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Understanding Medicare’s All Inclusive Care for the Elderly (PACE)

Written by Evens Stevenson

In addition to just health care and hospitalization benefits, Medicare also provides additional services its enrollees. One such service is PACE, its Programs of All Inclusive Care for the Elderly. This service is actually a joint Medicare and Medicaid program that is provided in many states across the U.S.

The PACE program allows those who may otherwise be required to reside in a skilled nursing home facility to remain active in their communities – a place where most individuals would much prefer to be.

Once an individual qualifies for the PACE program, a team of health care professionals will provide him or her with the coordinated care that they need. The program also provides coverage for prescription medications, doctors’ care, transportation, home health care, check-ups, hospital visits, and nursing home smedicare PACE programtays when they are needed.

PACE uses both Medicare and Medicaid funds to cover all of an enrollee’s medically-necessary care and services. An individual may have either Medicare or Medicaid (or both) in order to join the PACE program. If, however, a person does not have either of these, it is possible to join PACE and to pay privately for the service.

How to Qualify for PACE

In order to qualify for PACE, the following conditions must be met:

  • Age 55 or older
  • Residence within the service area of a PACE organization
  • Certification by the state as needing a nursing home level of care
  • At the time of joining, the enrollee has the ability to live safely in the community with the assistance of PACE services

Advantages of Joining PACE

In addition to the many services that PACE provides to the care recipient, the program is also helpful to the family and loved ones of the individual, as well as to the community at large. For example, the program supports an enrollee’s family members and other care providers with care training, support groups, and respite care.

The program also provides care and services in the recipient’s home, throughout the community, and at the local PACE centers that are located throughout the country. Because PACE has numerous contacts with specialists – as well as other providers from coast to coast – the organization helps to ensure that participants get the best care that they can possibly obtain.

All of the local PACE centers meet both federal and state safety requirements. These centers include primary care services that are provided by physicians and nurses. They also include adult day programs, activities, and both physical and occupational therapy facilities.

PACE organizations also provide all medically necessary transportation to the PACE centers for medical appointments, as well as for activities. In some cases, an enrollee may also be able to get transportation to medical appointments that are located within the community. This is extremely important for both the enrollee and their families. Having transportation to and from appointments relieves some of the stress and time constraints that a lot of families go through.

In order to help ensure the best health possible, PACE places a key emphasis on preventive care. With that in mind, each PACE organization focuses on preventive care – which centers on helping enrollees to live within the community for as long as possible.

Alternatives to PACE

Because everyone isn’t eligible for PACE, or the program doesn’t fit their needs, it’s important that you know some of the other options that you can use in addition to original Medicare. One of the most common options for additional coverage is a Medicare Supplemental insurance policy. Started by private insurance companies they give enrollees health care protection on top of what is offered by Medicare.

There are ten different Medicare Supplemental plans (often called “Medigap” plans) available in the marketplace. Each plan is set up to cover one or more of the situations that original medicare doesn’t. You need to make sure you know your situation well so you can enroll in the plan that suits your needs.

You’ll need to look at your health, finances, all of your options, family history and more. If you’re in poor health and have a history of complications, it’s a wise investment to enroll into one of the supplemental insurance policies that cover a majority of the expenses that Medicare doesn’t pay for. These policies do not cover long-term care, but that isn’t the only major expense that you can expect to pay for your health care.

You’ll also need to look at your finances, health care can put a strain on a retiree’s budget, you’ll need to decide how much you can fit into your finances without stretching your money too thin. Everyone would like to have a Medigap Plan F that covers all the expenses that Medicare doesn’t pay for, but there are a lot of Medicare enrollees that cannot afford the additional premiums.

Our agents are knowledgeable on all things Medicare and can help with any questions you have on the topics discussed. Our main goal in helping you is to learn your goals for insurance protection and find a plan that meets that. We want you to use your retirement and savings to live a full life and not worry about spending it on medical bills that could be avoided. Let us guide you through the process.

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