trade-off worth discussing honestly as a family, ideally with a certified senior care advisor who can compare PACE against the alternatives.

When and How to Enroll

PACE enrollment is voluntary and open year-round. It is not tied to Medicare’s annual election window, so you can apply in any month. Coverage generally begins on the first day of the month after you enroll. Just as important, you can leave PACE at any time, for any reason, and return to standard Medicare and Medicaid coverage. No one is locked in.

How to Find Out If PACE Serves Your County

Because programs are strictly local, the first practical question is whether one operates where your parent lives. Three ways to check:

Use the official PACE plan search on Medicare.gov, which lets you look up programs by ZIP code.
Contact your state Medicaid office or State Health Insurance Assistance Program (SHIP), which can confirm availability and help arrange the level-of-care assessment.
Reach out to the National PACE Association, which maintains a directory of member programs nationwide.

If a program exists nearby, call it directly. PACE staff will walk your family through the eligibility assessment and enrollment, and a visit to the PACE center is the best way to judge whether the day-program environment fits your parent. As with any major care decision, and especially where Medicaid eligibility and asset questions are involved, it is worth looping in an elder law attorney or senior care advisor before you sign anything.

Is PACE Right for Your Family?

PACE is not for everyone. It requires living in a service area, accepting a closed provider network, and needing a nursing-home level of care to begin with. But for a dual-eligible older adult who wants to stay home, who benefits from structured daytime supervision, and whose family is worn down by coordinating a dozen disconnected services, few options are as comprehensive or as affordable. It can even carry someone through end-of-life care at home, an alternative worth weighing alongside hospice in other settings.

An elderly mother and her adult daughter sharing a warm embrace outdoors. — Photo: "An elderly mother and adult daughter share a warm embrace on a sunny beach in Portugal." by Kampus Production on Pexels

The quiet tragedy is how many families never learn the program exists until after they have placed a parent in a nursing home nobody wanted. If your parent qualifies for that level of care but wants to stay put, PACE deserves a place near the top of your list of questions.