Medicare PACE Program Pays for In Home Care

medicare pace program pays for in home care

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.




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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

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

 

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.




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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.

 

Next Step  Find a Medicare PACE program in your area

 

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By DailyCaring Editorial Team
Image: Your Choice Senior Care

 

This article wasn’t sponsored and doesn’t contain affiliate links. For more information, see How We Make Money.


8 Comments

  • Reply October 23, 2019

    Debra Horton

    I believe that Medicare Advantage plans are also now eligible to pay for some types of home care based on assistance needed for activities of daily living or functional status.

    • Reply October 25, 2019

      DailyCaring

      It’s true that a recent change in the law now allows Medicare Advantage health care plans to offer coverage for home care services. However, this is up to the discretion of each insurance provider. And, since the change was relatively recent, most companies haven’t rolled out their offerings yet.

      The PACE program is different because it’s a comprehensive program offered by Medicare, and isn’t subject to decisions made by specific insurance companies.

  • Reply March 11, 2019

    Deborah Manning

    I’m experiencing difficulties finding how PACE program determines a clients need for higher level of care.

    • Reply March 28, 2019

      DailyCaring

      We’re not affiliated with any PACE programs so the best thing to do would be to contact one in your area to get more information about how they determine a client’s needs.

  • Reply December 10, 2018

    Jo Ann

    I am trying to find someone who can come to my sisters home where my 82 year old mother is living. My sister works during the day and she needs someone to come to her home to care for mom. My mother has medicare and medicaid. She is bed bound and needs diapers changed, she is also blind,and also to feed her. Will need care about 9 hours daily, Monday thru Friday. Will her medicare and medicaid pay for this and if so how long will it take to get services started.

  • Reply April 20, 2018

    Fern Hubbard

    Is there any information on when/if the PACE program will be available in Houston, TX? I am currently caring for my husband who has dementia and would be very interested in this program.

    Thanks.

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