Many Southern California families face the same dilemma: a parent or grandparent already needs a nursing-home level of medical care, but the family would rather they keep living at home. PACE (Program of All-Inclusive Care for the Elderly) exists for exactly that situation. This guide explains what it is, how it works, who qualifies, and how it differs from a Medicare Advantage plan or a D-SNP.
What PACE is and who it's for
PACE is a care model, with decades of history and recognized by both Medicare and Medicaid, built specifically for frail older adults who medically qualify for a nursing-home level of care but can safely remain in their own community if they receive enough medical, therapeutic, and social support. Instead of splitting those services across separate providers, PACE brings them all together under a single program responsible for your care.
The heart of PACE is a PACE day center, where you take part in activities, receive physical or occupational therapy, see your medical team, and socialize with other participants several times a week, combined with in-home services and transportation to and from the center. The goal is not to replace your life in the community, but to sustain it.
Eligibility requirements
To qualify for PACE you must meet several requirements at once. First, be 55 or older (not 65, as with most Medicare programs). Second, your state must certify that you need a nursing facility level of care, which is determined through a formal assessment, not simply by your age or a diagnosis. Third, you must live within the specific geographic service area of a PACE program, which usually covers only certain zones within a county, not the whole county.
In addition, the program's team must determine that you can safely live in the community with PACE's support, rather than requiring full-time residential care. This evaluation combines your medical history, your living situation, and available family support, and is carried out by the PACE program's interdisciplinary team, not an outside insurer.
Availability, cost, benefits, and eligibility vary by person, product, contract, and insurance company, as well as by your service area. Guarantees are subject to the claims-paying ability of the issuing insurance company. Karla Arámburo is not affiliated with or endorsed by Medicare or the federal government.
How PACE combines with Medicare and Medi-Cal
PACE is designed for people eligible for Medicare, for Medi-Cal, or for both at once. If you have full dual eligibility, PACE generally carries no premium, since Medicare and Medi-Cal jointly fund the program. If you only qualify for Medicare and not for Medi-Cal, you can still enroll in PACE by paying a monthly premium that covers the portion of long-term services Medicaid would normally pay for.
The key thing to understand is that, while you're enrolled in PACE, the program becomes your single source of medical coverage: you receive primary care, specialists, medications, therapies, transportation, and social services all through PACE, instead of separately maintaining a Medicare Advantage plan and a Medi-Cal plan. If you'd like to better understand how dual eligibility works outside of PACE, review our Extra Help and Medi-Medi dual eligibility guide.
What services PACE covers
PACE covers virtually everything you would need: primary and specialty care, hospitalization, prescription drugs, physical, occupational, and speech therapy, dental and vision care, in-home services, meals, transportation to the PACE center and to medical appointments, and, when necessary, short- or long-term nursing facility care. The program's goal is to prevent avoidable hospitalizations and nursing home admissions through constant follow-up, not just to react once a health crisis has already happened.
An interdisciplinary team — doctor, nurse, social worker, therapist, dietitian, and others — meets regularly to adjust your care plan as your health evolves, rather than waiting for your next annual visit to make changes.
PACE versus a regular Medicare Advantage plan
A regular Medicare Advantage plan gives you access to a network of outside providers that you choose within that network, and you generally continue living independently with no associated day center. PACE, by contrast, is not just insurance: it's a direct care program, with its own clinical team and its own day center, built specifically for people who already need a much more intensive level of support than a typical Advantage plan offers.
In other words, a regular Medicare Advantage plan makes sense for most people with Medicare who live independently. PACE makes sense for a much more specific group: people who medically qualify for nursing home care, but whose family and clinical team agree they can remain in the community with the right support.
PACE versus a D-SNP plan
It's also easy to confuse PACE with a D-SNP (Dual Eligible Special Needs Plan), since both are built around people with Medicare and Medi-Cal. The core difference is that a D-SNP is still a Medicare Advantage-style insurance product: you choose providers within a network, but you keep your medical life largely separate from the plan itself. PACE, by contrast, replaces that insurance structure entirely with a direct care model centered on a specific clinical team and day center, generally reserved for people with significantly greater care needs than a typical D-SNP member.
