To join PACE, the Program of All-Inclusive Care for the Elderly, you must meet four conditions: you are 55 or older, you live in the service area of a PACE organization, your state certifies that you need a nursing home level of care, and you are able to live safely in the community with help from PACE services. You do not need Medicare or Medicaid to join. If you have Medicaid, there is no monthly PACE premium. If you have Medicare but not Medicaid, you pay a monthly premium for the long term care part of the benefit plus a premium for Medicare drug coverage. Either way, you have no deductible, copayment, or coinsurance for any drug, service, or care your PACE team approves.
PACE exists to keep people who qualify for a nursing home living at home instead. As of July 2026 there were 204 PACE programs operating in 33 states and the District of Columbia, serving more than 90,000 participants, according to the National PACE Association.
PACE eligibility requirements at a glance
| Requirement | What it means | Who decides |
|---|
| Age 55 or older | No upper age limit. Younger than 55 cannot enroll, even with the same care needs. | PACE organization |
| Live in a PACE service area | Service areas are defined by ZIP code or county, not by state. | PACE organization |
| Need a nursing home level of care | Your functional and medical needs must meet your state's nursing facility standard. | State Medicaid agency |
| Able to live safely in the community | With PACE services in place, your home situation has to be workable. | PACE interdisciplinary team |
| Medicare or Medicaid | Not required. Both affect cost, neither affects eligibility. | Not applicable |
Source: Medicare "Quick Facts: Program of All-Inclusive Care for the Elderly (PACE)," CMS Product No. 11341, and medicaid.gov.
The age rule: 55, not 65
PACE is the rare Medicare-connected program that starts at 55. That matters for people with early onset dementia, Parkinson's disease, multiple sclerosis, stroke effects, or serious diabetes complications in their late fifties and early sixties, who often need long term care years before they turn 65.
Enrolling at 55 to 64 without Medicare is allowed. People in that group usually reach PACE through Medicaid long term care eligibility, or by paying privately. If you are 55 to 64 and get Medicaid through the ACA expansion group rather than a long term care pathway, note that Medicaid's new work requirement applies to expansion adults ages 19 to 64. It takes effect no later than January 1, 2027 in most expansion states, and earlier in some, including Nebraska since May 1, 2026, Montana since July 1, 2026, and Iowa for applications filed on or after December 1, 2026. Exemptions include people who are medically frail, which generally covers someone a state has certified as needing nursing home level care. Ask your caseworker to document the exemption rather than assume it is automatic.
Nursing home level of care: what states actually check
There is no single federal test. Each state sets its own nursing facility level of care standard, and your state Medicaid agency or its contractor runs the assessment. In practice, assessors look at:
- Activities of daily living: bathing, dressing, toileting, transferring, eating, mobility
- Instrumental activities: managing medications, cooking, housekeeping, handling money
- Cognitive status, including dementia diagnoses, memory loss, and safety judgment
- Behavioral needs such as wandering or exit seeking
- Skilled nursing needs such as wound care, injections, catheters, or tube feeding
- Medical instability, including frequent hospitalizations and multiple chronic conditions
Most states require a specific number of ADL deficits, or a cognitive impairment plus some functional need. The assessment is usually done in your home and typically takes one to two hours.
Once you are enrolled, your state reevaluates your level of care at least once a year. States may permanently waive that annual review when there is no reasonable expectation of improvement because of the severity of a chronic condition. If you improve enough that you no longer meet the standard, you can keep PACE under "deemed continued eligibility" until the next annual review when the state finds you would reasonably be expected to meet the standard again within 6 months without PACE. Those rules are at 42 CFR 460.160.
Where PACE is available in 2026
PACE is not nationwide, and eligibility stops at the service area boundary. As of July 2026, PACE programs operated in these states and DC:
| Region | States with PACE programs |
|---|
| Northeast | Massachusetts, New Jersey, New York, Pennsylvania, Rhode Island |
| South | Alabama, Arkansas, Delaware, District of Columbia, Florida, Kentucky, Louisiana, Maryland, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia |
| Midwest | Iowa, Illinois, Indiana, Kansas, Michigan, Missouri, Nebraska, North Dakota, Ohio, Wisconsin |
| West | California, Colorado, New Mexico, Oregon, Washington |
Source: National PACE Association, "PACE in the States," July 2026.
