Care at home benefits
Last checked: May 2026
PACE may help an older adult get nursing-home-level care while living at home or in another community setting.
It can bring medical care, long-term care, adult day services, rides, prescriptions, therapy, and home care under one care team.
Quick answer: PACE may pay for care at home when nursing-home-level care is needed
PACE stands for Program of All-Inclusive Care for the Elderly.
It is a Medicare and Medicaid program for some people age 55 or older who need a nursing-home level of care but can still live safely in the community with PACE help.
PACE is not a cash benefit. It is a care program. It can cover approved medical care, home care, adult day health care, transportation, prescriptions, therapy, and other needed services.
Start with the person’s ZIP code. Check the Medicare.gov PACE page, search Medicare Plan Compare, call a local PACE program, or contact the state Medicaid agency.
Who this helps
This page is for a caregiver who is asking:
- “Can my parent get nursing-home-level care at home?”
- “Is there one program for doctors, home care, rides, adult day care, and medicines?”
- “My spouse needs more help than I can give alone. Is there another path before a nursing home?”
PACE may help when the person has serious care needs, lives in a PACE service area, and can live safely with the support PACE provides.
PACE does not fit every family. Some people need nursing home care now. Some people do not live in a PACE area. Some people do not want to change doctors or use the PACE network.
What PACE is
PACE is a care program and a payment program. It serves frail older adults who meet the state’s nursing-home-level-care rules.
The goal is to help the person stay in the community when that is safe. Community may mean the person’s home, a relative’s home, or another local setting allowed by the program.
PACE uses a care team. The team may include doctors, nurses, social workers, therapists, home care workers, drivers, and other staff.
The team reviews the person’s health, daily care needs, home safety, caregiver support, and goals. Then the team decides what services PACE will approve.
Important point for family caregivers
PACE does not usually pay a family caregiver just because the person joins. It may reduce the work on the caregiver by adding services, rides, adult day care, and home help.
For payment paths, see Can I Get Paid to Be a Caregiver?
What may pay or help
PACE is tied to Medicare and Medicaid. Cost depends on the person’s coverage and finances.
Medicare.gov says people with Medicaid do not pay a monthly premium for PACE.
If the person has Medicare but does not qualify for Medicaid, the person may have to pay a monthly premium for the long-term care part of PACE and a premium for Part D drug coverage.
If the person has neither Medicare nor Medicaid, private pay may be possible if the person meets PACE rules.
Medicare.gov also says there is no deductible, copayment, or coinsurance for any drug, service, or care approved by the PACE team.
| Coverage | What to check |
|---|---|
| Medicaid and Medicare | Ask if there is any patient liability, spend-down, or income rule in your state. |
| Medicaid only | Ask the state Medicaid agency and the PACE program how enrollment works. |
| Medicare only | Ask for the full monthly cost in writing before signing. |
| No Medicare or Medicaid | Ask whether private pay is allowed and what the full premium is. |
Do not guess about cost. Ask the PACE program for a written cost sheet. If Medicaid spend-down may apply, read Medicaid Spend-Down.
What PACE services can include
PACE can cover Medicare-covered and Medicaid-covered care, plus other care the PACE team decides is needed to improve or maintain health.
Services may include:
- Primary care, nursing care, specialists, and hospital care
- Prescription drugs
- Adult day care or adult day health care
- Meals or special diet support at the center
- Home care and personal care
- Physical, occupational, and speech therapy
- Dental care, mental health counseling, and social work
- Lab and X-ray services
- Nursing home care when needed
- Transportation to the PACE center and medical appointments
The care plan is not the same for every person. The PACE team must approve care.
⚠️ PACE can change where care comes from
When someone joins PACE, they usually must use the PACE organization’s providers. Ask which doctors, hospitals, pharmacies, home care agencies, and specialists are in the network.
The adult day center and transportation model
Many PACE programs use an adult day health center as the main place for care.
The center may have a clinic, nursing care, therapy, meals, social work, personal care, and activities. PACE may also provide care at home and through outside providers.
Transportation is a major part of the model. This may help when the caregiver is missing work or cannot keep driving to many appointments.
Ask how often the person would attend the center, how rides work, and what happens if the person refuses to go.
Who may qualify
Medicare.gov lists four main PACE conditions. The person must:
- Be at least 55
- Live in the service area of a PACE organization
- Need a nursing-home level of care, as certified by the state
- Be able to live safely in the community with help from PACE
The nursing-home-level-care rule is key. It means the state must decide that the person’s needs meet its level of care standard. This standard can vary by state.
