PACE Medicare Plans

PACE Medicare plans help eligible Rhode Island adults age 55 and older receive coordinated medical care, home support, and adult day services while remaining in their communities. Learn how the PACE model works, what services it covers, and who may qualify for enrollment.

The PACE program is designed to replace a patchwork of appointments, transportation arrangements, and separate insurance decisions with one coordinated source of care. Each participant works with a PACE provider and an interdisciplinary team that may include primary care clinicians, nurses, therapists, social workers, dietitians, and specialists.

Together, they create a plan based on the person’s health needs, home situation, and goals for remaining independent. Services often center on a PACE day program, where participants can receive medical care, rehabilitation, meals, activities, and health education in a familiar setting.

A PACE bus or other arranged transportation helps participants get to the center and to approved medical appointments, an important practical support for people who no longer drive. The program also manages pharmaceutical benefits, including prescription drugs, rather than requiring members to compare standalone drug plans.

For eligible enrollees, PACE includes Medicare Part D prescription coverage and can coordinate Medicare Part A and Part B services, as well as Medicaid benefits when applicable. This integrated experience reduces the burden on families and makes it easier for the care team to respond before small concerns become emergencies. By linking clinical care with daily support, the program provides improved living at home and can support higher-quality outcomes over time. For more information, read our other articles on the topic, such as Medicare Dual Complete Plans.

• One care team coordinates medical, social, and daily living support.
• Personalized plans reflect health needs, home circumstances, and independence goals.
• Day centers offer care, therapy, meals, activities, and education.
• Arranged transportation supports center visits and approved medical appointments.
• PACE manages prescriptions and coordinates eligible Medicare and Medicaid benefits.

PACE program admission is designed for older adults who need coordinated health services yet can continue living at home with the right support. Participants generally must meet nursing-home-level criteria under state law, live in a service area, and be 55 or older. Medicaid may cover the monthly premium, often at less cost than comparable care.

Start online with Medicare.gov’s PACE search tool, then confirm that a PACE organization serves your exact address. Service areas are defined by ZIP code and can be narrower than a county line, so a nearby center does not always mean enrollment is available at home.

In Rhode Island, begin with the statewide PACE provider and ask which communities, transportation routes, and enrollment appointments apply to your location. In Westchester, search by city or ZIP code and speak directly with the local program about its approved service territory.

Medicare.gov and state aging agencies can help families find current contact information, but the organization itself makes the final service-area determination. Look beyond polished descriptions of world-class organizations.

Ask practical questions: Which specialists are in the network? How are urgent needs handled after hours? Is transportation reliable for your routine? Those answers reveal whether a program fits daily life as well as medical needs.

• Search Medicare.gov using your Rhode Island or Westchester ZIP code.
• Call the program to verify your exact address is eligible.
• Ask about transportation routes, pickup times, and appointment access.
• Confirm in-network specialists and after-hours urgent care procedures.
• Contact state aging agencies for current program contact information.

PACE Medicare plans are designed to replace the fragmented experience many older adults face when coordinating doctors, home care, transportation and prescription drugs across separate providers. For people who qualify, the PACE model brings those services under one locally managed care team, with an emphasis on keeping participants safe and independent at home rather than relying on avoidable hospital or nursing-home stays.

Coverage is comprehensive. PACE includes Medicare services, pharmaceutical benefits and the supports that conventional drug plans or standard plans Medicare options may not coordinate well, such as adult day health care, meals, therapies, dental care, specialist visits and transportation.

The care team determines what is medically necessary and arranges it, which can mean less cost and less administrative strain for families. Costs depend primarily on eligibility. People enrolled in both Medicare and Medicaid generally have no monthly premium for PACE. Medicare-only participants may pay a monthly premium, though they do not face deductibles or copayments for approved PACE services.

Before choosing a program, ask whether its clinicians, center locations and after-hours support fit daily life. A strong local program should clearly explain its service area, enrollment process and how its coordinated approach is intended to deliver higher-quality outcomes.

Generally, applicants must be age 55 or older, live within a PACE service area, meet Rhode Island’s nursing-home-level-of-care criteria, and be able to live safely in the community with PACE support.

PACE coordinates primary and specialty care, prescription drugs, transportation, adult day health services, therapies, meals, home care, and necessary hospital or nursing facility care. The interdisciplinary team arranges medically necessary approved services.

Costs depend on Medicare and Medicaid eligibility. People with both Medicare and Medicaid commonly have no monthly PACE premium. Medicare-only participants may pay a monthly premium, but approved PACE services generally have no deductibles or copayments.