Medicare + Medicaid for nursing-home-eligible seniors
PACE Program for the Elderly
PACE — the Program of All-Inclusive Care for the Elderly — is one of the most under-used Medicare-Medicaid benefits in the country. About 75,000 Americans are currently enrolled, per the National PACE Association — but roughly 3 million eligible seniors never enroll, mostly because they've never heard of it.
For dual-eligible seniors (Medicare + Medicaid), PACE covers everything — doctor, hospital, prescriptions, in-home aide, adult day care, transportation, dental, vision, hospice — at $0 out of pocket. There is essentially no other comprehensive program that comes close. This is the practical 2026 family guide: how PACE works, who qualifies, what it costs, what the drawbacks are, and how to find a program near you.
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What PACE actually is
PACE is a unified medical + social care system that wraps around a senior who would otherwise need a nursing facility. Instead of moving to a facility, the senior stays home and the PACE team comes to them OR brings them to the PACE day center 2-5 days a week.
The PACE care team
- Primary care physician (PACE-employed)
- Nurses (RN + LPN)
- Social workers
- Physical, occupational, and speech therapists
- Dietitian
- Recreational therapist + activity coordinators at the PACE day center
- Home health aides for in-home care
- Transportation drivers (PACE provides door-to-door rides)
- Personal care attendants
What PACE covers — everything Medicare + Medicaid covers, with no copays
- Primary care + specialist visits
- Hospital and post-acute rehab
- Prescription drugs (Part D-equivalent built in)
- Physical, occupational, speech therapy
- Dental, vision, hearing aids
- Durable medical equipment (walker, wheelchair, oxygen)
- Adult day care at the PACE center
- In-home aide visits
- Meals (at the PACE center + home delivery)
- Transportation to medical appointments (PACE bus or van)
- Personal emergency response systems
- Caregiver respite + family support services
- Hospice care at end of life
- Nursing home placement IF eventually needed (PACE pays)
Who qualifies for PACE — all four criteria
- Age 55+. Most enrollees are 75-90 but the legal floor is 55.
- Live in a PACE service area. 32 states + DC have PACE programs, but service areas are typically defined by zip code or county. Use the PACE Finder at npaonline.org to check your specific area.
- Meet your state's nursing-home level of care. Typically requires needing help with 2+ activities of daily living (ADLs: bathing, dressing, transferring, toileting, eating) OR significant cognitive impairment. The state Medicaid agency assesses this — usually a 1-2 hour home visit + medical record review.
- Able to live safely at home with PACE services in place. PACE will decline applicants who would need full skilled nursing-facility care even with full PACE supports. About 10-15% of applicants are declined at this stage.
Most enrollees are dual-eligible (qualify for both Medicare AND Medicaid). About 90% of PACE enrollees fall into this category. For dual-eligible, PACE is $0 out of pocket — one of the best deals in American healthcare.
If your parent qualifies medically but NOT financially for Medicaid, they can still enroll in PACE — they just pay the Medicaid portion themselves. Medicaid asset-protection planning via an elder-law attorney 5+ years before needing PACE can preserve eligibility while keeping family assets.
How much does PACE cost?
The honest drawbacks of PACE
PACE is genuinely valuable but isn't right for everyone. The trade-offs:
1. You lose your existing doctors
PACE is a closed network. All medical care goes through PACE-employed doctors and PACE-approved specialists. The 20-year relationship with mom's primary care doctor typically ends. PACE can sometimes coordinate with outside specialists for one-off issues, but routine care is in-network only.
2. Geography restricts you
If you move outside the PACE service area (e.g. from Tampa to Naples), your PACE enrollment ends. You'd need to re-apply in the new area or revert to traditional Medicare. For seniors thinking about moving, PACE adds a constraint.
3. The PACE center is central to the model
Most PACE programs expect enrollees at the PACE day center 2-5 days a week for assessments, therapies, social activities, and meals. Seniors who strongly prefer to stay home may find this disruptive. (PACE handles transportation, so it's not a logistics problem — it's a preference issue.)
4. Enrollment friction
Application takes 2-6 weeks: state Medicaid agency does a level-of-care assessment, the PACE program does its own assessment, paperwork between Medicare + Medicaid + PACE has to coordinate. Some programs have waitlists. Not a same-week solution.
5. Limited availability
Only 32 states have PACE. Many counties within those states have no PACE. Rural areas especially underserved. Per NPA: about 75,000 enrollees nationwide vs. ~3 million eligible.
6. Not for low-needs seniors
PACE is designed for seniors who would otherwise need a nursing facility. If your parent is independent and just wants daily social contact, PACE is dramatically overkill — a daily check-in service ($30-180/mo) plus part-time aide is more fitting.
How to find and apply for PACE
- Find a program near you. Use the PACE Finder at npaonline.org or search Medicare.gov "PACE" with your zip code.
- Call the PACE program directly. Most have a dedicated enrollment line. Tell them you're inquiring for a parent or yourself; they'll schedule an information session.
- Attend the info session (usually free, 1-2 hours, at the PACE center or virtual). You'll see the day center, meet some of the team, and learn the specifics for that program.