If your loved one still lives independently and only needs coordination between Medicare and Medi-Cal, a D-SNP is probably enough. If they already qualify for nursing-home-level care but the family would rather keep them at home, PACE deserves a serious look.
PACE availability in Southern California
PACE programs operate in Southern California counties, including areas of Los Angeles County, San Diego County and Riverside County, but each program covers only its own geographic service area, which is usually limited to certain ZIP codes within the county, not the entire county. Don't assume PACE is available at your address just because a program exists somewhere in your county; exact coverage should always be confirmed before moving forward with an application.
I work with families in cities such as Los Angeles, San Diego and Riverside, helping them confirm whether a PACE program actually covers their specific address before considering the application process.
How to start the process
The process starts with an evaluation by the local PACE program to confirm the level of care and geographic eligibility, followed by a visit to the day center so you and your family can see the care model firsthand before deciding. Since PACE completely replaces your Medicare and Medi-Cal coverage, it's a decision worth taking time with, understanding exactly what you gain and what changes relative to your current coverage.
Bilingual, licensed help in Southern California
I am Karla Arámburo, an independent, bilingual, licensed insurance agent serving families in Orange, Los Angeles, San Diego, and Riverside counties. If you have a loved one who already medically qualifies for nursing-home-level care but you'd rather they keep living at home, I review their eligibility, their current Medicare and Medi-Cal coverage, and whether a PACE program actually covers their address, in Spanish or English, at no cost to you.
You can call or text (619) 321-8733 or schedule a free consultation. This page is general education, not individualized advice or a recommendation to enroll in a specific program.
Frequently asked questions
What does PACE stand for?
PACE stands for Program of All-Inclusive Care for the Elderly, a care model that combines medical, social, and daily support services so frail older adults can keep living in their community instead of moving into a nursing home.
Do I have to give up Medicare or Medi-Cal to enroll in PACE?
You don't lose them; PACE replaces them as your single source of coverage while you're enrolled. Once you join PACE, you stop using your separate Medicare Advantage or Original Medicare plan and your separate Medi-Cal plan, because PACE becomes the provider of all the services covered by both programs at once.
Does PACE cost the same as a Medicare Advantage plan?
It depends on your eligibility. If you qualify for both Medicare and full Medi-Cal, you generally pay no premium for PACE. If you only qualify for Medicare, you may need to pay a monthly premium for the Medicaid portion of the program, plus any Medicare cost-sharing that isn't covered.
Can I keep my current doctor if I enroll in PACE?
Generally not. PACE operates with its own interdisciplinary team of doctors, nurses, therapists, and social workers within a PACE center, so most participants receive primary care from that team instead of continuing with their previous outside doctor.
What happens if I decide I no longer want to be in PACE?
You can leave PACE at any time, with no waiting period, and return to Original Medicare or a Medicare Advantage plan, and to regular Medi-Cal if you qualify. Enrollment in PACE is voluntary and reversible at any time, unlike some other programs with more rigid enrollment rules.
Is PACE the same as a nursing home?
No. PACE is specifically designed as an alternative to a nursing home: the program's goal is for you to keep living in your own home or with family while receiving enough medical and social support to do so safely, even though you medically qualify for a nursing-home level of care.
Is PACE available in every ZIP code in Southern California?
No. Each PACE program serves a specific geographic service area, usually limited to certain zones within a county. PACE programs operate in counties such as Los Angeles, San Diego, and Riverside, but exact ZIP code availability varies and should always be confirmed rather than assumed for your address.
Can you help me figure out if I qualify for PACE?
Yes. I review your age, your current level of care needs, your Medicare and Medi-Cal coverage, and whether you live within the service area of a nearby PACE program, to help you understand whether PACE is a realistic option for your situation, in Spanish or English, at no cost to you.