PACE (Program of All-Inclusive Care for the Elderly) is a Medicare and Medicaid program that provides comprehensive medical and social care — including primary care, dental, transportation, meals, and home health — to adults age 55 and older who need nursing-home-level care but want to remain in their community. For most people enrolled in both Medicare and Medicaid, PACE is completely free: no premiums, no deductibles, no copays. As of 2026, PACE operates through more than 376 centers across 33 states.
What Is PACE?
The Program of All-Inclusive Care for the Elderly—almost always called PACE—is a federal healthcare program run jointly by Medicare and Medicaid. It was designed to solve a specific, painful problem: What do you do when an aging parent or spouse needs the kind of intensive, 24-hour care a nursing facility provides but desperately wants to stay home?
PACE’s answer is to bring the nursing home to the person — not physically, but in terms of the scope and quality of care. Rather than placing a senior in a facility, PACE surrounds them with a dedicated team of up to 11 healthcare professionals who coordinate every aspect of their medical, social, and personal care. Primary care, specialist visits, physical therapy, dental cleanings, medication management, transportation to appointments, hot meals, mental health counseling — it all flows through a single, unified plan.
The program was founded in San Francisco in 1971 as an experiment to see whether comprehensive community-based care could actually keep frail seniors out of nursing homes. It worked. By 1994, PACE was established as a permanent Medicare benefit. Today it operates through 194 organizations running more than 376 centers across 33 states, serving approximately 87,000 participants.
The average PACE participant is 76 years old, has multiple chronic conditions, and would otherwise qualify for a nursing home bed. About 94% of them live in the community — in their own homes or with family — rather than in a facility. That number, by itself, tells you most of what you need to know about how PACE works.
Who Qualifies for PACE?
PACE eligibility comes down to four requirements. All four must be met:
- Age 55 or older. There is no upper age limit.
- Live in a PACE service area. PACE organizations define geographic coverage zones. You must reside within the designated area served by a local PACE organization.
- Certified as needing nursing-home-level care. Your state must certify that your health condition meets the clinical threshold for nursing facility placement. This doesn’t mean you have to be bedridden—it means your chronic conditions, functional limitations, or cognitive impairments are serious enough that a nursing home would be the standard recommendation.
- Able to live safely in the community with PACE support. At the time of enrollment, you must be able to live at home or in a community setting—with the help PACE provides—without posing a risk to your own health or safety.
Do You Need Medicare or Medicaid to Enroll?
No — you do not need to be enrolled in Medicare or Medicaid to apply for PACE. However, approximately 90% of PACE participants are dual-eligible, meaning they qualify for both programs. Being dual-eligible is significant because it means PACE is free.
If you have Medicare but not Medicaid, you can still enroll in PACE. You’ll pay a monthly premium for the long-term care portion of PACE benefits and a separate premium for prescription drug coverage (Part D). If you don’t qualify for either program, you can enroll as a private-pay participant — though this is considerably more expensive.
What Doesn’t Disqualify You
There are no financial criteria that determine whether you can apply for PACE. Income and asset levels are not evaluated as part of the eligibility assessment — they only affect how much you pay, not whether you qualify.
What Disqualifies You
There are a few conditions that make someone ineligible, even if they meet all four requirements above:
- Current enrollment in a Medicare Advantage (Part C) plan, a Medicare prepayment plan, or a Medicare Prescription Drug Plan (Part D)—you must disenroll from these before joining PACE
- Current enrollment in hospice services
- Current enrollment in certain other long-term care programs that conflict with PACE’s all-inclusive structure
What Services Does PACE Cover?
PACE’s coverage is exceptionally broad. It covers everything Medicare and Medicaid normally cover, plus additional services the interdisciplinary care team determines you need. In practice, this means PACE will cover services that most insurance plans routinely deny.
Medical and Clinical Services
Therapeutic Services
Dental, Vision, and Hearing
This is one of PACE’s most significant advantages over standard Medicare. Traditional Medicare Part A and Part B provide no coverage for routine dental, vision, or hearing care. PACE covers all three—cleanings, exams, dentures, glasses, and hearing aids—when the interdisciplinary team determines these services are necessary for the participant’s overall health.
Home and Personal Care
Social and Mental Health Services
Transportation
PACE covers transportation to and from the PACE day center, to specialist appointments, and to other approved activities. For many seniors — especially those who no longer drive — this service alone is transformative. Transportation is not a secondary benefit; it is considered a core component of the PACE model.