Be ready to give real examples. Does the person fall? Miss medicine? Need help bathing? Wander? Leave the stove on? Need help at night? These details can matter more than a general statement that the person “needs help.”
Where PACE is available
PACE is not available everywhere.
Medicare.gov says PACE is available only in some states that offer PACE under Medicaid. Even in a PACE state, the person must live in a local PACE service area.
Check these places:
- Medicare Plan Compare
- National PACE Association program finder
- State Medicaid agency contact page
- Eldercare Locator for local aging services
State routing matters
This national page is a starting point. PACE depends on state Medicaid rules, local service areas, and local program capacity. Confirm the rule with the local PACE program or state Medicaid agency.
Where to start first
- Search the person’s ZIP code for PACE.
- If a PACE program serves the ZIP code, call and ask for intake or enrollment.
- If no program appears, call the state Medicaid agency and ask if PACE serves the address.
- Ask who does the nursing-home-level-care review.
- Ask whether the person should apply for Medicaid long-term care before or during PACE intake.
- Ask for costs, provider network rules, and appeal rights in writing.
If the person is in the hospital or rehab, ask the discharge planner about PACE before discharge. Also read Hospital Discharge Rights.
☎️ Call script for the local PACE program
“Hi, I’m calling about PACE for my [mother/father/spouse]. They are [age] and live at [ZIP code]. They need help with [bathing, walking, medicines, dementia safety, meals, rides, or other needs]. We are trying to keep them safely at home. Do you serve this ZIP code? What is the first step for intake? Who does the nursing-home-level-care assessment? What documents should I gather?”
Before you hang up, ask for the contact person’s name, direct number, next step, and written cost information.
📄 Documents you may need
Each program can ask for different proof. Gather what you can:
- Medicare card, Medicaid card, and other insurance cards
- Photo ID and proof of address
- Medication list and diagnosis list
- Doctor, hospital, rehab, home health, or nursing notes
- List of falls, wandering, missed medicines, or safety risks
- List of daily tasks the person cannot do alone
- Income proof and bank records if Medicaid review is needed
- Power of attorney, guardianship papers, or health care proxy if you speak for the person
If you do not have legal papers yet, read Power of Attorney for an Aging Parent.
Pros and trade-offs to check before signing
Possible pros
- One care team plans many parts of care.
- Adult day health care may reduce time alone.
- Rides may be included for the center and medical visits.
- Home care, therapy, and personal care may be part of the plan.
- Approved care may have no copay or deductible.
Trade-offs
- The person may need to change doctors.
- The person usually must use the PACE network.
- A separate Medicare drug plan can cause PACE disenrollment.
- Medicare-only or private-pay costs may be high.
- Not every requested service will be approved.
If the caregiver mostly needs breaks, also check Respite Care for Caregivers.
What usually goes wrong
- The ZIP code is outside the service area. PACE is local.
- The care need is not clear on paper. Give exact daily examples.
- The family does not ask about the provider network. This can lead to surprise doctor changes.
- The person joins another Medicare drug plan. Medicare.gov says this will disenroll the person from PACE.
- The family thinks PACE pays the caregiver. PACE is mainly a care program, not a paycheck program.
- The family waits until a crisis. PACE intake can take time.
What to do if the first path does not work
If the answer is no, ask why and ask for the reason in writing.
| Reason you were told no | Next step |
|---|---|
| No PACE serves the ZIP code | Ask about Medicaid HCBS waivers, adult day care, personal care, transportation, and respite. |
| Not nursing-home level of care | Ask how the review was scored and whether missing records can be added. |
| Not safe in the community | Ask what support would be needed for safety and what other long-term care options exist. |
| Cost is too high | Ask Medicaid about long-term care coverage, spend-down, and Medicare Savings Programs. |
| A service is denied after enrollment | Ask how to request the service, file a grievance, or appeal. |
If PACE is not available, ask about Medicaid home and community-based services. See Medicaid HCBS Waivers Explained.
If the person may qualify for VA help, read VA Aid and Attendance.
If end-of-life care may be needed, read What Does Hospice Cover?. Medicaid.gov says a PACE member who wants to elect hospice must voluntarily disenroll from PACE, so ask before making any change.
If PACE denies, reduces, or stops a service
Ask for the decision in writing. Keep the letter, email, portal notice, and envelope.
Federal PACE rules include grievance and appeal processes. The eCFR says a PACE appeal can be about noncoverage or nonpayment for a service, including denial, reduction, or stopping services.
