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 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 460.1 A PACE organization is unusual in that it is both the insurer and the provider: it is paid a fixed monthly capitation amount for each participant, and in exchange it must deliver all Medicare-covered services, all Medicaid-covered services in your state's plan, and any other services its team decides you need, adult day care and meals among them.1,2 While you are enrolled, you get your Medicare and Medicaid benefits only through the PACE organization.3

An interdisciplinary team decides which services each participant gets, basing each decision on an evaluation of the person's medical, physical, emotional, and social needs.7 Most people in PACE are dually eligible for both Medicare and Medicaid.6 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 the state agency that administers PACE. It is a test of the care you need, not of your finances.
3. Live in a PACE organization's service area. Each PACE organization serves a defined service area, so your address controls whether you can enroll at all.
4. Meet any extra conditions in the program's PACE agreement. These can add requirements but cannot change the first three.

Separately, at the time you enroll you must be able to live in the community without jeopardizing your health or safety.1

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 are eligible for Medicaid (including dual eligibles, who have both Medicare and Medicaid), PACE cannot charge you a monthly premium, and it must accept Medicaid's payment as payment in full, so it cannot bill you for the care your team approves. The one exception: you still owe any Medicaid spend-down liability, plus any share of your income your state's post-eligibility rules require you to put toward your care.1

If you have Medicare but not Medicaid, you pay PACE a monthly premium equal to the Medicaid capitation amount, the monthly rate Medicaid would otherwise pay the program to cover you. If you have Medicare Part A but not Part B, or Part B but not Part A, the premium also adds Medicare's rate for the part you lack.1 Expect that premium to be substantial, because it stands in for the long-term-care payment Medicaid would make. If you are enrolled in Part B, you also keep paying the standard Part B premium, which is $202.90 a month in 2026.8 Medicare.gov also lists a separate premium for Medicare Part D drug coverage for a participant with Medicare but not Medicaid. If you have neither Medicare nor Medicaid, you can pay the PACE premium privately.2

Assuming "no financial test to enroll" means "no Medicaid rules" is where families get caught. To have Medicaid pay for PACE, you have to qualify for Medicaid, and that brings its long-term-care rules with it. In Tennessee, for example, the Medicaid group for PACE participants covers people who would be eligible under institutional (nursing-home) rules.9 Federal law applies a 60-month look-back when Medicaid decides long-term-care eligibility: giving assets away or selling them for less than fair market value in the 60 months before you apply can trigger a penalty period (California's Medi-Cal now uses a 30-month look-back for nursing-facility care).4 Ask your state Medicaid agency how its transfer rules apply to the Medicaid that pays for PACE. 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, and the state applies its spousal-impoverishment rules, those rules protect the at-home spouse. For 2026, each state picks a resource standard for the at-home spouse between $32,532 and $162,660, and the maximum monthly maintenance needs allowance is $4,066.50. Those are not hard ceilings: a fair hearing or a court order can protect more assets, and a fair hearing can raise the income allowance when exceptional circumstances cause significant financial duress.10 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.1 A PACE organization can involuntarily disenroll you on the grounds federal rules list, and those grounds come with conditions. Unpaid premiums, spend-down, or income contributions count only after a 30-day grace period in which you neither pay nor make satisfactory arrangements to pay. The program cannot drop you for behavior such as missed appointments or not following medical advice when that behavior is related to a mental or physical condition, unless it jeopardizes your health or safety or the safety of others. The state agency that administers PACE must review the disenrollment and find the grounds adequately documented before it takes effect, and it takes effect no sooner than the first of the month beginning 30 days after the program sends you notice.1 One caveat: joining a separate Medicare drug plan, or another Medicare or Medicaid plan, while you are in PACE counts as leaving PACE, so line up the replacement coverage deliberately before you quit.11

Providers: yes, it is a closed network. Once you enroll, you must get all of your care, including primary care and specialists, from the PACE organization or from providers it authorizes; emergency services are the exception.3 If you keep seeing a former doctor, a specialist, or a hospital that PACE has not authorized, you may be fully and personally liable for the cost.3 This closed-network design is the real "lock-in."

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 the National PACE Association's September 2026 roster, 205 PACE programs operated in 33 states and the District of Columbia, which left seventeen states with none; total PACE enrollment is close to 92,000 people nationwide.6 Even inside a participating state, a program serves only its own service area, so a frail adult outside it cannot enroll no matter how well they qualify.

Availability is also changing. Georgia, for example, ran a state PACE procurement in 2025 and has since issued awards for its Gainesville and Savannah regions, but state records do not yet say whether any awarded PACE center has opened to participants.14 States can also brand the program differently: Pennsylvania's version of PACE is called LIFE (Living Independence for the Elderly).15 Watch the acronym in Pennsylvania especially, where "PACE" separately names an unrelated state program that helps older residents pay for prescription drugs.16

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 TennCare lists living in Hamilton County as a PACE eligibility requirement.9

How to Enroll, and How to Leave

Enrolling takes more than a form. After you contact a local program, your state's administering agency has to determine that you need a nursing-facility level of care.1 You (or your representative) then sign an enrollment agreement acknowledging that the PACE organization will be your sole service provider, and joining ends your enrollment in any other Medicare or Medicaid prepayment plan, including a Medicare Advantage plan.3,11 Enrollment is not permanent, either: to stay eligible, you must meet PACE's annual recertification requirements.1

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.1 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.