PACE in 2026: The All-Inclusive Care Program Most Families Have Never Heard Of
6 min read · Last updated August 19, 2026
- PACE (Program of All-Inclusive Care for the Elderly) covers all Medicare- and Medicaid-covered services, plus adult day care, meals, transportation, and home care, coordinated by one care team instead of separate providers.
- You qualify at age 55 or older if you live in a PACE organization’s service area, need a nursing-home level of care as certified by your state, and can still live safely in the community with PACE’s help.
- If you have Medicaid, you pay no monthly premium for PACE at all. If you have Medicare but not Medicaid, you pay a monthly premium covering the long-term care portion plus a Part D drug premium, but never a deductible, copay, or coinsurance for anything your PACE team approves.
- PACE is only available where a PACE organization operates, so the first real step is checking whether one exists in your area, not applying to a program that may not reach your county at all.
In this article
- What PACE actually is
- Who qualifies
- What PACE covers
- What PACE costs
- What seniors get wrong
- Frequently asked questions
Grace, 78, was certified by her state as needing a nursing-home level of care after a hospital stay for a fall. Her daughter assumed that certification meant a nursing home was next. Instead, a caseworker mentioned PACE, and three months later Grace spends weekdays at a day center near her house, gets picked up by van, and sleeps in her own bedroom every night.
What PACE actually is
The Program of All-Inclusive Care for the Elderly (PACE) is a joint Medicare and Medicaid program that coordinates every service an eligible older adult needs, medical, social, and personal, under one team rather than a patchwork of separate providers and appointments. CMS describes PACE as designed specifically to help people who would otherwise qualify for nursing home care stay in the community instead.
Unlike a typical Medicare Advantage plan or Medicaid managed care arrangement, PACE assigns you an interdisciplinary team, doctors, nurses, social workers, therapists, and aides, who build a single care plan and stay involved as your needs change, rather than you coordinating referrals between separate specialists yourself.
Who qualifies
Medicare’s own PACE page lists four conditions, and you need all four: you’re at least 55 years old; you live in the service area of a PACE organization; your state has certified that you need a nursing-home level of care; and you’re able to live safely in the community with help from PACE’s services. PACE is also only available in states that have chosen to offer it under Medicaid, and even within those states, only in the specific counties or regions a PACE organization actually serves.
That geographic limit is the most practically important part. A program that would otherwise fit someone’s situation exactly is simply not an option if no PACE organization operates where they live, which is why checking service-area availability comes before evaluating anything else about eligibility.
| Requirement | What it means |
|---|---|
| Age 55 or older | No upper age limit |
| Live in a PACE service area | Only available in specific counties/regions where a PACE organization operates |
| Nursing-home level of care, state-certified | Your state’s Medicaid program makes this determination, not PACE itself |
| Able to live safely in the community with PACE’s help | Assessed by the PACE team, not a self-declaration |
What PACE covers
PACE covers everything Medicare and Medicaid would otherwise cover separately, plus services those programs don’t typically cover on their own: adult day primary care, meals and special dietary needs, recreational therapy, dentistry, home care, hospital care, laboratory and imaging services, occupational and physical therapy, nutritional counseling, prescription drugs, primary and specialty care, social services, and transportation to and from the PACE center and medical appointments.
If your PACE team decides you need something to improve or maintain your health, whether or not that item is on Medicare’s or Medicaid’s usual covered list, they can approve it, because PACE operates on a capitated model rather than billing each service separately.
Enrollment in PACE is also voluntary and ongoing rather than locked in for a plan year. You can leave PACE at any time, for any reason, and return to receiving Medicare and Medicaid benefits the standard way. That flexibility matters for a family still deciding whether the day-center model fits their parent’s routine, since trying it doesn’t foreclose other options if it turns out not to be the right fit.
What PACE costs
Cost depends on which coverage you already have. If you have Medicaid, whether alone or alongside Medicare, you pay no monthly premium for PACE. If you have Medicare but don’t qualify for Medicaid, you pay a monthly premium that covers the long-term care portion of PACE, plus a separate premium for Part D drug coverage. If you have neither Medicare nor Medicaid, you can still enroll and pay the full PACE premium yourself.
Regardless of which category applies to you, once you’re enrolled, there’s no deductible, copayment, or coinsurance for any drug, service, or care your PACE team approves. That’s a meaningful difference from Original Medicare or a typical Medicare Advantage plan, where copays and coinsurance apply even to approved care.
If your family is weighing PACE against arranging Medicaid coverage for at-home aides on your own, our guide to Medicare Savings Programs and the QMB, SLMB, and QI income tiers explains the dual-eligibility rules that often determine which path costs less.
What seniors get wrong
The most common mistake is assuming a nursing-home-level-of-care certification is a decision that a nursing home is next, rather than a technical threshold that actually opens the door to PACE and other community-based alternatives. The second is not checking whether a PACE organization even serves the applicant’s specific address before spending time on the rest of the eligibility process, since availability, not eligibility, is often the real limiting factor.
Program availability and cost structures vary by state and PACE organization. Confirm current details directly with a local PACE organization or your state Medicaid office before making a decision.
If PACE is not available in your county, or you need something short of full-scale coordinated care, home-delivered meals under the Older Americans Act are a separate program with no income test, worth checking on their own.
Frequently asked questions
Is there an upper age limit for PACE? No. The minimum age is 55, and there’s no maximum age limit as long as the other three eligibility requirements are met.
Does a nursing-home-level-of-care certification mean I have to move into a nursing home? No. It’s a state determination of care need that qualifies you for community-based alternatives like PACE, which exists specifically to let people who meet that threshold stay in their own homes.
What if PACE isn’t available where I live? PACE only operates in specific service areas where a PACE organization has been established. If none serves your area, ask your state Medicaid office or Area Agency on Aging about other home and community-based service alternatives.
Will I lose my current doctor if I join PACE? Typically, yes, since PACE coordinates your care through its own interdisciplinary team rather than your existing outside providers. Ask a specific PACE organization how they handle this before enrolling if continuity with a current doctor matters to you.
How is PACE different from a regular Medicare Advantage plan? PACE assigns you a full care team that coordinates medical, social, and personal services under one plan, including transportation and adult day care, rather than you accessing separate covered services individually the way you would under most Medicare Advantage plans.
