PACE has four clear eligibility requirements. Here is exactly what it takes to qualify and how the program works with your coverage.
What are the PACE program eligibility requirements?
Four requirements must all be met to enroll in PACE. First, you must be 55 years of age or older. Second, your state must certify that you need a nursing-home level of care based on a functional assessment. Third, you must live within the service area of a PACE organization. Fourth, you must be able to live safely in the community with the help PACE provides at the time of enrollment. You do not have to have Medicaid — you can join with Medicare alone, Medicaid alone, both, or by paying privately. Call 1-800-MEDIGAP (1-800-633-4427) to confirm whether you meet these criteria.
What does 'nursing-home level of care' mean for PACE?
A nursing-home level of care means a state assessment has determined you need help significant enough that you would otherwise qualify for nursing facility placement. This is typically based on limitations in activities of daily living — such as bathing, dressing, eating, and mobility — or cognitive impairment requiring supervision. Each state sets its specific criteria, and a PACE intake team conducts the evaluation. Meeting this standard does not mean you must enter a facility; PACE exists precisely to keep you at home with intensive support. A 1-800-MEDIGAP specialist can help you understand the process.
How does PACE eligibility affect my Medicare coverage?
Once enrolled, PACE becomes your sole provider of Medicare-covered services. You would not keep a separate Medicare Supplement (Medigap), Medicare Advantage, or stand-alone Part D plan, because PACE covers all of that and more. Because this is a major change to your coverage, it is wise to compare PACE against keeping a Medigap plan paired with home care before you enroll. Call 1-800-MEDIGAP (1-800-633-4427) for a free, unbiased comparison so your family chooses with full information.