No, PACE is not a Medicare Advantage plan. The Program of All-Inclusive Care for the Elderly is a separate category of managed care, authorized under its own sections of the Social Security Act, that bundles Medicare, Medicaid, and long-term care services into a single program for frail adults 55 and older who need nursing-home-level care but want to keep living at home. As of mid-2025, 188 PACE organizations operate across 33 states and the District of Columbia.
Why PACE Sits in Its Own Category
PACE and Medicare Advantage look similar at first glance. Both replace traditional fee-for-service Medicare with managed care, and both receive fixed monthly payments from the federal government for each enrollee. The resemblance ends there.
PACE is authorized under Section 1894 of the Social Security Act for Medicare and Section 1934 for Medicaid, giving it a separate legal foundation from Medicare Advantage.1Social Security Administration. 42 U.S.C. 1395eee – Payments to, and Coverage of Benefits Under, Programs of All-Inclusive Care for the Elderly (PACE) A Medicare Advantage plan covers Part A and Part B benefits and may add extras like dental or vision. PACE covers every Medicare service, every Medicaid service, and anything else the care team determines you need, with no limits on amount, duration, or scope.2Social Security Administration. Social Security Act 1934 – Program of All-Inclusive Care for the Elderly That includes long-term care services like personal care attendants and adult day programs that Medicare Advantage does not touch.
The trade-off is flexibility. With Medicare Advantage, you can see any in-network provider and often have out-of-network options. With PACE, you receive all your healthcare exclusively through the PACE organization. Joining a separate Medicare drug plan while enrolled in PACE will automatically disenroll you from the program.3Medicare.gov. PACE This lock-in is the feature that trips people up most often. PACE works for people who want one team managing everything; it’s a poor fit for anyone who wants to keep seeing current doctors outside the program.
What PACE Covers That Medicare Advantage Does Not
Federal regulations require every PACE organization to cover all Medicare-covered services, all Medicaid-covered services under the state’s approved plan, and any additional services the care team decides are necessary to improve or maintain your health.4eCFR. 42 CFR 460.92 – Required Services That third category is what sets PACE apart from any Medicare Advantage plan.
In practice, PACE benefits include:
- Primary and specialty care, hospital care, nursing services, lab work, and x-rays
- Physical, occupational, and speech therapy, plus mental health counseling
- Prescription drugs, including Part D medications and any other drugs the team approves
- Personal care and support services, home care, and nursing home care when needed
- Adult day primary care, meals, dietary accommodations, and recreational therapy at the PACE center
- Social services, nutritional counseling, dentistry, preventive care, and transportation to the PACE center and medical appointments
You do not owe a deductible, copayment, or coinsurance for any service your PACE team approves, regardless of your financial situation.3Medicare.gov. PACE The care team functions as both the provider and the gatekeeper, so getting a service approved is usually a conversation with the people already managing your care rather than an insurance appeal.
Who Qualifies for PACE
You must meet all four of these requirements at enrollment:
- Age 55 or older
- Living in the service area of a PACE organization
- Certified by your state as needing nursing-home-level care
- Able to live safely in the community with the support PACE provides
The nursing-home-level-of-care determination is where most of the uncertainty lives. Each state sets its own standard, so the bar varies depending on where you live.6Centers for Medicare & Medicaid Services. Programs of All-Inclusive Care for the Elderly (PACE) Manual The assessment generally looks at how much help you need with daily activities like bathing, dressing, eating, and moving around. You do not need to qualify for Medicaid to enroll, and you do not need to already have Medicare Part A or Part B.
The geographic requirement is a real constraint. With 188 programs across 33 states, large parts of the country have no PACE option at all. You can search for programs through Medicare’s plan comparison tool at medicare.gov or by calling your state Medicaid office.3Medicare.gov. PACE
What PACE Costs Compared to Medicare Advantage
Where a Medicare Advantage plan typically charges a monthly premium plus copays and coinsurance, PACE pricing depends almost entirely on whether you have Medicare, Medicaid, or both.
Dual-Eligible Participants
If you qualify for both Medicare and Medicaid, the PACE organization cannot charge you a premium.7eCFR. 42 CFR 460.186 – PACE Premiums You also owe no deductibles, copayments, or coinsurance for any approved service. Most PACE participants are dually eligible.5Medicaid.gov. Program of All-Inclusive Care for the Elderly
Medicare-Only Participants
If you have Medicare but do not qualify for Medicaid, you will pay a monthly premium to the PACE organization for the long-term care portion of the benefit, plus a premium for Part D prescription drug coverage through PACE. You are also still responsible for your standard Medicare Part B premium, which is $202.90 per month in 2026.8Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles The PACE premium itself is pegged to the Medicaid capitation amount, which varies by location.7eCFR. 42 CFR 460.186 – PACE Premiums
Medicaid-Only Participants
If you have Medicaid but not Medicare, the PACE organization cannot charge you a premium.7eCFR. 42 CFR 460.186 – PACE Premiums Some participants may owe a Medicaid share-of-cost amount, depending on your state’s rules.
Switching Between PACE and Medicare Advantage
You can enroll in PACE at any point during the year; PACE is not limited to Medicare’s annual enrollment period. If you are currently in a Medicare Advantage plan or a standalone Part D plan, you will need to drop that coverage when you join PACE.
Leaving works the same way in reverse. You can voluntarily disenroll from PACE at any time, for any reason. Your disenrollment takes effect on the first day of the month after the PACE organization receives your notice.9eCFR. 42 CFR 460.162 – Voluntary Disenrollment Once you leave, you have a special enrollment period lasting two full months after the month you disenroll to join a Medicare Advantage plan or a standalone Medicare drug plan.10Medicare.gov. Special Enrollment Periods If you miss that window, you may need to wait until the next annual enrollment period. The PACE organization is required to help with the transition by providing referrals and making your medical records available to new providers.1Social Security Administration. 42 U.S.C. 1395eee – Payments to, and Coverage of Benefits Under, Programs of All-Inclusive Care for the Elderly (PACE)