If you are helping an aging parent stay out of a nursing home, you have probably heard the phrase “Medicaid pays for long-term care” and assumed it only meant a nursing facility. It does not have to. A federal-state program called PACE, the Program of All-Inclusive Care for the Elderly, is built specifically to let frail seniors who qualify for nursing-home-level care keep living in their own home instead. Here is what PACE actually covers, who qualifies, what it costs, and how it compares to a nursing home or a Medicare Advantage plan in 2026.

What Is PACE and Who Runs It

PACE stands for Program of All-Inclusive Care for the Elderly. It is jointly administered by Medicare and Medicaid, and each state decides for itself whether to offer it, which is why PACE is not available everywhere. Instead of paying separately for a doctor visit here, a home health aide there, and a prescription somewhere else, PACE bundles comprehensive medical and social services through a single capped-financing provider.

The goal is straightforward: keep participants living at home or in their community for as long as it is safe to do so, rather than moving into an institutional setting like a nursing home. A single PACE organization becomes the participant’s complete source of care, coordinated by one team instead of a patchwork of separate providers.

Who Is Eligible for PACE (4 Requirements)

PACE eligibility comes down to four conditions, and a participant has to meet all four:

1. Age 55 or older

PACE is designed for older adults, so the minimum enrollment age is 55, even though most participants are considerably older.

2. Live in a PACE organization’s service area

This is the requirement that trips people up most often. PACE is not a statewide benefit. Coverage is organized around specific ZIP codes or counties served by a local PACE organization, so two people in the same state can have very different access depending on where they live.

3. Certified by the state as needing a nursing-home level of care

The state has to certify that the applicant’s health and functional needs meet the same standard used to qualify someone for nursing-facility care.

4. Able to live safely in the community with PACE’s support at enrollment

At the time of enrollment, the PACE team has to determine that the person can live safely at home once PACE services are in place.

Most, but not all, PACE participants are “dual eligible,” meaning they qualify for both Medicare and Medicaid. However, someone can qualify for PACE with Medicare only, Medicaid only, or neither, and simply pay privately.

What PACE Actually Pays For

Once enrolled, a participant receives every Medicare and Medicaid covered service through the PACE plan, plus a long list of extras that traditional Medicare or Medicaid typically do not cover on their own, including:

• Adult day care at a PACE center
• Meals
• Transportation to and from appointments and the day center
• In-home personal care and home care services
• Dentistry
• Hearing and vision care
• Nutritional counseling
• Social work support
• Prescription drugs

All of this is coordinated by an interdisciplinary care team, typically a doctor, nurse, social worker, and various therapists, who meet regularly to review each participant’s needs and adjust the care plan. Because PACE operates on a capped-financing model, the organization is paid a set amount per participant rather than billed service-by-service, which means the team can authorize whatever care is medically necessary rather than only what would be separately reimbursable under traditional fee-for-service rules.

How Much Does PACE Cost

Cost depends heavily on a participant’s existing Medicare and Medicaid status:

• Participants who are eligible for Medicaid pay $0 premium for the long-term care portion of PACE.
• Participants who qualify for Medicare but not Medicaid pay a monthly premium for the long-term care portion, plus a separate premium for Part D prescription drug coverage.
• There are no deductibles or copayments for any service, drug, or item of care that the PACE team approves, regardless of income level.

One important caution: services obtained outside the PACE provider network without prior authorization from the care team are generally not covered. Because PACE becomes a participant’s full source of care, going around the network can mean paying out of pocket.

PACE vs. Nursing Home vs. Medicare Advantage

PACE sits in an unusual middle ground between two more familiar options. The table below lays out the key differences.

Feature	PACE	Nursing Home	Medicare Advantage
Where you live	Your own home/community	Institutional facility	Your own home (coverage plan only, does not provide housing)
Who administers it	Joint Medicare/Medicaid, single provider organization	Facility billed through Medicaid/Medicare/private pay	Private insurer contracted with Medicare
Replaces other coverage?	Yes — becomes sole source of Medicare/Medicaid benefits	No — Medicare/Medicaid still bill separately for medical care	Yes for Medicare, but does not replace Medicaid long-term care
Typical out-of-pocket cost	$0 if Medicaid-eligible; premium if Medicare-only	Often thousands per month unless Medicaid-covered	Varies by plan; premiums, copays, network rules apply
Can you leave anytime?	Yes, disenroll at any time	Discharge planning required, less flexible	Yes, during enrollment periods or special circumstances
Best suited for	Frail seniors who need significant daily support but want to stay home	Those who need round-the-clock institutional care	Seniors who mainly need medical coverage, not daily personal care

The biggest practical difference is that PACE participants give up their other Medicare and Medicaid coverage and rely on PACE as their sole source of benefits, whereas a Medicare Advantage plan simply coordinates medical coverage and does not replace Medicaid long-term-care services. Nursing homes remain an option and, importantly, PACE can still arrange and pay for nursing-home care if a participant’s needs eventually require it. In general, PACE tends to benefit seniors who need substantial daily support but strongly prefer to avoid or delay moving into a facility.

Is PACE Available Where You Live

PACE currently operates in a limited number of states and counties, not nationwide, so availability really does depend on your exact address. To check whether a PACE organization serves your area:

• Use Medicare.gov’s PACE locator tool to search by ZIP code.
• Contact your state Medicaid agency directly, since states opt in individually.

If there is no PACE site near you, it is not a dead end. Ask your state Medicaid agency about Home and Community-Based Services (HCBS) waivers or other long-term-care programs that serve a similar purpose of keeping people out of institutional care.

How to Apply for PACE

Applying for PACE generally follows three steps:

1. Confirm a PACE organization serves your area. Use the Medicare.gov locator or your state Medicaid office to verify coverage by ZIP code or county.
2. Contact the local PACE provider directly for an assessment. The provider’s team will evaluate whether the applicant meets the nursing-home level-of-care standard and can live safely at home with PACE support.
3. Enroll. There is no annual enrollment period restriction for PACE — you can join, and later leave, at any time.

Before contacting a provider, it helps to have the following ready: proof of age and address, a summary of current care needs and diagnoses, and current Medicare and/or Medicaid status and ID numbers.

Frequently Asked Questions

Can I keep my own doctor on PACE?
Generally no. Once enrolled, PACE becomes your full source of care, and you use the doctors and specialists within the PACE organization’s own network and care team.

Can family caregivers still help?
Yes. PACE is designed to support family caregiving, not replace it. Services like adult day care, transportation, and in-home care are meant to ease the burden on family members while still allowing them to stay involved.

What happens if my needs change and I need a nursing home?
PACE does not stop covering you if your condition worsens. The program still covers and coordinates nursing-home care if it becomes medically necessary, so you do not lose coverage during a transition.

PACE will not be the right fit for everyone, since it requires giving up other coverage in exchange for a single coordinated network, and it is only available in specific areas. But for a frail senior who meets the eligibility rules and wants to avoid an institutional setting, it can cover a remarkably wide range of services, often at no premium at all. The first real step is simply checking the PACE locator tool to see if a provider serves your ZIP code.