PACE Covered Services: What PACE Includes and How the Team Decides
PACE covered services include everything Medicare and Medi-Cal cover, plus other care your PACE team decides you need: doctors, hospital care, drugs, a PACE center, therapy, home care, meals, rides and nursing home care when needed. Here is the full list and how the team decides.
PACE, the Program of All-Inclusive Care for the Elderly, is a Medicare and Medicaid program for people who need a nursing home level of care but want to keep living at home. PACE covered services are broad. They include everything Medicare and Medicaid (Medi-Cal in California) cover, plus other care your PACE team decides you need.
This post lists what PACE covers in 2026 and 2027, who decides, and the rules for getting care. For who can join and where PACE is offered, see our PACE in California guide.
What are PACE covered services?
PACE covered services come in three layers. Medicare.gov says PACE covers "all Medicare- and Medicaid-covered care and services, and anything else the health care professionals in your PACE team decide you need to improve and maintain your health."
- Everything Medicare covers: hospital, doctor, lab and other Part A and Part B care, and your Part D drugs.
- Everything Medi-Cal covers: the services in California's Medicaid plan.
- What your team decides you need: other care the team finds necessary for your health.
The federal rule (42 CFR 460.92) says this package is the same for every member, however PACE is paid for. The team bases each decision on your medical, physical, emotional and social needs.
What does PACE cover? The full list
What does PACE cover in daily life? Medicare.gov lists most of the services below. The PACE organization provides them at its PACE center, in your home, or at a hospital or other facility it works with.
| Kind of care | What PACE may cover |
|---|---|
| Primary care | Doctor and nursing services, check-ups and preventive care |
| Specialists | Medical specialty services the team arranges |
| Hospital and emergency | Hospital care, emergency services, lab work and X-rays |
| Prescription drugs | Your Part D drugs and other medicines you need |
| Adult day care | Time at the PACE center, with meals and recreational therapy |
| Therapy | Physical, occupational and speech therapy |
| Help at home | Home care, plus personal care and support services |
| Food | Meals, special diets and nutrition counseling |
| Getting around | Transportation to the PACE center and medical appointments |
| Mind and support | Mental health counseling and social services |
| Dental, vision and hearing | Dentistry; eye and hearing care when Medi-Cal covers it or the team decides you need it |
| Nursing home | Nursing home care when it is medically necessary |
PACE prescription drug coverage
If you have Medicare, your PACE prescription drug coverage replaces a separate Part D plan. Medicare.gov says you get "your Part-D covered drugs and all other necessary medication from PACE." Be careful here: if you join a separate Medicare drug plan while in PACE, you will be disenrolled from PACE.
Does PACE cover nursing home care?
Yes, when it is medically necessary and your team approves it. The handbook Medicare & You 2027 lists "nursing home stays as approved by your care team." PACE is built to help you stay at home as long as possible, but it keeps covering your care if you later need a nursing home. If you have a Medi-Cal share of cost, ask the PACE organization what you may owe.
Who is on the PACE interdisciplinary team?
The PACE interdisciplinary team is the group of professionals who plan and approve your care. Federal rules say every PACE center must have one. Each person in PACE is assigned to the team at the center they attend. One person can fill two roles if they are qualified for both.
- A primary care provider (a doctor, nurse practitioner or physician assistant)
- A registered nurse
- A master's-level social worker
- A physical therapist and an occupational therapist
- A recreational therapist or activity coordinator
- A dietitian
- The PACE center manager
- A home care coordinator
- A personal care attendant
- A driver
How the team decides
The team assesses you when you join, reassesses you over time and writes your plan of care. It orders, approves and checks your care, and the PACE organization is responsible for it 24 hours a day, every day of the year. You, a caregiver or your representative can ask for a new service or a change. Ask out loud or in writing, to any PACE staff member who cares for you.
Your request must reach the team within 3 calendar days, and the team must decide and tell you within 3 calendar days after that. It can take up to 5 more days in some cases. If the team says no, you can appeal, and the PACE organization must explain how in writing.
What PACE center services can you expect?