- Apply. The state Medicaid agency does a level-of-care assessment (typically a 1-2 hour home visit with a nurse). PACE does its own clinical and social assessment. You provide medical records, list of medications, insurance cards.
- Enrollment decision. Within 2-6 weeks. If approved, you select a start date.
- Transition from your current care. PACE notifies your current Medicare plan + doctors. You begin receiving all care through PACE on the start date.
- Reassessment annually — you continue to qualify as long as you meet the level-of-care criteria.
Most families learn about PACE from a hospital discharge planner, geriatric care manager, or Area Agency on Aging — not from their primary care doctor. If your parent has been hospitalized recently and is being discharged with significant care needs, ask the discharge planner specifically about PACE.
Where Call Mabel fits alongside PACE
PACE provides comprehensive medical and care coordination. What it generally doesn't provide: a daily warm voice between center visits. PACE day centers operate 2-5 days/week, and home aide visits aren't daily for most enrollees. The days in between can be lonely, especially for solo-aging seniors.
Mabel fills the daily social gap with: a 15-30 minute warm conversation each morning at the time you choose, medication reminders, family alerts via SMS if Mabel detects distress, conversational continuity (Mabel remembers your parent's name, family, hobbies, medical history, PACE schedule). Plans from $29.97/mo. Cancel anytime.
Frequently asked questions
What is the PACE program for the elderly?
PACE (Program of All-Inclusive Care for the Elderly) is a Medicare and Medicaid program that provides comprehensive medical and social services to seniors who would otherwise qualify for nursing home care — but lets them stay at home. Each PACE program operates as a coordinated team: doctors, nurses, social workers, therapists, dietitians, and aides all working from a central PACE day center plus visiting homes. PACE covers all Medicare and Medicaid services with no copays or deductibles for dual-eligible enrollees. About 75,000 Americans are currently enrolled across ~150 nonprofit PACE organizations in 32 states + DC, per the National PACE Association.
Who qualifies for the PACE program?
Four criteria: (1) age 55+; (2) live in a PACE service area (check npaonline.org); (3) meet your state's nursing-home level of care — typically need help with 2+ ADLs OR significant cognitive impairment; (4) able to live safely at home with PACE services in place. Most enrollees are dual-eligible (Medicare + Medicaid).
How much does PACE cost per month for seniors?
Depends on insurance: dual-eligible (Medicare + Medicaid) = $0/mo (most enrollees). Medicare only = ~$4,000-5,000/mo per NCOA 2024 (you pay the Medicaid share). Medicaid only = $0 typically. Private pay = ~$8,000-10,000/mo (rare; usually more expensive than nursing home). Compare to assisted living at $5,000-10,000/mo or nursing home at $9,000-15,000/mo.
Does Medicare pay for PACE?
Yes. PACE is a Medicare and Medicaid program — Medicare pays its share for any enrollee who has Medicare. Once enrolled, PACE replaces your Original Medicare or Medicare Advantage plan. You receive ALL Medicare-covered AND Medicaid-covered services through the PACE team. The trade-off: you lose your existing Medicare Advantage plan and your established providers.
What are the disadvantages of the PACE program?
(1) Network restriction — you must use PACE doctors. (2) Geographic limit — moving outside the service area ends enrollment. (3) PACE center centrality — most programs expect attendance 2-5 days/week. (4) Enrollment friction — 2-6 week application process. (5) Limited availability — only 32 states. (6) Not for low-needs seniors — PACE is for nursing-home-eligible seniors, not for independent ones.
What is the income limit for PACE?
PACE itself has no income limit — eligibility is medical. But because most PACE enrollees rely on Medicaid to cover their share, you effectively need to qualify for Medicaid to enroll affordably. Medicaid 2026 baselines: ~$2,829/mo individual income, ~$2,000 in countable assets (home, one vehicle, and personal belongings don't count). Married couples get higher community-spouse protections. If income is above the threshold, a Miller Trust / Qualified Income Trust may help — consult an elder-law attorney.
Can I switch back to regular Medicare if PACE doesn't work for us?
Yes. PACE enrollment can be terminated at any time (yours or PACE's decision). If you disenroll, you re-enroll in Original Medicare or a Medicare Advantage plan. There's a transition period; bring your medications and recent test results to whichever new provider you choose. PACE programs also disenroll members occasionally — usually when the senior needs more skilled care than PACE can safely provide, or when they move out of the service area.
Trusted resources
- National PACE Association (npaonline.org) — PACE Finder + program directory
- Medicare.gov PACE page (medicare.gov/health-drug-plans/health-plans/your-coverage-options/other-medicare-health-plans/PACE) — official CMS documentation
- CMS PACE overview (cms.gov/medicare/medicaid-coordination/about/pace) — federal program rules
- NCOA — National Council on Aging (ncoa.org) — independent PACE explainer + senior benefits navigator
- NAELA (naela.org) — find an elder-law attorney for Medicaid planning
- Eldercare Locator (eldercare.acl.gov) — find local Area Agency on Aging for help navigating PACE applications
Reviewed by the Call Mabel team. Last reviewed: .
We cite primary sources from CMS, Medicare.gov, the National PACE Association, and NCOA. We do not accept paid placement in our content.