What Is the PACE Program? All-Inclusive Elder Care (2026)

PACE, the Program of All-Inclusive Care for the Elderly, bundles all of a frail older adult's Medicare and Medicaid care into one plan so they can stay home instead of entering a nursing facility. Two questions decide whether it fits your family, and both trip people up: whether PACE is actually free, and whether enrolling locks you in.

In This Guide

• Key Takeaways
• What the PACE Program Is and Who Runs It
• Do You Qualify? The Four-Part Test
• What PACE Actually Costs
• Are You "Locked In"? The Two Lock-Ins, Separated
• PACE vs. a Nursing Home
• Where the PACE Program Exists
• How to Enroll, and How to Leave
• Frequently Asked Questions
• Learn More

What the PACE Program Is and Who Runs It

PACE is a permanent Medicare and Medicaid benefit, authorized by Congress in the Balanced Budget Act of 1997 and governed by the federal PACE rules at 42 CFR Part 460.2 A PACE organization is unusual in that it is both the insurer and the provider: Medicare and Medicaid each pay it a fixed monthly amount per participant, and in exchange the program delivers everything, primary care, specialists, prescriptions, hospital and nursing-home care, physical and occupational therapy, adult day care, meals, and rides to appointments.

An interdisciplinary team, typically including doctors, nurses, therapists, social workers, dietitians, and home-care aides, meets to plan and authorize each participant's care. Most people in PACE are dually eligible for both Medicare and Medicaid. The model exists for one kind of person: someone sick enough to qualify for a nursing home who would rather stay in their own home.

Do You Qualify? The Four-Part Test

Federal law sets four basic requirements to enroll in PACE. You must:

1. Be 55 or older.
2. Need a nursing-facility level of care, as determined by your state's Medicaid agency. This is a clinical judgment about how much help you need with daily activities and medical needs, not a financial one.
3. Live in a PACE organization's service area. PACE is approved county by county, so your address controls whether you can enroll at all.
4. Be able to live safely in the community at the time you enroll, with the support PACE provides.2

Two points surprise families. First, there is no income or asset test to enroll in PACE itself, and eligibility is not limited to people who already have Medicare or Medicaid. Second, being under 55 does not qualify you no matter how serious your disability, and living outside a service area disqualifies you no matter how great your need.

What PACE Actually Costs

The cost depends entirely on whether you also have Medicaid, and "no financial test to enroll" does not mean "free."

If you have full Medicaid (or are dually eligible for Medicare and Medicaid), PACE charges no premium, deductible, copayment, or coinsurance for any care your team approves.2 For a dual-eligible participant, PACE costs $0 a month.

If you have Medicare but not Medicaid, you pay a monthly premium for the long-term-care portion of PACE, the part Medicaid would otherwise cover, and you keep paying your standard Part B premium, which is $202.90 a month in 2026.3 That long-term-care premium is not a small number; it commonly runs to several thousand dollars a month, because it represents the full cost of the care Medicaid would pay for. If you have neither Medicare nor Medicaid, you can pay the entire cost privately.

Assuming "no financial test to enroll" means "no Medicaid rules" is where families get caught. The Medicaid that makes PACE free is institutional (nursing-home-level) Medicaid, so the same machinery applies: you generally must spend down income and assets to qualify, transfers of assets in the 60 months before you apply can trigger a penalty period,4 and after death the state can seek repayment from your estate through Medicaid estate recovery.5 Where a married couple has one spouse entering PACE and one staying home, federal spousal-impoverishment rules let the at-home spouse keep between $32,532 and $162,660 in assets and up to $4,066.50 a month in income in 2026.6 If you are weighing PACE, read our guides to Medicaid estate recovery and Medicaid planning before you apply.

Are You Locked In? The Two Lock-Ins, Separated

"Can I get out of PACE?" and "Can I keep my own doctor?" are two different questions with two different answers. Answer them separately.

Enrollment: you are not locked in. PACE enrollment is voluntary. You can disenroll at any time, for any reason, and the change takes effect the first day of the month after the program receives your notice.2 A PACE organization can only involuntarily disenroll you on narrow, federally listed grounds (for example, if you move out of the service area, or fail to pay a premium you owe). One caveat: leaving PACE means re-entering regular Medicare, and Medicare's own enrollment-period timing can affect when your new coverage starts, so line up the replacement coverage before you quit.

Providers: yes, it is a closed network. Once you enroll, your PACE team provides or authorizes all of your non-emergency care. Seeing your former primary-care doctor, a specialist, or a hospital that PACE has not authorized generally means PACE, Medicare, and Medicaid will not pay, because the program has already been paid a lump sum to cover everything, so you can be personally responsible for the bill. Emergencies are covered wherever you are. This closed-network design is the real "lock-in," and it is a common reason people leave PACE in the first few months.

PACE vs. a Nursing Home

Both PACE and nursing-home Medicaid serve people who need the same level of care. The difference is where you live and who directs your care.

Where the PACE Program Exists

PACE is not available everywhere. As of 2026, there are 202 PACE programs operating in 33 states and the District of Columbia, and seventeen states have none at all; close to 92,000 people are enrolled in PACE nationwide.1 Even inside a participating state, a program only serves designated counties, so a frail adult in the wrong county cannot enroll no matter how well they qualify.

Availability is also changing. Georgia, for example, had no operating PACE site as of mid-2026 and was still in the process of procuring one.7 States also brand the program differently: in Pennsylvania, New Jersey, and some New York plans, all-inclusive-care PACE is marketed as LIFE (Living Independence for the Elderly).8 Watch the acronym in Pennsylvania especially, where "PACE" separately names an unrelated state program that helps older residents pay for prescription drugs.9

To find out whether a program serves your area, use the National PACE Association locator or call your state Medicaid agency. Our state guides walk through the specifics where PACE operates, including New York and Tennessee, where the only program serves Hamilton County.

How to Enroll, and How to Leave

Enrolling is a deliberate, in-person process, not a form you submit online. After you contact a local program, its team assesses your health and your existing benefits, your state confirms you meet the nursing-facility level of care, and you (and your family) tour the PACE center and meet the team. You choose to enroll; PACE cannot auto-assign you the way a managed-care plan sometimes can.

Leaving is simpler. Because there is no enrollment lock-in, you give the program notice and your disenrollment takes effect the first of the next month.2 The one thing to plan for is your next coverage: arrange your return to regular Medicare (and any Medicare Advantage or drug plan) so you are not left with a gap.

Learn More

Find personalized help deciding whether PACE fits your family and finding a program near you at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.