What are Programs of All-inclusive Care for theElderly (PACE)?
PACE is a Medicare program for older adults and people over age 55 living with disabilities. This program provides community-based care and services to people whootherwise need nursing home level of care. PACE was created as a way toprovideyou, your family, caregivers, and professional health care providers flexibility to meetyour health care needs and to help you continue living in the community.An interdisciplinary team of professionals will give you the coordinated care youneed. These professionals are also experts in working with older people. They willwork together with you and your family (if appropriate) to develop your mosteffective plan of care.PACE provides all the care and services covered by Medicare and Medicaid, asauthorized by the interdisciplinary team, as well as additional medically-necessarycare and services not covered by Medicare and Medicaid. PACE provides coveragefor prescription drugs, doctor care, transportation, home care, check ups, hospitalvisits, and even nursing home stays whenever necessary. With PACE, your abilityto pay will never keep you from getting the care you need.
Who can join a PACE Plan?
You can join PACE if you meet the following conditions:•You are 55 years old or older.•You live in the service area of a PACE organization.•You are certified by the state in which you live as meeting the need for the nursinghome level of care.•You are able to live safely in the community when you join with the help of PACEservices.Note:You can leave a PACE program at any time.
PACE services include but aren't limited to the following:
• Primary Care (including doctor and
nursing services)
• Hospital Care
• Medical Specialty Services
• Prescription Drugs
• Nursing Home Care
• Emergency Services
• Home Care
• Physical therapy
• Occupational therapy
•Adult Day Care•Recreational therapy•Meals•Dentistry•Nutritional Counseling •Social Services •Laboratory / X-ray Services•Social Work Counseling•Transportation
PACE also includes all other services determined necessary by your team of healthcare professionals to improve and maintain your overall health.
You should know this about PACE:
PACE Provides Comprehensive Care
PACE uses Medicare and Medicaid funds to cover all of your medically-necessarycare and services. You can have either Medicare or Medicaid or both to join PACE.
The Focus is on You
You have a team of health care professionals to help you make health care decisions.Your team is experienced in caring for people like you. They usually care for a smallnumber of people. That way, they get to know you, what kind of living situation youare in, and what your preferences are. You and your family participate as the teamdevelops and updates your plan of care and your goals in the program.
PACE Covers Prescription Drugs
PACE organizations offer Medicare Part D prescription drug coverage. If you join aPACE program, you'll get your Part D-covered drugs and all other necessary medication from the PACE program. Note:If you are in a PACE program, you don't need to join a separate Medicaredrug plan. If you do, you will lose your PACE health and prescription drug benefits.
You should know this about PACE: (continued)
PACE Supports Family Caregivers
PACE organizations support your family members and other caregivers with caregiving training, support groups, and respite care to help families keep theirloved ones in the community.
PACE Provides Services in the Community
PACE organizations provide care and services in the home, the community, andthe PACE center. They have contracts with many specialists and other providersin the community to make sure that you get the care you need. Many PACE participants get most of their care from staff employed by the PACE organizationin the PACE center. PACE centers meet state and Federal safety requirements andinclude adult day programs, medical clinics, activities, and occupational and physical therapy facilities.
PACE is Sponsored by the Health Care Professionals Who Treat You
PACE programs are provider sponsored health plans. This means your PACE doctor and other care providers are also the people who work with you to makedecisions about your care. No higher authorities will overrule what you, your doctor, and other care providers agree is best for you. If you disagree with theinterdisciplinary team about your care plan, you have the right to file an appeal.
Preventive Care is Covered and Encouraged
The focus of every PACE organization is to help you live in the community for aslong as possible. To meet this goal, PACE organizations focus on preventive care.Although all people enrolled in PACE are eligible for nursing home care, only 7%live in nursing homes.
PACE Provides Medical Transportation
PACE organizations provide all medically-necessary transportation to the PACE center for activities or medical appointments. You can also get transportation toappointments in the community.
CMS Publication No. 11341
January 2008
You should know this about PACE: (continued)
What You Pay for PACE Depends on Your Financial Situation
If you qualify for Medicare, all Medicare-covered services are paid for by Medicare.If you also qualify for your State's Medicaid program, you will either have a smallmonthly payment or pay nothing for the long-term care portion of the PACE benefit. If you don't qualify for Medicaid you will be charged a monthly premiumto cover the long-term care portion the PACE benefit and a premium for MedicarePart D drugs. However, in PACE there is never a deductible or copayment for anydrug, service, or care approved by the PACE team. ... show more
