A Medicare program that covers in home care
You probably already know that Medicare doesn’t cover in home care services.
However, there is one exception to that rule.
Medicare 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.
We explain what PACE is, which services it covers, how much it costs, who can qualify, advantages and disadvantages, and how to sign up.
What is the Medicare PACE program?
PACE stands for Program of All-inclusive Care for the Elderly.
In some states, this program is called LIFE, which stands for Living Independence for the Elderly.
PACE / LIFE is 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 older adults stay in their homes as they age instead of having no choice but to move to skilled nursing facilities.
Which services does PACE cover?
Under PACE, a team of healthcare professionals works with the older adult and their family to develop a care plan, decide which services are needed, and coordinate the care.
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
How much does PACE cost?
If an older adult has Medicaid, they won’t have to pay a monthly premium for the long-term care portion of the PACE benefit.
If they don’t qualify for Medicaid, but do 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 an older adult doesn’t have Medicare or Medicaid, they have the option to pay for the PACE monthly premium out of pocket.
With PACE, 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 PACE 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 been diagnosed with 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 with the program’s support.
The pros and cons of Medicare PACE
Advantages of PACE program
- It’s best for families who want their older adult 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 an older adult needs nursing home care while enrolled in PACE, the program will pay for it.
Disadvantages of PACE program
- Seniors must give up their primary care physician and use a PACE-preferred doctor instead.
- Currently, there are only 263 PACE centers 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.
Recommended for you:
- 2020 Medicare Open Enrollment: Reduce Costs, Improve Coverage
- Medicare vs. Medicaid: What You Need to Know
- How Medicaid Spend Down Helps Seniors Qualify for Long Term Care Benefits
By DailyCaring Editorial Team
Image: Your Choice Senior Care
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