Could PACE Be a Fit for You or Someone You Care About?

When you may need more support than another plan change

It may be time to ask about a more connected kind of care if several of these situations sound familiar. A chronic condition, repeated urgent visits, falls, difficulty with everyday tasks, trouble getting to appointments, or feeling isolated may all be reasons to ask about added support.

These experiences do not automatically qualify someone for PACE. A diagnosis, loneliness or depression by itself is not enough. California must determine that the person needs a nursing-home level of care and can still live safely in the community with support.

What kind of help can PACE include?

PACE brings medical, daily-living and social needs together in one care plan. Depending on the person's assessed needs and the local program, services may include primary and specialist care, prescription medicines, hospital care, home care, nursing, physical or occupational therapy, dental care, social services and transportation.

A PACE center may also offer meals, social activities and personal-care services such as haircuts. Services and center offerings vary, and not every participant receives every service.

Who may qualify for the local PACE program?

The general PACE requirements include being 55 or older, living in the program's approved service area, meeting California's nursing-home-level-of-care requirement, and being able to live safely in the community with PACE support.

The local program discussed here also requires Medi-Cal. Medicare is not required if the person has Medi-Cal. If someone has Medicare but not Medi-Cal, they can ask about whether applying for Medi-Cal could be a next step; approval is not guaranteed.

PACE uses its own care team

PACE is an alternative to receiving coverage through a regular Medicare Advantage plan. The PACE program coordinates coverage and payment for approved care, provides services through its own doctors and care team, and may serve participants at a local center and at home.

Participants should expect to use the PACE doctors for routine care. Current doctors may not be available unless they participate in or are approved by the program. PACE is different from a regular Medicare Advantage plan, so make sure you understand how its care team works before deciding.

You can explore PACE at any time of year

You do not have to wait for Medicare's Annual Enrollment Period (AEP). Once eligibility is confirmed and the PACE organization receives the signed enrollment agreement, enrollment generally begins on the first day of the following month.

Check the exact ZIP code

PACE service areas include specific ZIP codes. Some parts of Murrieta, Menifee, Lake Elsinore and Perris may be covered, but the city name alone does not confirm that an address is in the service area.

Call Franco and he can check the ZIP code with you and go through an initial needs analysis. He can help explain the next steps; the PACE organization and California make the official eligibility decision.