PACE center services are the heart of the program. Every PACE center must offer, at a minimum:
- primary care and nursing
- social services
- physical and occupational therapy
- personal care and support
- nutrition counseling
- recreational therapy
- meals
How often you go to the center is up to the team, based on your needs and what you prefer. Care also comes to your home when you need it.
Do you have to get all your care through PACE?
Yes. This is the main trade-off. Once you join, you get your Medicare and Medi-Cal benefits only through the PACE organization. Your primary care provider is part of your PACE team, and the team arranges specialists, hospitals and other care through its own network.
- Emergencies: you can get emergency care anywhere, in or out of the PACE service area, without asking first. Your PACE organization must explain how.
- Urgent care away from home: if you are traveling and need urgent care, the PACE organization must have an on-call provider 24 hours a day to approve it.
- Other outside care: care the team has not approved may not be covered, so ask first.
- Long trips: being out of the service area for more than 30 days in a row can end your enrollment, unless the PACE organization agrees to a longer absence.
Who qualifies, and what does PACE cost?
PACE has four basic rules. You must be age 55 or older, live in a PACE service area, need a nursing home level of care (as certified by your state), and be able to live safely in the community with PACE's help when you join. Our post on PACE eligibility requirements goes deeper.
Medicare.gov says that if you have Medicaid (Medi-Cal in California), you won't pay a monthly premium for the PACE benefit. With Medicare but not Medi-Cal, you pay a monthly premium for the long-term care part and a premium for Part D drugs. Without either, you can pay privately. There is no deductible, copayment or coinsurance for care your team approves. See what PACE costs.
How do you join or leave PACE?
You join through a local PACE organization. To find one, search Medicare.gov/pace or call your county Medi-Cal office.
- Contact a PACE organization in your area and ask for an assessment.
- Get the state's decision. In California, the Department of Health Care Services (DHCS) decides whether you need a nursing home level of care.
- Sign the enrollment agreement. Coverage starts on the first day of the month after the PACE organization receives it.
You can leave PACE at any time, for any reason. Leaving takes effect on the first day of the next month after the PACE organization gets your notice. After you leave, Medicare.gov gives you 2 full months after the month you leave to join a Medicare Advantage plan or a drug plan.
How does PACE compare with other options?
PACE is one of several ways to get help when care needs grow. Medicare Advantage plans and Medi-Medi Plans let you keep living at home too, with different networks and rules. Our post on PACE vs Medicare Advantage and Medi-Medi Plans compares them side by side. For nursing homes and help at home under Original Medicare, see does Medicare cover long-term care.
Next steps
If you think PACE may help you or a family member, a few steps make the decision easier. Start with what care is needed now and which doctors matter most.
- Write down the help needed each day, such as meals, bathing or rides.
- List current doctors, specialists and prescriptions.
- Check whether PACE serves your ZIP code in our PACE in California guide.
- Ask a PACE organization to explain its center, its network and how its team works.
- For counseling at no cost to you, call HICAP (California's Health Insurance Counseling & Advocacy Program) at 1-800-434-0222.
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Frequently asked questions
What services does PACE cover?
PACE covers all Medicare- and Medicaid-covered care, plus other services your PACE team decides you need. That includes doctors, hospital care, drugs, therapy, home care, meals, rides and nursing home care when it is medically necessary.
Does PACE cover dental, vision and hearing?
Medicare.gov lists dentistry as a PACE service. Other care, such as eye exams, glasses or hearing aids, may be covered if Medi-Cal covers it or your team decides you need it. Ask the PACE organization how its team handles these requests.
Can I keep my own doctor in PACE?
Your primary care provider must work with the PACE organization, so you may need a new one. Your team arranges specialists through its network. Ask whether a doctor you see now works with the PACE organization before you join.
What if I need a service PACE hasn't approved?
Ask a PACE staff member who cares for you, out loud or in writing. The team must decide within 3 calendar days after it gets your request, and sometimes up to 5 more. If it says no, you can appeal. In an emergency, get care right away; no approval is needed.
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