After you decide on home care for your parent, the next step is to look at options for paying for the care.
Medicare has a home health services benefit that covers part-time skilled care services such as nursing care, physical therapy, speech-language pathology services, and occupational therapy. This benefit doesn’t pay for more than part-time, intermittent skilled care and doesn’t pay for services such as personal care, homemaking services, and delivered meals. Using this benefit requires that your parent have a plan of care from a doctor who certifies that your parent is homebound and that you use a Medicare-certified home health agency.
Medicare and Medicaid offer a program called PACE (Program of All-inclusive Care for the Elderly) that helps people who need nursing-home-level care stay in their homes. PACE covers a wide range of care, from medical care and rehabilitation to personal care and transportation, to adult day care centers or medical appointments.
PACE programs are a joint effort of your state government, the federal government, and the PACE provider organization. These programs are available only in states that offer the programs as part of Medicaid. States are responsible for approving the applications of organizations to become PACE providers. Medicare or Medicaid makes monthly payments to PACE programs.
To qualify for PACE, a person must be at least 55 years old, live in an area served by a PACE program, and have certification from the state that nursing-home-level care is required. In 2012, 88 PACE programs operated in 29 states, according to the National PACE Association. Some states have different names for PACE programs. For example, Pennsylvania calls the programs Living Independence for the Elderly (LIFE).
To apply for PACE for your parent, contact the Medical Assistance (Medicaid) program in your state.
How PACE Works
If your parent qualifies for Medicare, Medicare pays for all Medicare-covered services. However, unless your parent qualifies for the Medicaid program in your state, your parent may have to pay a small monthly premium for long-term care PACE services (such as personal and homemaking services) and a premium for Medicare Part D drugs. People who don’t have Medicare or Medicaid can pay for PACE privately. PACE has no deductibles, coinsurance, or copayments.
Once your parent is enrolled in PACE, coordination of all medical and social services is done through the PACE program. Your parent will be assigned a primary care provider within the PACE organization (it’s not an option to keep a current primary care provider).
Because PACE is a Medicare program, a person enrolled in a PACE program cannot be enrolled in another Medicare program. A person can choose to leave a PACE program at any time.
For more information, see Quick Facts about Programs of All-Inclusive Care for the Elderly (PACE) from the Centers for Medicare & Medicaid Services.