What Does PACE Cover? A Complete Guide to PACE Benefits in California

One of the most common questions I hear from families exploring PACE is: what exactly does it cover? The answer is more comprehensive than most people expect. PACE — the Program of All-Inclusive Care for the Elderly — is designed to be a complete care solution. For seniors who qualify, PACE replaces Medicare and Medi-Cal as the primary source of coverage, and the PACE organization takes on full responsibility for coordinating and delivering all covered services.

The Care Team Model

Every PACE participant is assigned an interdisciplinary care team that typically includes a primary care physician, a registered nurse, a social worker, a physical therapist, an occupational therapist, a dietitian, a home care coordinator, and a transportation coordinator. This team meets regularly to review each participant's care plan and coordinate all services. This model is fundamentally different from traditional Medicare, where a senior might see multiple specialists operating independently with limited communication. In PACE, all providers are part of one coordinated team working from a single care plan.

Medical and Behavioral Health Care

PACE covers primary care, specialist care, and hospital care. Participants see their PACE primary care physician at the adult day health center, and specialist referrals are coordinated through the PACE network. Behavioral health services — including psychiatry and counseling — are included. Dental care, vision care, and hearing services are also covered, which is notable because traditional Medicare provides very limited coverage in these areas.

Prescriptions

All medications approved by the PACE care team are covered, with no separate Part D premium or deductible. Many PACE organizations offer prescription delivery directly to the participant's home, eliminating the need for pharmacy trips. Participants must use medications approved by their care team — if a participant wants a medication the team has not approved, they may be responsible for the cost.

For how premiums, dual-eligible $0 scenarios, and share of cost work in California, see PACE Costs in California. For the enrollment path, see How to Enroll in PACE.

Transportation

Transportation to and from the adult day health center, medical appointments, and other PACE-covered services is included. PACE organizations typically operate their own fleets of accessible vehicles with trained drivers. For many families, this is one of the most immediately practical benefits — it eliminates the need for family members to take time off work for medical appointments.

Adult Day Health Services and In-Home Support

Most PACE participants attend an adult day health center several days per week, where they receive medical monitoring, therapy, meals, social activities, and caregiver respite. PACE also covers in-home care as determined by the care team, including personal care assistance, skilled nursing visits, and home safety modifications. The level of in-home support is individualized and adjusted as needs change.

Summary of Covered Services

Cost

Participants who qualify for both Medicare and Medi-Cal often pay $0 out of pocket for all covered PACE services. Participants who have Medicare but not Medi-Cal pay a monthly premium. Those without either program may pay privately. Final cost depends on individual eligibility as determined by the PACE organization and the State of California, not by this website.

About the Author

Leslie Kaz, RHU is a licensed California insurance agent specializing in Medicare and PACE programs, operating through Syndicated Insurance Agency, LLC (CA License #0B32530).