Several states use their own names. In Pennsylvania, PACE sites are called LIFE programs, for Living Independence for the Elderly. Be careful with that one: Pennsylvania also runs a completely separate prescription assistance program named PACE, short for Pharmaceutical Assistance Contract for the Elderly. They are unrelated. Wisconsin runs PACE alongside Family Care. Alabama and Massachusetts have sites branded Mercy LIFE.
Even in a PACE state, coverage is local. A program in one metro area often serves only a handful of counties. Use the Medicare plan finder at medicare.gov or the National PACE Association locator at npaonline.org to check your ZIP code.
What PACE costs in 2026
| Your coverage | Monthly PACE premium | Other costs | Cost sharing on approved care |
|---|
| Medicare and Medicaid (dual eligible) | $0 | Medicare Part B premium is usually paid by Medicaid | None |
| Medicare only, no Medicaid | Premium for the long term care part of the benefit, plus a premium for Medicare drug coverage | Part B premium of $202.90 a month in 2026 | None |
| Medicaid only | $0 | None typically | None |
| Neither Medicare nor Medicaid | Full private pay premium | None | None |
The long term care premium for a Medicare-only participant is set at the Medicaid capitation rate the state would otherwise pay. That is the full cost of the care package, so it commonly runs into the thousands of dollars a month and varies widely by program and region. Ask the PACE organization for its exact figure in writing before you sign anything.
The flip side is real. Regardless of your financial situation, you have no deductible, copayment, or coinsurance for any drug, service, or care your PACE team approves. For a dual eligible participant, PACE is one of the few benefits in American health care with no cost sharing at the point of service.
Medicaid income and asset limits that decide whether you pay a premium
PACE itself has no income or asset test. Medicaid does, and Medicaid eligibility is what determines whether your premium is zero. Most states screen PACE applicants under their nursing home or home and community based services rules rather than ordinary adult Medicaid.
| 2026 standard | Figure | Note |
|---|
| Income limit, states using 300% of the SSI federal benefit rate | $2,982 a month for one applicant | 3 times the 2026 SSI rate of $994. Rises to $3,087 in January 2027, when the SSI rate goes to $1,029 |
| Countable asset limit, individual | $2,000 federal floor | Some states set higher limits |
| Countable asset limit, couple both applying | $3,000 federal floor | Varies by state |
| Community spouse resource allowance | $32,532 to $162,660 | The at-home spouse keeps this much |
| Minimum monthly maintenance needs allowance | $2,643.75 to $4,066.50 | Income protected for the at-home spouse |
| Home equity limit | $752,000 to $1,130,000 | State sets its figure in the range |
Sources: SSA 2026 SSI amounts (90 FR 49047); CMS Center for Medicaid and CHIP Services informational bulletin on 2026 SSI and spousal impoverishment standards, April 27, 2026.
Some states run a medically needy or spend down pathway, which lets people above the income limit qualify after subtracting medical expenses. Others use a Qualified Income Trust, sometimes called a Miller Trust. Rules differ enough that this is worth a conversation with your state's Medicaid office or a free SHIP counselor.
One 2026 change matters here. Since October 1, 2026, full Medicaid and CHIP are limited to citizens and nationals, green card holders, Cuban and Haitian entrants, and citizens of Micronesia, the Marshall Islands, and Palau. Refugees, asylees, parolees, and other immigrants without a green card generally no longer qualify for full Medicaid. Most green card holders also must wait 5 years from the date they got their qualifying status, with no wait for people who came as refugees or asylees, for veterans and active duty service members and their families, or for citizens of the three freely associated states. Emergency Medicaid still pays for emergency care. A person who cannot get Medicaid can still enroll in PACE by paying privately.
