What Is the PACE Program? (And What They Don't Tell You)

Maybe a hospital social worker mentioned it. Maybe a friend said, "Have you looked into PACE?" And now you're trying to figure out whether this is the answer you've been looking for, or one more program with a catch.

Honestly, it can be both. For the right family, PACE is remarkable: one team that handles the doctor, the medications, the rides, the adult day center, the home care, even the hospital, with no copays. For others, the rules are a deal-breaker, especially if Mom loves her doctor.

The difference usually comes down to a few rules that aren't on the brochure. This guide explains how PACE works, who qualifies, what it costs, the fine print, and how to find a program near you.

What Is PACE, Exactly?

PACE stands for the Program of All-Inclusive Care for the Elderly. Medicare.gov describes it as a program that "helps eligible older adults who need nursing home-level care meet their health care needs in the community", in other words, at home, instead of moving to a nursing home.

Translation: a single local organization takes over all of a person's health care, from primary care and prescriptions to rides, home care and hospital stays, and coordinates it through a care team that actually knows them.

In Pennsylvania, PACE is called LIFE (Living Independence for the Elderly). Same program, different name.

PACE is growing fast. About 98,066 people are enrolled in 205 PACE programs, and Medicare enrollment in PACE has more than doubled in ten years.

How PACE Works Day to Day

At the heart of every PACE program is a PACE center: an adult day health center with a primary care clinic inside. Participants come for the day to see their doctor or nurse, get therapy, have lunch, join activities and see friends. How often someone attends is decided by the care team with the participant, from once a week to most weekdays.

Around the center works an interdisciplinary care team. Federal rules require at least eleven roles, from the doctor and nurse to the dietitian and the driver, and the team usually cares for a small group of people, so they get to know each one.

PACE covers everything Medicare and Medicaid cover, plus anything else the team decides you need. Medicare.gov lists, among others: adult day care with meals and recreation, primary care, specialists, dentistry, prescription drugs, home care, hospital care, nursing home care when medically necessary, therapy, social services, and transportation to the center and to appointments.

Who Qualifies?

Under federal rules, you can join PACE if you:

• Are 55 or older
• Live in the service area of a PACE organization (defined by ZIP code or county)
• Need a nursing home level of care, as certified by your state
• Can live safely in the community with PACE's help at the time you join

You do not need Medicare or Medicaid to join, although in practice almost everyone has one or both. "Nursing home level of care" sounds severe, but it's a state assessment of how much help someone needs with daily activities like bathing, dressing, eating, moving around or managing medications. Many people living at home with a family caregiver meet it. The state checks it again at least once a year.

Once you're in, enrollment continues for life unless you leave, even if your health changes.

What Does PACE Cost?

This depends almost entirely on whether your loved one has Medicaid.

For people without Medicaid, federal rules set the premium equal to what the state's Medicaid program pays the PACE organization each month, so it varies by state and program and is often several thousand dollars a month. The drug premium is also high: the National PACE Association says it can cost "up to 22 times more" than a typical Part D plan. Ask each program for its exact rate.

81% of PACE participants have both Medicare and Medicaid, and another 19% have Medicaid only. Fewer than 1% pay privately.

That figure (from MACPAC, the congressional advisory commission on Medicaid, 2023 data) is the honest bottom line: for most families, PACE makes financial sense only with Medicaid. If your loved one is close to qualifying, ask your state Medicaid office or the PACE program to help check.

Two costs people miss even with Medicaid: some states require a monthly "share of cost" if income is above the Medicaid limit, and if your loved one lives in assisted living, room and board is usually paid separately.

What They Don't Tell You

None of this is hidden; it's all in the federal rules and the enrollment agreement. But families often learn it after they've signed.

"You'll have to use PACE's doctors"

When you join, PACE becomes your only provider. You choose your primary care doctor and specialists from within the PACE network, and the rules say outright that PACE "guarantees access to services, but not to a specific provider." If a long-time doctor matters a lot to your parent, ask before anything else whether that doctor works with the program.

"The team decides"

Services are covered when the care team approves them, based on an assessment of your needs and current clinical guidelines. That's what makes the care coordinated, but it also means you can't simply book a specialist yourself. If the team says no, you have the right to appeal.

