Medicare PACE (Programs of All-inclusive Care for the Elderly) and LIFE (Living Independence for the Elderly)
Overview of PACE Programs
Medicare PACE is short for Programs of All-inclusive Care for the Elderly. PACE is not a source of funds for paying for senior care; rather it is an optional program that covers all of a participating senior’s medical needs. It is open to Medicare and Medicaid beneficiaries and provides comprehensive medical and social services at home, adult day health centers and inpatient facilities as an alternative for those who would otherwise require nursing home care.
All of a patient’s medical needs are determined and provided by a set group of medical service providers. This includes medications and medically-necessary transportation.
This model of care is sometimes referred to as Managed Care at Home and in certain states PACE Programs are called LIFE Programs.
Pros & Cons:
PACE programs are intended for families that wish to have the care recipient live at home instead of instead of in a skilled nursing home / facility. Participating families are expected to provide some personal care themselves and not rely entirely on the program for 24 hr care. However, if a PACE program can no longer safely support the care of an enrolled participant at home or in adult day care, the program will pay for care in a skilled nursing home.
While PACE programs are a very good option for families that are able to provide some level of care, unfortunately, they are currently available in only 30 states and only within certain regions of those states. Another drawback to this program is that seniors must give up their primary care physician to enroll in the program. Finally, in some areas it can take many months to apply and have the application processed prior to enrollment.
Be Aware That:
-In some locations, it can take as long as 9 months to process a PACE application.
-PACE programs are only open to seniors with Medicare or Medicaid coverage.
PACE Programs are Also Known As:
-Programs of All-inclusive Care for the Elderly
-In PA and NJ, they are called LIFE or Living Independence for the Elderly
-Managed Care at Home
What are the Qualifications for PACE Programs
To be eligible for a PACE program, the participant must be at least 55 years old.
Disabilities / Health Requirements
Participants in PACE programs must agree to be screened by a team of doctors and nurses who certified them as eligible for nursing home care. Alzheimer's and dementia patients do not automatically qualify.
There are no marital status or other family requirements to participate in a PACE program. However, a family must be able to provide a level of care at home.
Financial Status Requirements
PACE programs in and of themselves do not have financial eligibility requirements, however participating seniors must be enrolled in Medicare or Medicaid, therefore they must meet the Medicare requirements or the Medicaid requirements.
Veteran Status Requirements
Medicare PACE / LIFE programs are available to both Veteran and non-Veterans.
Currently PACE programs are not available nationwide. Of as 2012, 30 states have PACE or LIFE Programs. Enrollees must reside in a Medicare PACE or LIFE Program eligibility area within one of the 30 states to participate in a program.
|States with PACE / LIFE Programs
||States without PACE / LIFE Programs
What are the Benefits of PACE Programs
Types of Benefit Payout
PACE benefits come only in the form of medical and care services. Seniors do not receive cash payments. Benefits are determined on a case by case basis and can include any of the following.
-Adult Day Care
-Nursing Home Care
-Prescription Drugs / Medications
-Social Work Counseling
Restrictions on How Payout Can be Used
PACE benefits are restricted to direct payments to medical and care service providers.
Benefits Amounts & Limits
PACE programs cover 100% of a senior’s medical costs. Seniors are responsible for making the Medicare / Medicaid payments.
Time to Receive Benefits
The national average time to process a Medicare PACE or LIFE application is 9 months. However in some areas of the country it can be faster. Claims can be processed in as few as two months time.
Costs of PACE Programs
PACE programs receive monthly payments from Medicare or Medicaid. Participating seniors do not make payments to the PACE program.
If an individual qualifies for Medicaid, there is no monthly premium for long term care. Seniors that are not Medicaid eligible, but have Medicare, will pay a monthly premium but do not have deductibles or co-payments.
How to Apply for PACE Programs
Page Reviewed / Updated Apr. 2013