PACE: the Medicare program that keeps a nursing-home-eligible parent at home

Most of the families who call us about a parent who “needs more than we can give but refuses a nursing home” have never heard of PACE, and a fair number of them live within its service area. That is a failure of publicity rather than of the program, which has existed in some form since the early 1970s and has been a permanent part of Medicare since 1997.

It is worth understanding properly, because it is a different shape from everything else in elder care. It is not a benefit that pays for a service. It is a team that takes responsibility for the whole person.

A PACE organization is a local, non-profit or for-profit provider that receives a fixed monthly payment from Medicare and Medicaid for each participant, and in return provides everything: primary care, specialists, hospital and nursing home care when needed, prescriptions, physical and occupational therapy, home health aides, personal care at home, meals, social work, an adult day health center, and transportation to and from the center and medical appointments. There is no list of covered and uncovered services in the usual sense. If the interdisciplinary team decides your parent needs it, PACE provides it.

The team is the point. A PACE participant is cared for by a small group of people, typically a doctor, nurses, a social worker, therapists, aides, a dietitian, a recreation therapist and drivers, who see the same participants week after week, meet regularly to review each one, and adjust the care plan as needs change. Most of the people in that meeting will know your mother by name and know what her kitchen looks like.

Four conditions, all of them required. You do not need Medicare or Medicaid to join, though almost everyone in PACE has one or both.

1. 1.Age 55 or older.
2. 2.Living in the service area of a PACE organization. Service areas are drawn tightly, often a set of ZIP codes around the center, partly because the program drives participants to and from it.
3. 3.Certified by the state as needing a nursing-home level of care. Each state sets that standard; broadly it means needing hands-on help with several daily activities such as bathing, dressing, moving about and managing medication, or supervision because of dementia.
4. 4.Able to live safely in the community with PACE’s support at the time of enrollment.

The Medicare-only premium is the figure that decides things for middle-income families, and it varies widely by program; it is worth calling the local program and asking for the number before assuming it is out of reach. Compare it with what the family is already spending on home care, medications and copays, and with the cost of the nursing home the program is an alternative to. For people with Medicaid, PACE is usually the most comprehensive care available at no cost at all.

PACE is all-inclusive in both directions. Your parent’s care comes from the PACE team and the specialists, hospitals and pharmacies the program contracts with. In almost every case that means leaving the primary care doctor they have had for years and, if they are in one, leaving their Medicare Advantage plan and Part D plan, because PACE replaces them. Care from outside the program, other than emergencies, is generally not covered.

For some families that is a deal-breaker, and it is better to know it before the enrollment visit. For others, the trade of one trusted doctor for a whole team that comes to the house and answers the phone at 2 a.m. is the best trade they ever made. Two things soften it: PACE participants can disenroll at any time, effective the first of the following month, and go back to Original Medicare or a plan; and the PACE doctor, seeing a small panel of participants, typically spends far more time with each one than a community practice can.

• A van picks your mother up two or three mornings a week and takes her to the day center, where she sees the nurse, has physical therapy, eats lunch with people she knows, and is driven home.
• An aide comes to the house on the other days to help with bathing and to make sure the medications were taken.
• Her prescriptions arrive from the PACE pharmacy, with no copay.
• When she needs the cardiologist, PACE books it, drives her there and sends the records ahead.
• When she falls, the family calls one number, and the team that already knows her decides what happens next, including a hospital stay if needed.
• When she needs a hospital bed at home, or grab bars, or a wheelchair, the team orders it. There is no separate equipment supplier to chase.

As of March 2026 there are 202 PACE organizations operating in 33 states and the District of Columbia, serving about 92,000 people, and new sites open most months. The states with no program at all, as of that date, are Alaska, Arizona, Connecticut, Georgia, Hawaii, Idaho, Maine, Minnesota, Mississippi, Montana, Nevada, New Hampshire, South Dakota, Utah, Vermont, West Virginia and Wyoming. Within the other states, coverage is patchy; a program in one city says nothing about the next county.

1. 1.Search by ZIP code at Medicare.gov’s PACE page or the National PACE Association’s directory at npaonline.org.
2. 2.Call the program directly. Ask whether your parent’s address is in the service area, what the level-of-care assessment involves, and, if your parent does not have Medicaid, what the monthly premium is.
3. 3.Ask about the Medicaid application at the same time. Many PACE participants qualify for long-term care Medicaid and did not know it; the program’s enrollment staff help with that application routinely.
4. 4.Visit the center. The day center is where your parent will spend a lot of time, and families know within an hour whether it feels right.
5. 5.Enrollment is voluntary, and coverage starts on the first day of the month after the enrollment agreement is signed.

One more thing to know: PACE cannot be combined with hospice, a Medicare Advantage plan, a standalone Part D plan, or a Medicaid home and community-based services waiver. It replaces them. If your parent is already receiving hospice care, PACE is not an option unless hospice is revoked, and that is a conversation for the hospice team.

“PACE is the answer to the question every family eventually asks: is there a way to get nursing-home care without the nursing home? In 33 states, in the right ZIP codes, there is.”