PACE: the program that coordinates all your care at home

By Shirley Chia · Last reviewed June 11, 2026

When you can no longer manage fully on your own but you don't want to move into a nursing home, the usual answer is a patchwork: a home aide from one agency, a primary doctor across town, specialists who never talk to each other, rides you arrange yourself, and meals you sort out. For someone aging alone, holding that patchwork together is a second job, and it is exactly the coordinating work a spouse or adult child would normally absorb. There is a program built to do that job for you, and almost no one explains it: PACE.

PACE (the Program of All-Inclusive Care for the Elderly) is a Medicare and Medicaid program that wraps all of your care into one team that coordinates everything, so you can keep living in your own home. For a solo ager, it is the closest thing the system offers to a built-in family. Here is how it works, who qualifies, what it costs, and the real trade-off before you sign up.

What PACE actually is

PACE provides and coordinates all the care a frail older adult needs — primary care, specialists, prescription drugs, hospital and nursing-home care if it ever becomes necessary, physical and occupational therapy, in-home aides, an adult day health center, meals, dentistry, eye and foot care, and transportation to appointments — through one interdisciplinary team. That team includes doctors, nurses, social workers, therapists, aides, dietitians, and drivers, and they meet regularly about you and run your care plan together.

Most participants spend a few days a week at a PACE center, where the medical team and the day program are under one roof, and get care at home the rest of the time. The defining idea is simple: instead of you, or a relative, stitching a dozen separate providers together, the PACE team owns the whole picture and makes it fit.

Why it fits a solo ager

The hardest part of declining health on your own is rarely any single service. It is the coordination: who notices you are slipping, who gets you to the cardiologist, who reconciles the medications three different doctors prescribed, who arranges help after a fall, who follows up when something does not add up. That is the work a family quietly does. PACE hands it to a team whose literal job is to coordinate your care and keep an eye on you. For someone with no spouse or nearby adult child, that coordination is the gap PACE closes, and it is why the program is worth knowing about even if you are years away from needing it.

Who qualifies

Four conditions have to be met:

• You are 55 or older.
• You live in the service area of a PACE program.
• Your state certifies that you need a nursing-home level of care.
• At the time you enroll, you can live safely in the community with the help PACE provides.

You do not have to be on Medicaid to join. But whether you are on Medicaid is the single biggest factor in what PACE costs you.

What it costs

• If you have both Medicare and Medicaid (dual-eligible), you usually pay nothing — no monthly premium, no deductible, and no copays for care or drugs covered by PACE.
• If you have Medicare only and do not qualify for Medicaid, you pay a monthly premium that covers the long-term-care portion Medicaid would otherwise pay, plus a premium for Part D prescription coverage. Because you are privately paying the share Medicaid covers for dual-eligibles, this can run well into the thousands of dollars a month.
• If you have neither, you can pay the full cost privately, but few people do — the value of PACE is wrapped up in the Medicare and Medicaid coverage.

Within PACE there are no copays or deductibles for approved services and medications. Whether you reach dual-eligible status often comes down to your assets and your state's rules. The Medicaid spend-down estimator and your state's page show where you stand.

The real trade-off

PACE is all-or-nothing on your providers. Once you enroll, PACE becomes your sole source of care: you generally must use its doctors and its network, and if you go outside it (except in a true emergency) you can be billed for the cost. If you are attached to a primary-care doctor you have seen for years, that is a real loss, and it is the most common reason people hesitate. PACE also exists in limited places. There are roughly 170 programs across about 30-plus states, so many areas have none at all, and you can be disenrolled if you move out of a program's service area.

PACE versus the alternatives

• Versus a nursing home: PACE is designed to keep you out of one, delivering nursing-home-level support while you stay in your own home.
• Versus hiring home care yourself: PACE coordinates and pays for the aides as part of the bundle, instead of leaving you to manage agencies and pay out of pocket.
• Versus a Medicaid home-care waiver (HCBS): a waiver also funds care at home, but you still have to coordinate the providers. PACE does the coordinating for you.

For a solo ager, that coordination is the whole point of the comparison.

How to find a program and decide

• Find programs: the National PACE Association keeps a locator at npaonline.org, Medicare lists programs on medicare.gov, or call 1-800-MEDICARE.
• Check eligibility: your state Medicaid agency handles the nursing-home level-of-care assessment, and the PACE program itself walks you through enrollment.
• Compare the cost honestly: if you are dual-eligible, PACE is usually free and hard to beat for someone aging alone. If you are Medicare-only with significant assets, weigh the monthly premium against the cost — and the coordination headache — of keeping your own doctors and arranging care privately.
• Talk it through first: because enrolling means switching to PACE's providers, it is worth a free session with a SHIP Medicare counselor before you commit.

For the wider question of how you would fund care, see paying for long-term care on your own, and run the Medicaid spend-down estimator to see whether you are close to dual-eligible. If staying home is not realistic, where to live compares the other options, and the resources directory will help you find a free SHIP counselor or your Area Agency on Aging.

What a week in PACE looks like

For most participants, PACE is built around the day center. A van the program runs picks you up at home and brings you in a few days a week. At the center you see your PACE doctor and nurses, get physical or occupational therapy, have a meal, and join activities; on the other days, the same team's aides and nurses come to your home or check in by phone. If you need a specialist, the team arranges and pays for the visit. If you are hospitalized, the team manages the stay and the discharge, the exact moment a solo ager is otherwise most exposed, with no one to drive them home or follow the instructions. The rhythm is the real benefit: regular contact with people who know your baseline and will notice when something changes, before it becomes a crisis.

Questions people ask before enrolling

• Can I keep my own doctor? Usually not. PACE provides your primary care through its own team, and that is the single biggest adjustment for most people who join.
• Is it just an adult day program? No. The day center is the hub, but PACE covers and coordinates your full medical care, prescriptions, home help, and transportation — far more than a day program does.
• What if I try it and don't like it? You can disenroll at any time, for any reason. Enrollment is voluntary and not a one-way door, though you will then need to line up regular Medicare and any other coverage again.
• Do I have to give up Medicare? You keep your eligibility, but while you are in PACE your Medicare and Medicaid benefits are delivered through the program rather than separately. You cannot also be in a separate Medicare Advantage plan or use a standalone Part D drug plan at the same time.

How enrollment actually works

You start by contacting a PACE program in your area. Intake staff confirm you live in the service area and arrange the state's level-of-care assessment. The interdisciplinary team then evaluates you, both in your home and at the center, to build your initial care plan and confirm you can be served safely in the community. Enrollment takes effect on the first day of a month, and there is no fixed enrollment window — you can join whenever you qualify and a spot is open, and you can leave the same way. Because the decision swaps out your providers, this is the stage to bring in a free SHIP counselor and, if you would be paying a Medicare-only premium, to price it carefully before you sign anything.

Who PACE is right for, and who it isn't

PACE fits best if you already qualify for a nursing-home level of care but want to stay home, if you are dual-eligible so the cost is covered, and if you do not have a doctor relationship you are unwilling to give up. It fits poorly if you live where no program operates, if keeping your current providers matters more to you than the coordination, or if you are still fully independent — PACE is for people who already need substantial help, not something to buy early as insurance. For a solo ager who meets the criteria, though, trading your own doctors for a team that coordinates everything and actively watches for trouble is often the best arrangement the long-term-care system offers.