What PACE covers
PACE covers everything Medicare and Medicaid cover when your care team approves it, and it can cover services neither program normally pays for. The standard list includes adult day care, primary care, specialty care, prescription drugs, dentistry, hospital care, nursing home care, home care, personal care, physical therapy, occupational therapy, speech therapy, mental health counseling, nutritional counseling, lab and x-ray services, preventive care, social services, transportation to the PACE center and to medical appointments, and emergency services.
Most programs center on a PACE day center, where you see the medical team, get therapy, eat meals, and socialize. Attendance varies from one day a week to five, depending on your plan of care.
How to enroll in PACE
- Check your ZIP code. Use the plan finder at medicare.gov or the locator at npaonline.org. If there is no program in your area, ask your state Medicaid agency about a home and community based services waiver instead.
- Call the PACE organization directly. You do not apply through Medicare or through a broker. Programs take enrollment inquiries year round.
- Complete the intake and home visit. The interdisciplinary team assesses your medical needs, your home, and your support network, and decides whether you can live safely in the community with PACE services.
- Get your level of care certified. The program coordinates the state assessment. Expect two to six weeks, depending on the state.
- Apply for Medicaid long term care if you have not already. This is the step that decides your premium. Do it in parallel, not after. Most PACE organizations have staff who help with the application.
- Sign the enrollment agreement. Read the network and premium terms first.
- Coverage starts the first day of the next month. Enrollment takes effect on the first day of the calendar month after the PACE organization receives your signed agreement, under 42 CFR 460.158.
Three rules catch people off guard. First, you must use providers in the PACE organization's network, so if you want to keep a longtime specialist, ask whether that doctor contracts with the program before you sign. Second, if you join a separate Medicare drug plan while you are in PACE, you will be disenrolled from PACE, because PACE already includes your drug coverage. Third, PACE has no restricted enrollment windows. You can join in any month and leave in any month. Voluntary disenrollment takes effect on the first day of the month after the program receives your notice.
Frequently Asked Questions
Do I need Medicare to qualify for PACE?
No. Joining PACE is voluntary and you can enroll even if you have neither Medicare nor Medicaid, as long as you meet the four eligibility conditions and pay the premium yourself. Medicare and Medicaid status affects what you pay, not whether you qualify.
What is the income limit for the PACE program in 2026?
PACE has no income limit of its own. The limit that matters is your state's Medicaid long term care limit, because Medicaid eligibility is what makes your PACE premium zero. In states that use 300% of the SSI federal benefit rate, the 2026 figure is $2,982 a month for one applicant, rising to $3,087 in January 2027.
Can I get PACE if I live alone?
Often yes. The test is whether you can live safely in the community with help from PACE services, not whether you have a family caregiver. Programs serve many people living alone by combining day center attendance, home care aides, meals, and transportation. If the team concludes your home is unsafe even with those supports, it can decline enrollment.
Does PACE pay for nursing home care?
Yes. If you later need to move to a nursing facility, PACE pays for it and your care team keeps managing your care. You do not have to disenroll, and you do not get a new bill for the facility.
Can I keep my own doctor in PACE?
Only if that doctor is in the PACE organization's network. PACE uses a closed provider network with its own primary care team, which is the main tradeoff for the no cost sharing design. Emergency care outside the network is covered.
Is PACE the same as a Medicare Advantage plan?
No. Medicare Advantage plans are insurance products with copays, networks, and annual enrollment windows. PACE is a care delivery program with one interdisciplinary team, no cost sharing on approved services, year round enrollment, and a requirement that you need nursing home level care. You cannot have both at the same time.
How long does PACE enrollment take?
Usually four to eight weeks from first call to coverage. The state level of care assessment is the longest step, and a pending Medicaid application can add more time. Enrollment always starts on the first of a month.
What happens if my health improves?
You may keep PACE under deemed continued eligibility if the state finds you would reasonably be expected to need nursing home level care again within 6 months without the program. Many states also permanently waive the annual review for participants whose chronic conditions are not expected to improve.
