The Program of All-Inclusive Care for the Elderly — PACE — is one of the most generous senior care benefits in the U.S. federal system. It bundles primary care, specialty care, prescriptions, hospital care, home care, adult day programs, transportation, and even nursing home care into a single coordinated program. For most enrollees, the entire benefit is free. For some, the monthly cost is modest.
And almost nobody enrolls. As of 2025, about 90,580 people are in PACE nationally. The eligible population is at least 30 to 50 times larger.
Why so few? Geographic limits — PACE only operates in 33 states and about 198 programs. Awareness gaps — most hospital social workers and primary care physicians don't mention it. And eligibility rules that look daunting until you parse them.
This guide walks through what PACE actually covers, who qualifies, how it's funded, and how to find a program near your parent.
What PACE covers
The full name says it: All-Inclusive Care for the Elderly. That includes virtually every category of care a senior might need:
- Primary care physician visits
- Specialist visits (cardiology, neurology, etc.)
- Prescription drugs (Part D-equivalent)
- Hospital inpatient and outpatient care
- Skilled nursing facility care
- Home care aides (custodial)
- Home health (skilled)
- Adult day care
- Physical, occupational, and speech therapy
- Dental, vision, hearing care
- Mental health care
- Nutritional counseling and meals
- Transportation to medical appointments and adult day center
- Emergency services
- Medical equipment and supplies
One coordinated team — the PACE Interdisciplinary Team — manages everything. The participant doesn't navigate separate providers, separate insurance approvals, separate billing. It's all under one roof.
$0
Typical out-of-pocket cost for PACE participants who qualify for both Medicare and Medicaid (dual-eligible). For Medicare-only participants, modest monthly premiums apply.
Who qualifies
To enroll in PACE, all four must be true:
- Age 55 or older
- Live in the service area of a PACE program
- Need nursing-home-level care according to the state's criteria (functional and/or medical), AND
- Be able to live safely in the community at the time of enrollment, with PACE services
The fourth criterion is the one most families miss. PACE is for people who couldbe in a nursing home but can stay in the community with comprehensive support. The participant doesn't have to be currently healthy — just stable enough to be safely at home with the right help.
How PACE is paid for
PACE participants fall into three payment categories:
1. Dual-eligible (Medicare + Medicaid)
The most common PACE participant: qualifies for both Medicare and Medicaid. For these participants, PACE is typically $0 out of pocket. Medicare and Medicaid both pay the PACE organization a fixed monthly capitation amount, and PACE provides all the care.
2. Medicare only (not Medicaid)
Some participants have Medicare but not Medicaid. They pay a monthly premium for the Medicaid portion of services. The amount varies by program and state, typically a few thousand dollars per month.
3. Private pay (no Medicare or Medicaid)
Rare. The participant pays the full PACE capitation rate, which is substantial — often $5,000–8,000/month. At that price, PACE still tends to be a better value than the equivalent à la carte (nursing home + specialist visits + prescriptions + home care), but most private-pay families opt for assisted living instead.
How PACE is different from other options
Comparing PACE to the alternatives a family typically considers:
PACE vs Medicare Advantage
Both bundle services under one organization. Medicare Advantage is plan-based — you stay in your home, manage providers, deal with prior authorizations. PACE is much more comprehensive (covers custodial care that no MA plan covers) and far more integrated (one team manages everything). PACE also includes the adult day program component, which MA plans rarely do.
PACE vs Medicaid HCBS waivers
Medicaid Home and Community-Based Services waivers also pay for home care. PACE participants get more comprehensive services (including hospital, specialty care, transportation) and a single coordinated team. Waivers often have long waitlists; PACE typically enrolls within weeks once eligibility is established.
PACE vs nursing home
PACE is the alternative to nursing-home placement, by design. The program exists because federal and state policymakers concluded that comprehensive community-based care produces better outcomes than institutional care for many seniors — and often costs less. Most PACE participants would otherwise be in nursing homes.
PACE vs assisted living
PACE participants live at home (or sometimes in subsidized senior housing). Assisted living means moving into a residential facility and paying $5,000–8,000/month privately. For families weighing assisted living for a parent who would actually prefer to stay home, PACE is often the better path — if there's a program in the service area.