Nursing Home Care
If at any point it becomes necessary for a PACE participant to receive care in a nursing home—due to a health crisis or significant decline—PACE covers this too. The interdisciplinary team continues to supervise the participant’s care even during a nursing home stay. Importantly, participants do not lose their PACE benefits simply because they need temporary nursing home placement.
How Much Does PACE Cost?
Cost is where PACE often surprises people. For the majority of participants, PACE costs nothing out of pocket. For others, the cost structure depends on their insurance status.
| Insurance Status | Monthly Premium | Deductibles | Copays |
|---|---|---|---|
| Dual-eligible (Medicare + Medicaid) | $0 | $0 | $0 |
| Medicaid only (no Medicare) | $0 | $0 | $0 |
| Medicare only (no Medicaid) | Varies by program; typically $500–$900/month for LTC portion + Part D premium | $0 | $0 |
| Private pay (no Medicare or Medicaid) | Typically $4,000–$7,000/month (varies by program and location) | $0 | $0 |
Even for private-pay participants, the cost is often comparable to or lower than a nursing home bed, which averages over $8,000 per month nationally for a semi-private room—and does not include extras like dental or transportation that PACE provides as standard.
How Does PACE Get Funded?
PACE organizations receive monthly capitation payments from Medicare and Medicaid for each enrolled participant. In exchange, the PACE organization assumes full financial responsibility for all of that participant’s healthcare needs. This structure is what enables PACE to cover services that traditional fee-for-service Medicare does not—because the organization is managing a fixed budget across its participant population and has a financial incentive to keep people healthy and out of expensive hospital beds.
For participants, there are never any deductibles or copayments for any drug, service, or care that the PACE team approves—regardless of which payment category you fall into.
PACE vs. Nursing Home: Key Differences
Most families facing the question of senior care end up comparing PACE to a nursing home or skilled nursing facility. The comparison is stark.
| Factor | PACE | Nursing Home |
|---|---|---|
| Where you live | At home or in community | In the facility |
| Monthly cost (dual-eligible) | $0 | $0 (Medicaid pays, but assets/income rules apply) |
| Monthly cost (private pay) | $4,000–$7,000 | $7,500–$12,000+ |
| Dental, vision, hearing | Covered | Typically not covered |
| Transportation | Covered | N/A (you live there) |
| Caregiver respite | Included | N/A |
| Independence | High — you set your schedule | Low — facility determines daily structure |
| Family involvement | Active and encouraged | Visits limited by facility rules |
| Personalized care plan | Yes—updated regularly | Varies by facility |
| Can you leave the program? | Yes, any time, no penalty | Yes, with discharge planning |
For most people who qualify, PACE is the superior option in terms of quality of life, range of services, and cost. The primary reasons families choose a nursing home over PACE are geographic (no PACE program nearby), safety concerns that make community living impractical even with maximum support, or the participant’s preference for a more structured, supervised environment.
Is PACE Available Where You Live?
InnovAge operates PACE centers in Florida, California, Colorado, New Mexico, Pennsylvania, and Virginia. Find out if there’s a center near you.
The PACE Interdisciplinary Care Team
The heart of PACE is the interdisciplinary team, universally called the IDT. This is the group of professionals who assess your needs, build your care plan, and coordinate every service you receive. Federal regulations require a specific composition for the IDT:
- Primary care physician
- Registered nurse
- Social worker
- Physical therapist
- Occupational therapist
- Recreational therapist or activity coordinator
- Dietitian
- PACE center supervisor
- Home care coordinator
- Personal care attendant representative
- Transportation coordinator
All 11 members conduct a comprehensive assessment of each new participant. The team then meets regularly—in person, as a group—to review each participant’s status, update care plans, and make decisions about services. This is categorically different from fragmented fee-for-service care, where a participant’s cardiologist may not know what their neurologist prescribed or where a fall at home goes unreported to any physician for weeks.
The IDT structure also enables PACE to catch problems early. Because participants are seen regularly at the day center and are known personally to a team of 11 professionals, a subtle change in gait, mood, or appetite can trigger an immediate clinical response — often preventing hospitalizations that would otherwise be costly and traumatic.
The PACE Day Health Center
Each PACE organization operates at least one PACE center — a facility that functions as the hub of the program. It is not a nursing home and not a traditional adult day program. A PACE center typically includes:
- A primary care clinic
- An adult day health program with structured activities
- Physical, occupational, and speech therapy areas
- Social spaces for meals and recreation
- Mental health and social work offices
- Personal care areas
Participants typically attend the day center two to three times per week on average, though frequency ranges from once a month to daily depending on individual care needs. Attendance is based on the IDT’s determination of what is clinically appropriate, not on a fixed schedule. Transportation to and from the center is provided.
