When it comes to planning for senior care, one of the biggest concerns families face is cost. Between doctor visits, specialist appointments, prescription medications, therapy services, transportation, and long-term care needs, expenses can quickly add up. Understanding what is covered—and what you may be expected to pay out of pocket—can make a significant difference when choosing the right care option.
For many older adults and their caregivers, the Program of All-Inclusive Care for the Elderly (PACE) offers a simpler, more affordable approach to comprehensive senior care. But a common question remains: Is PACE covered by Medicare and Medi-Cal?
The good news is that for many eligible participants, the answer is yes.
Understanding How PACE Is Funded
PACE is designed to provide coordinated, comprehensive care for adults age 55 and older who qualify for nursing home-level care but wish to remain living safely in their communities. Rather than managing multiple providers, bills, and insurance plans, participants receive all medically necessary care through a single, integrated program.
PACE combines funding from Medicare and Medicaid (known as Medi-Cal in California) to cover a wide range of services, including:
- Primary and specialty medical care
- Prescription medications
- Dental, vision, and hearing services
- Physical, occupational, and speech therapy
- Home care and personal assistance
- Transportation to medical appointments
- Adult day health services
- Hospital and emergency care when needed
- Long-term care services and supports
The goal is to provide a complete care solution that helps participants stay healthy, independent, and connected to their communities.
What Does PACE Cost if You Have Medicare and Medi-Cal?
For many people who qualify for both Medicare and Medi-Cal, PACE offers exceptional financial relief.
Participants who are eligible for both programs often receive comprehensive PACE services with $0 copayments and no deductibles for approved care and services. This means families no longer have to worry about juggling separate bills for doctor visits, prescriptions, therapies, medical equipment, or transportation.
Instead of managing multiple insurance cards, co-pays, and coverage rules, PACE brings everything together under one coordinated program.
For many families, this can provide peace of mind as much as financial savings.
Eliminating the Burden of Multiple Medical Bills
Traditional healthcare coverage often leaves seniors responsible for various out-of-pocket expenses. Over time, even relatively small costs can become difficult to manage:
- Prescription copays
- Specialist visit fees
- Physical therapy charges
- Medical equipment costs
- Transportation expenses
- Home care support services
With PACE, eligible participants often have access to these services through a single care model, reducing the financial uncertainty that can come with complex health needs.
Families can focus less on tracking healthcare expenses and more on supporting their loved one's health and well-being.
What If You Don't Qualify for Both Programs?
Some individuals may qualify for Medicare but not Medi-Cal. In those cases, PACE may still be available, though participants may be responsible for monthly premiums depending on their coverage situation. Even then, PACE can simplify healthcare administration by coordinating services through one care team and one care plan.
A Providence PACE representative can help determine eligibility and explain potential costs based on an individual's unique situation.
Financial Simplicity Meets Personalized Care
Senior healthcare shouldn't require families to become insurance experts. Providence PACE is built around the idea that older adults deserve comprehensive, coordinated care without the stress of navigating multiple providers, bills, and benefit programs.
For many participants who qualify for both Medicare and Medi-Cal, that means access to a broad range of services with $0 copayments, helping remove financial barriers to the care they need.
If you're exploring care options for yourself or a loved one, Providence PACE can help you understand your eligibility, coverage, and costs—so you can make informed decisions with confidence.
Learn more about Providence PACE and discover whether this comprehensive care program may be the right fit for your family.
If you live outside our service area and wish to find your local PACE provider, please visit the National PACE Association website.