How PACE works day-to-day
Most PACE participants spend significant time at the PACE day center. A typical week:
- 2–5 days at the day center — primary care visits, physical therapy, social activities, meals, monitoring
- Transportation provided — van picks up and drops off
- Home care aides visit on non-center days — help with bathing, dressing, medication, light housekeeping
- Medications delivered from the PACE pharmacy
- 24/7 nurse hotline for emergencies
- Family caregiver support — many programs offer respite, counseling, and education for family
The day center model is core to PACE. Participants get social contact, structured activity, and continuous medical monitoring in one place. For seniors who would otherwise be isolated at home — especially after a spouse's death — this single feature often extends quality of life by years.
The trade-offs to know going in
PACE isn't perfect for every family. Things to consider:
Provider restrictions
PACE participants generally must use PACE-affiliated doctors, specialists, and facilities. If your parent has a longtime relationship with a specific cardiologist outside the PACE network, that's a friction point. Some programs accommodate; most do not.
Day-center requirement
The day center attendance is core. Participants who refuse to go to the day center, or who can't physically get there, may not be a fit for PACE.
Geographic limits
PACE only operates in 33 states. Within those states, programs cover specific service areas. If your parent doesn't live in a PACE service area, the program isn't available.
Disenrollment
PACE participants can voluntarily leave the program at any time. But disenrollment triggers a return to regular Medicare and (if applicable) Medicaid coverage, with all the navigation complexity that comes with that. The reverse switch can take 30–60 days, during which gaps in coverage are possible.
How to find a PACE program
Two steps:
- Search the National PACE Association directory at npaonline.org. The directory lists every PACE program by state and service area.
- If a program serves your parent's area, call them directly. They will schedule an intake assessment, which is free. The PACE intake team determines eligibility and handles the Medicaid certification.
Don't go through the state Medicaid office to apply for PACE — go directly to the PACE program. They handle the Medicaid pieces on the participant's behalf.
The state-by-state availability gap
PACE programs operate in: Alabama, Arkansas, California, Colorado, Delaware, Florida, Hawaii, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Missouri, Nebraska, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Vermont, Virginia, Washington, Wisconsin.
States without PACE: Alaska, Arizona, Connecticut, Georgia, Idaho, Illinois, Maine, Minnesota, Mississippi, Montana, Nevada, New Hampshire, North Dakota, South Dakota, Utah, West Virginia, Wyoming.
Within states that have PACE, coverage is concentrated in larger metropolitan areas. Rural seniors often live outside the service area of any program.
If your parent is in a state without PACE, the closest equivalents are Medicaid HCBS waivers (more limited, often waitlisted) and some Medicare Advantage Special Needs Plans (D-SNPs) for dual-eligible enrollees.
Common mistakes
- Not asking about PACE at hospital discharge. The discharge planner may not bring it up. You should.
- Assuming a parent doesn't qualify because they're "not sick enough". The threshold is "needs nursing-home-level care." Many seniors meet this on functional dependency alone, even if they're medically stable.
- Confusing PACE with hospice. Hospice is end-of-life care for those with life expectancy under 6 months. PACE is comprehensive ongoing care for seniors with nursing-home-level needs. Completely different programs.
- Not pairing PACE with a Medicaid spend-down strategy for families with assets above Medicaid limits. An elder-law attorney can structure spend-down toward Medicaid eligibility, which then unlocks the most generous version of PACE.
- Refusing to consider it because of the day-center requirement. Many participants who initially resisted day-center attendance end up valuing it more than any other part of the program — for the social contact alone.
Bottom line
PACE is one of the most generous senior care benefits in the U.S., and one of the least-known. If your parent is 55+, lives in a PACE service area, would qualify for nursing-home-level care, and would prefer to stay in the community, PACE may be the best single solution available.
Cost: often $0 for dual-eligible families. Coverage: nearly everything. Coordination: one team. The catch: it's only available where it's available, the day-center model is required, and provider choice is limited.
Check the National PACE Association directory. Call the program serving your parent's area. The intake is free. The benefit can be transformative — if it's a fit.