*6 min read · Last updated June 15, 2026*
In this article
– What PACE actually is – Who qualifies in 2026 – What PACE covers – What PACE costs – How to apply – Common reasons people get turned away or disenrolled – Frequently asked questions
Mr. Tran is 78, lives alone in a first-floor apartment, and has both Medicare and Medicaid. After a fall last winter, his doctor said he needed a nursing-home level of care. His daughter assumed that meant moving him into a facility she could not really afford. In their county, a program called PACE sent a team to his home instead. It paid for his day care, his medications, his rides to appointments, and a home aide, and Mr. Tran kept his apartment.
What PACE actually is
PACE stands for Programs of All-Inclusive Care for the Elderly. It is a joint Medicare and Medicaid program run through approved local organizations and overseen by the federal Centers for Medicare & Medicaid Services (CMS).
Here is the plain version. Instead of juggling separate doctors, a separate drug plan, a separate home aide, and separate bills, you get one team that handles all of it. This is called an interdisciplinary team: doctors, nurses, social workers, therapists, and aides who all work for the same PACE organization and coordinate your full care plan. Most members spend part of their week at a PACE day center and the rest at home.
PACE is not available everywhere. It operates in selected service areas across most states, so the first question is always whether a program serves the address where you live.
Who qualifies in 2026
There are four requirements, and you have to meet all four.
Age 55 or older. PACE is open at 55, which is younger than most people expect. You do not have to be 65.
You need a nursing-home level of care. Your state must certify that your health needs are serious enough that you would otherwise qualify for nursing-home care. In plain terms: a state assessor reviews whether you need daily help with things like bathing, dressing, moving safely, or managing complex medical conditions.
You can live safely in the community. This is the balance point. You must need nursing-home-level care on paper, but still be able to live at home safely with the help PACE provides. If you cannot be kept safe at home even with full support, PACE may not be the right fit.
You live in a PACE service area. You must live in the geographic area a PACE organization is approved to serve. This single rule turns away many otherwise-eligible seniors, so check it first before you do anything else.
You do not need both Medicare and Medicaid to enroll. Most members have both, but you can join with only one, or pay privately if you have neither. What you have changes the cost, not your eligibility.
What PACE covers
PACE covers everything Medicare and Medicaid cover, and then adds more. Once you are enrolled, your PACE team decides what care you need, and the program pays for it.
Covered care typically includes primary and specialty doctor visits, hospital and nursing-home care, prescription drugs, adult day care, physical and occupational therapy, home care and personal aides, medical equipment, transportation to the day center and to appointments, meals, social work, and even dentistry, eye care, and hearing care. The point is that there is no separate Part D drug plan and no separate long-term care bill. It is all inside PACE.
If your health declines and you eventually need to move into a nursing home, PACE pays for that too, and the same team stays involved.
What PACE costs
This is where the dual-eligible advantage is large.
If you have both Medicare and Medicaid: you usually pay nothing each month. There is no premium for the long-term care part of PACE, no premium for prescription drugs, and no deductibles or copays for any service your PACE team approves.
If you have Medicare but not Medicaid: you pay a monthly premium for the long-term care portion of PACE and a premium for Medicare Part D drug coverage. You still pay no deductibles or copays for approved services.
If you have neither: you can pay privately for the full cost.
If you are close to qualifying for Medicaid but not sure, it is worth applying, because Medicaid is what removes the monthly premium. People who qualify for PACE often also qualify for the Medicare Savings Programs and Medicare Extra Help, which can cover Medicare premiums and drug costs.
How to apply
Start by finding a PACE organization near you. Medicare.gov keeps a directory, or you can call your local Area Agency on Aging or state Medicaid office and ask.
Call the program and ask two things first: do you serve my address, and am I likely to meet the care requirement. If both answers point to yes, the program walks you through enrollment. Your state will arrange an assessment to confirm the nursing-home level of care, and the PACE team will do its own evaluation.
You can enroll in any month of the year. There is no limited enrollment window like there is for some Medicare plans. You can also leave PACE at any time.
Gather proof of age, your Medicare card, your Medicaid information if you have it, a list of your current medications, and your doctors’ contact details before the assessment.
Common reasons people get turned away or disenrolled
The service-area rule is the most common dead end. If no PACE organization serves your address, you cannot enroll, no matter how well you meet the other requirements. Check this before you get your hopes up, and ask whether a nearby program is expanding.
That network rule causes the most friction after enrollment. You agree to use the PACE team and the providers it contracts with. Emergency care is always covered, but routine care from a doctor outside the network usually is not. If staying with a long-time specialist matters to you, ask the program whether that doctor can be part of your plan before you sign up.
A few other things to know. If your health improves and you no longer need a nursing-home level of care, you may be reassessed and moved out of PACE. If you move outside the service area, you lose eligibility. And PACE is a full commitment, so you cannot also be enrolled in a separate Medicare Advantage plan or a standalone Part D plan at the same time. Readers comparing broader coverage paths can review how Medicaid expansion affects coverage options for a fuller picture.
Frequently asked questions
Do I qualify for PACE if I am only 60 and not yet on Medicare? You can. PACE eligibility starts at 55, and you do not need Medicare to join. If you have Medicaid only, or no coverage at all, you can still enroll as long as you meet the care requirement and live in the service area. Your coverage type affects what you pay, not whether you qualify.
What documents do I need to apply for PACE? You need proof of age, your Medicare card, your Medicaid details if you have them, a complete list of your current medications, and your doctors’ contact information. Your state will also schedule an assessment to confirm you need a nursing-home level of care.
How long does PACE enrollment take? Enrollment runs on a rolling basis, so you can join any month. The main step is the care assessment by your state and the PACE team, which usually takes a few weeks to schedule and complete before your coverage starts.
Can I keep my own doctor in PACE? Sometimes, but not automatically. PACE coordinates all of your care through its own team and contracted providers. Ask the program before enrolling whether your current doctor can join your care network, because non-emergency care from an outside doctor is generally not covered.
What happens to PACE if I need a nursing home later? PACE keeps covering you. If your needs grow beyond what home support can handle, the program pays for nursing-home care, and your PACE team stays involved in managing your care.
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