Ask the PACE program: “Is this a service determination? Can I file a grievance or appeal? What is the deadline? Can services continue during the appeal?”
You can also call 1-800-MEDICARE. Medicare.gov says SHIP programs can help people with Medicare and families file complaints or appeals. For more, see How to Appeal a Medicare Denial.
☎️ Call script if a service is denied
“I’m calling about a PACE service decision for [name]. We asked for [service]. We were told it was [denied/reduced/stopped]. Please send the decision in writing. I need the steps and deadline to request a service determination, file a grievance, or file an appeal. If services are being reduced, please tell me if they can continue during the appeal.”
Questions to ask before enrollment
- Do you serve this exact address?
- Who decides nursing-home-level care?
- Which doctors, hospitals, and pharmacies are in the network?
- How often would the person go to the PACE center?
- What transportation is included?
- What home care might be approved?
- What will the person pay each month?
- How does the person leave PACE if it does not work?
Federal rules allow a PACE participant to leave the program voluntarily at any time. The effective date is usually the first day of the month after the PACE organization receives the notice.
Official sources used / What we checked for this update
For this May 2026 update, we checked:
- Medicare.gov: PACE
- Medicare.gov: Quick Facts: Program of All-Inclusive Care for the Elderly
- Medicaid.gov: Program of All-Inclusive Care for the Elderly
- Medicaid.gov: PACE Benefits
- CMS.gov: Program of All-Inclusive Care for the Elderly
- eCFR: 42 CFR Part 460
- Medicaid.gov: State Medicaid agency contacts
- Medicare.gov: Contact Medicare
- Eldercare Locator
- National PACE Association: Find a PACE Program
Resumen corto en español
PACE es un programa de Medicare y Medicaid para algunas personas de 55 años o más que necesitan un nivel de cuidado parecido al de un hogar de ancianos, pero que pueden vivir en la comunidad con ayuda.
PACE puede incluir atención médica, medicinas, cuidado en casa, centro de día para adultos, terapia, transporte y otros servicios aprobados por el equipo de PACE.
No está disponible en todas partes. Primero busque si hay un programa PACE en el código postal de la persona. Luego llame al programa PACE o a la oficina estatal de Medicaid.
About This Guide
CaregiverBenefits.org writes guides for family caregivers who need real benefit steps, not general caregiving tips. This guide explains PACE as a care-at-home benefit path. It uses federal sources first and points readers to state and local offices because PACE depends on local service areas and state Medicaid rules.
Plain disclaimer
This guide is general information. It is not legal, financial, or medical advice. PACE rules, Medicaid rules, costs, service areas, and appeal steps can change. Confirm details with Medicare, your state Medicaid agency, the local PACE program, or a qualified local adviser.
FAQ
What is PACE?
PACE is the Program of All-Inclusive Care for the Elderly. It helps some older adults who need nursing-home-level care get care in the community instead of moving to a nursing home, when that can be done safely.
Is PACE Medicare or Medicaid?
PACE is tied to both Medicare and Medicaid. Many people in PACE have both. Some people may have only one, or may pay privately if they meet program rules.
Does PACE pay family caregivers?
PACE is mainly a care program, not a family caregiver paycheck program. It may provide care, rides, adult day services, and home help that reduce caregiver strain.
Who can qualify for PACE?
The person must usually be 55 or older, live in a PACE service area, need a nursing-home level of care as certified by the state, and be able to live safely in the community with PACE help.
Does PACE cover transportation?
Yes. Medicare.gov lists transportation to and from the PACE center and medical appointments as a possible PACE service.
Can a person keep their own doctor in PACE?
Maybe not. PACE members usually must use the PACE organization’s network. Ask for the provider list before signing.
What happens to Medicare Part D if someone joins PACE?
Medicare.gov says PACE provides Part D covered drugs and other needed medicines. It also says joining a separate Medicare drug plan while in PACE will disenroll the person from PACE.
Is PACE available in every state?
No. PACE is available only in some states and service areas. Search by ZIP code and confirm with the local PACE program or state Medicaid agency.
What if PACE says no?
Ask for the reason in writing. If the issue is service area, ask about Medicaid HCBS waivers and local aging services. If the issue is level of care, ask whether missing records can be added.
Can someone leave PACE?
Yes. Federal rules allow a PACE participant to leave the program voluntarily at any time. The effective date is usually the first day of the month after the PACE organization receives the notice.