"Leaving isn't instant, and hospice counts as leaving"

You can leave PACE at any time, for any reason, but it takes effect on the first day of the following month, and until then you keep using PACE. Choosing the separate Medicare hospice benefit, or joining a separate Medicare drug plan, also ends PACE membership. PACE provides its own end-of-life and palliative care, which many families value, but it's worth knowing in advance.

"In an emergency, go to the nearest ER"

Emergency care needs no prior approval, anywhere in the country. But once someone is stable, follow-up care outside PACE should be approved by PACE, so call the program as soon as you can. You'll get an emergency information sheet to keep at home.

"Some people do end up in a nursing home"

PACE pays for nursing home care when the team decides it's needed, and some participants eventually live in one while staying in PACE. In 2023, about 7% of PACE participants with Medicare had a nursing home stay of 90 days or more, and 86% of them stayed enrolled through it.

Does PACE Work? What the Research Says

The best recent evidence is encouraging. A 2026 federal study for HHS compared PACE participants with similar people in Medicare Advantage plans. PACE participants were less likely to be hospitalized, less likely to visit the ER, and less likely to die over the study period. Nursing home use was a little lower too, but that difference wasn't statistically significant.

The picture isn't all rosy. An earlier federal evaluation (Mathematica, 2015) found lower mortality in PACE too, but also that PACE cost state Medicaid programs more than expected and that participants were more likely to have short nursing home stays. And in 2026, MACPAC told Congress that PACE quality data are "limited and non-standardized", which makes it hard to compare programs. In practice, that means you can't look up a star rating for a PACE program the way you can for a Medicare Advantage plan, so your own visit and questions matter more.

Is PACE Right for Your Family?

PACE tends to work well when:

• Your loved one has Medicaid, or will soon qualify
• They need a lot of help and see many different providers, and coordinating it all is wearing you out
• They'd enjoy, or at least accept, going to a day center regularly
• You want them to stay at home as long as possible

Think twice if:

• Keeping a particular doctor or specialist is non-negotiable
• They have Medicare only and the private premium would be a stretch
• They travel or spend long stretches away from home (being out of the service area for more than 30 days in a row can end enrollment)
• You're already planning for hospice

If PACE isn't available or isn't the right fit, a regular adult day center can still give your loved one daytime care and you a break, often paid for by a Medicaid waiver. See What Is Adult Day Care? and Respite Care.

PACE in Your State, and How to Apply

PACE runs in 33 states and the District of Columbia. California has the most programs by far, followed by Pennsylvania, Michigan, Florida and North Carolina. Seventeen states have none yet.

How Enrollment Works

1. Contact the PACE program directly.You can't enroll through Social Security. Find programs above, on NPA's PACE finder, or with Medicare's PACE plan search. Your state Medicaid office can help too.
2. Intake visits.PACE staff visit your loved one at home, and you visit the PACE center. They explain the rules, the network, and any premium or share of cost.
3. State assessment.The state confirms that your loved one needs a nursing home level of care. Medicaid financial eligibility is checked separately.
4. PACE assessment.The team confirms they can care for your loved one safely at home.
5. Sign the enrollment agreement.Read it with the rules above in mind, and ask about anything unclear.
6. Start on the first of the month.Enrollment begins the first day of the month after the agreement is signed. You'll get a membership card and an emergency sheet for the fridge.

Questions to Ask a PACE Program

• Does our ZIP code fall within your service area? Is there a waiting list?
• Which doctors and specialists are in your network? Is our current doctor?
• How many days a week would my parent attend the center? How long is the ride?
• How many hours of home care do participants like my parent typically get?
• What would our monthly cost be, including any share of cost or Part D premium?
• What happens if my parent needs a nursing home, or end-of-life care?
• Can we talk to a few current participants or family members?

Next Steps

1. Check whether PACE exists near you. Use the lookup above.
2. Check Medicaid. If your loved one might qualify, start that application; it changes the math.
3. Ask about the doctor. If a current doctor matters, ask the program first.
4. Visit the center together. Would your loved one enjoy spending days there?
5. Read the enrollment agreement. Especially the parts about providers, leaving, and hospice.

PACE trades choice for coordination. For families worn out by juggling doctors, rides and pharmacies, that trade is often worth it.

The right program is the one that fits your loved one's needs, your finances and your family. PACE is one good answer among several, and knowing the fine print up front means you can choose it with your eyes open.