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Using Medicare PACE Programs for Long Term Care
| Definition |
Qualifications |
Costs |
| Pros & Cons |
Benefit Types & Limits |
How to Apply |
| Overview of PACE Programs | ||
PACE (Programs of All-inclusive Care for the Elderly) is not a source of funds for paying for senior care; rather it is an optional program that covers all participating seniors’ medical needs. It is open to both Medicare and Medicaid beneficiaries and provides comprehensive medical and social services at home, adult day health centers or at inpatient facilities, instead of in institutions.
All the patient’s medical needs are determined and provided by a set group of medical service providers. This includes medications and medically-necessary transportation.
PACE programs are designed to keep a senior that requires skilled nursing care living at home and receiving care on a part-time basis from their family. Therefore, while these programs are not a direct source of funds, they can keep the cost of senior long term care low and have been included for this reason.
The PACE program is a good option for families that are able to provide some level of care. Unfortunately, PACE programs are currently available in only 31 states and only within certain regions of those states. The other major drawback to this program is that seniors must give up their primary care physician to enroll in the program. In addition, it can take many months to apply and have the application processed prior to enrollment.
By design, PACE programs do not pay for skilled nursing or assisted living communities. They offer in-home care and care in an adult day care setting. Once the elderly have been accepted into a PACE program, they can continue receiving care for the remainder of their life or until they are required to move into a full-time skilled nursing facility.
The PACE program is a good option for families that are able to provide some level of care. Unfortunately, PACE programs are currently available in only 31 states and only within certain regions of those states. The other major drawback to this program is that seniors must give up their primary care physician to enroll in the program. In addition, it can take many months to apply and have the application processed prior to enrollment.
By design, PACE programs do not pay for skilled nursing or assisted living communities. They offer in-home care and care in an adult day care setting. Once the elderly have been accepted into a PACE program, they can continue receiving care for the remainder of their life or until they are required to move into a full-time skilled nursing facility.
Be Aware That:
The average time to process a PACE application is 9 months. 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
Age Requirements
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.
Family Status
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. Participating seniors must be enrolled in Medicare or Medicaid, so they meet those Medicare requirements or the Medicaid requirements.
Veteran Status Requirements
Medicaid and Medicare PACE programs are available to both Veteran and non-Veterans.
Geographic Requirements
Currently PACE programs are not available nationwide. Enrollees must reside in an eligibility area in one of the 31 states offering PACE programs.
Types of Benefit Payout
PACE benefits come only in the form of medical services. Seniors do not receive cash payments.
Restrictions on How Payout Can be Used
PACE benefits are restricted to direct payments to medical 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 average time to process a Medicare PACE application is 9 months.
This Source Can Help For
A senior’s entire medical needs be that at home or in a skilled nursing facility.
PACE programs receive a set monthly payment from Medicare or Medicaid. Participating elders do not make payments to the PACE program. The senior only pays what they would for Medicare costs or Medicaid costs.
Seniors apply for PACE with the individual regional PACE providers. Click here for a list of Pace Providers.