For many participants, the day center becomes a meaningful source of social connection—one of the most underappreciated aspects of PACE. Isolation and loneliness are significant contributors to health decline in older adults, and the regular, structured social environment of the PACE center addresses this directly.
PACE for Dementia and Alzheimer’s
PACE is particularly well-suited for seniors living with dementia, Alzheimer’s disease, or other cognitive impairments—and for the family caregivers who support them.
Several features of the PACE model benefit dementia patients specifically:
Behavioral health integration
The IDT includes social work and mental health professionals who regularly assess cognitive and behavioral changes. Early intervention with dementia-related symptoms—agitation, sleep disruption, wandering risk—is part of the standard care model.
Caregiver respite
Family caregivers of dementia patients face extraordinary burnout. PACE’s day center program provides structured, supervised time for the participant away from home—giving caregivers essential breaks during the week. PACE also provides caregiver training and formal respite programs for longer periods of caregiver absence.
Home safety assessments
The PACE home care coordinator conducts home safety assessments and can recommend and arrange modifications—grab bars, removal of fall hazards, door alarms—to allow dementia patients to remain home safely longer than they otherwise could.
Continuity through decline
PACE does not discharge participants as their condition worsens. The care plan evolves with the participant’s needs. If nursing home placement eventually becomes necessary, PACE covers that too, and the IDT remains involved in the participant’s care.
How to Apply for PACE: Step-by-Step
Enrolling in PACE is a structured process that typically takes two to six weeks from first contact to coverage start date. Here’s exactly what to expect.
You must be 55 or older, live in a PACE service area, and have a health condition that your state would classify as requiring nursing-home-level care. If you’re unsure about the nursing-home-level requirement, the PACE enrollment team can help assess this during an initial conversation — you do not need to figure this out on your own.
Use the PACE program finder at npaonline.org or call 1-800-MEDICARE (1-800-633-4227) and ask for PACE programs in your zip code. If InnovAge operates in your state (FL, CA, CO, NM, PA, or VA), visit our InnovAge state-by-state guide for direct contact information.
Call or visit the PACE organization and express interest in enrolling. They will schedule a comprehensive health assessment—typically conducted by the IDT physician and a nurse, either in your home or at the PACE center. This assessment evaluates your medical conditions, functional needs, and living situation.
Your state must formally certify that you meet the nursing facility level of care (NFLOC) standard. The PACE organization typically assists you in completing this step and coordinates with the appropriate state agency. In most states, the PACE team does the heavy lifting here — you do not have to navigate this paperwork alone.
If you believe you may qualify for Medicaid but are not enrolled, the PACE enrollment team can help you apply. Medicaid eligibility determines whether PACE is free for you. In states like Colorado, you can apply via an online portal (Colorado uses the PEAK system). PACE staff will guide you through this process.
Once eligibility is confirmed and all assessments are complete, you’ll sign a PACE enrollment agreement. This agreement outlines your rights, the services you’ll receive, and the terms of the program. You will also disenroll from any existing Medicare Advantage plan or Medicare prescription drug plan, as PACE becomes your sole Medicare provider.
Your PACE benefits begin on the first day of the month following your enrollment agreement. Your IDT will conduct a comprehensive initial assessment and build your personalized care plan within the first few weeks of enrollment.
States Where PACE Is Available
As of 2026, PACE operates in 33 states and the District of Columbia. The program is not available in: Alaska, Arizona, Connecticut, Georgia (in implementation), Hawaii, Idaho, Maine, Minnesota, Mississippi, Montana, Nevada, New Hampshire, South Dakota, Utah, Vermont, West Virginia, and Wyoming.
If you live in a state without PACE, or in a part of a PACE state that falls outside a service area, contact your State Health Insurance Assistance Program (SHIP) for information about alternative long-term care options, including Medicaid HCBS waiver programs.
Important California Update
For the states where InnovAge operates—Florida, California, Colorado, New Mexico, Pennsylvania, and Virginia—see our detailed guide: InnovAge PACE Centers: State-by-State Guide.
Pros and Cons of PACE
The Case For PACE
- Free for most participants. If you’re enrolled in both Medicare and Medicaid, there are no premiums, deductibles, or copays—for any service, any drug, any transportation. This is exceptional value.
