Medicare Pays for In-Home Care Under the PACE Program

medicare PACE program

A Medicare program that covers in-home care

Most of you probably know that Medicare doesn’t cover in-home care services. However, there is one exception to that rule. PACE is a government program that helps older adults get the medical and social services they need to continue living in their homes as they age.

 

What is PACE?

PACE stands for Program of All-inclusive Care for the Elderly. Some states call this program LIFE, which stands for Living Independence for the Elderly.

It’s a Medicare and Medicaid program that provides home-based care and services to people aged 55+ who qualify for a nursing home level of care. The program’s goal is to help more older adults stay in their homes as they age instead of having to move to skilled nursing facilities.

 

How does PACE work?

Under PACE, a team of healthcare professionals works with the senior and their family to develop a care plan, decide which services are needed, and coordinate the care.

 

Which services does PACE cover?

PACE covers a wide variety of services, including:

  • Primary medical care from a PACE doctor
  • Specialized medical care like audiology, dentistry, optometry, podiatry, and speech therapy
  • Prescription and non-prescription medication and necessary medical equipment
  • Emergency care, nursing home care (if necessary), and hospitalization
  • In-home care, like help with activities of daily living and light housekeeping
  • Transportation to PACE centers and medical appointments
  • Rehab services like physical and occupational therapy
  • Social services (case management)
  • Recreational and social activities


PACE also supports family caregivers with caregiving training, support groups, and respite care to help them keep their older adults at home.

 

How much does PACE cost?

If a senior has Medicaid, they won’t have to pay a monthly premium for the long-term care portion of the PACE benefit.

If a senior doesn’t qualify for Medicaid, but does have Medicare, they’ll pay a monthly premium to cover the long-term care portion of the PACE benefit and a premium for Medicare Part D drugs.

If a senior doesn’t have Medicare or Medicaid, they can pay for PACE privately.

With the PACE program, there are no co-pays, deductibles, or coverage gaps. But seniors may have to pay out-of-pocket for any care received outside the program that isn’t approved by their PACE healthcare team.

 

Who qualifies for PACE?

To qualify for PACE, a person must:

  • Be age 55 or older
  • Live in a PACE service area
  • Be certified by the state to need nursing home level care
  • Be able to live safely in their home with PACE services

For example, a typical participant is an 80 year old woman with eight medical conditions who needs help with three activities of daily living. And, almost half of PACE participants have dementia.

The good news is that even though these older adults need a high level of care, more than 90% of PACE participants are able to continue to live in their homes.

 

Pros and cons of PACE

Pros

  • It’s best for families who want their senior to live at home instead of in a nursing home.
  • It’s a good option if the family can provide some care and won’t need to rely on PACE for 24 hour care.
  • Participants can un-enroll from PACE any time and go back to traditional Medicare and Medicaid programs.
  • If a senior needs nursing home care while enrolled in PACE, the program will pay for it.

Cons

  • Seniors must give up their primary care physician and use a PACE-preferred doctor instead.
  • Currently, there are only 121 PACE programs in 31 states.
  • Because there are so few available programs, in some areas it can take as long as 9 months to apply and get approval.
  • If Medicaid is used, Medicaid estate recovery rules may apply.

 

How to sign up for PACE

Apply for PACE (or LIFE) programs by contacting the PACE office in your area.

 

Next Step  Find a PACE program in your area

 

You might also like:
2016 Medicare Costs: How Much Will Seniors Pay?
Financial Help for Caregiving Expenses
Medicaid May Reclaim Money from Your Senior’s Estate

 

By DailyCaring Editorial Staff
Sources: Medicare.gov (1, 2, 3), Paying for Senior Care
Image: Home Health & Hospice Care

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