- Truly comprehensive coverage. Dental, vision, hearing, transportation, meals, home care, mental health — covered. Standard Medicare covers none of these.
- You stay home. For most seniors, remaining in their own home or with family is vastly preferable to institutional care. PACE is specifically designed to make this possible for people who would otherwise need a nursing home.
- Coordinated care. The IDT structure eliminates the fragmented, siloed care most seniors experience. One team knows your complete picture.
- Social connection. The day center provides structured social engagement — a documented factor in longevity and cognitive health.
- Voluntary. You can leave anytime. There is no lock-in, no penalty, and no long-term commitment required.
- Caregiver support. Respite care, training, and support groups reduce the burden on family caregivers significantly.
The Trade-offs
- You must use PACE’s provider network. This is the most significant downside for many families. If your parent has a trusted cardiologist or oncologist outside the PACE network, continuing to see them is generally not permitted under PACE. All care must flow through the PACE IDT.
- Geographic availability is limited. PACE does not operate in all states, and even within PACE states, service areas are defined geographically. If you live outside a service area, you cannot enroll.
- The day center is a requirement, not optional. Attendance at the PACE day center is part of the program model. Frequency is set by the IDT based on your clinical needs, not your personal preference.
- Application can take time. The enrollment process—assessment, state certification, and Medicaid application—typically takes two to six weeks. In some cases, especially if Medicaid applications are complex, it can take longer.
- All or nothing. When you enroll in PACE, it becomes your complete healthcare plan. You cannot supplement it with a separate Medicare Advantage plan or keep a standalone Part D drug plan.
Frequently Asked Questions About PACE
Does PACE cover prescription drugs?
Yes — completely. PACE covers all prescription drugs, and in many cases over-the-counter medications, that the interdisciplinary care team determines are medically necessary. There are no formulary restrictions, no coverage gaps, and no copays for medications approved by the PACE team. PACE replaces Medicare Part D drug coverage entirely.
Can a person with dementia enroll in PACE?
Yes. Cognitive impairment — including Alzheimer’s disease and other forms of dementia — does not disqualify someone from PACE. In fact, PACE is often an excellent option for dementia patients because of the program’s behavioral health integration, structured day center activities, caregiver respite, and ability to scale care intensity as the disease progresses. A family member or legal representative can complete the enrollment process on behalf of a person who cannot do so independently.
What happens if I need to go to the hospital or a nursing home while enrolled in PACE?
PACE covers all necessary hospital and nursing home care. If you are hospitalized, your PACE team coordinates with the hospital and maintains oversight of your care. If you require temporary nursing home placement, PACE pays for it, and your IDT continues to manage your care plan. You do not lose your PACE benefits during a nursing home stay.
Can I keep my current doctor if I enroll in PACE?
Not in most cases. PACE is an all-inclusive model — you receive all your care through the PACE network, led by the PACE primary care physician who is part of your IDT. If your current doctor is not affiliated with PACE, you would need to transition your primary care to the PACE physician. Specialist referrals outside the PACE network require IDT authorization and are handled case-by-case.
How often do I have to go to the PACE day center?
Attendance frequency is determined by your IDT based on your clinical and social needs. On average, PACE participants attend the day center about two to three times per week, but the range is wide — from once a month to every day. The day center is not optional; it is a clinical component of the program. However, attendance schedules are built around your needs and are adjusted as those needs change.
Can I enroll in PACE if I live in an assisted living facility?
Yes. PACE participants can live in a variety of community settings, including their own home, a family member’s home, or an assisted living facility. The key eligibility requirement is that you must be able to live safely in the community — wherever that is — with the support PACE provides.
Is PACE available for veterans?
Veterans who meet PACE eligibility criteria can enroll. If you are a veteran with VA healthcare benefits, enrolling in PACE will change how you receive certain services — you should speak with both a PACE enrollment counselor and a VA benefits coordinator before making a decision to ensure you understand the impact on your VA coverage.
What states call PACE by a different name?
In Pennsylvania, Maryland, and parts of the mid-Atlantic region, PACE is called LIFE — Living Independence for the Elderly. The program structure, eligibility requirements, and benefits are identical; only the name differs. If you’re searching for PACE in Pennsylvania, search for “LIFE program” as well.
Ready to Learn More or Find a PACE Program?
InnovAge is one of the largest PACE providers in the country, with centers in Florida, California, Colorado, New Mexico, Pennsylvania, and Virginia.
