To be eligible for PACE, an individual must: The National PACE Association operates a “locator” map to identify PACE sites near you. Medical care comes to the elder via the interdisciplinary team at the PACE site. In these uniquely comprehensive programs frail elders who need daily support are provided an adult day like environment during weekdays. Though not available everywhere, the program called “PACE” is a type of insurance coverage for elders who are eligible for both Medicare and Medicaid. Program of All Inclusive Care for the Elderly For elders with personal funds there is a requirement to “spend down” personal assets to a specified level (which varies by state) before they will be eligible for Medicaid coverage. Unlike Medicare, which is provided to all seniors, Medicaid has financial eligibility for its coverage. The most common use is for long-term care aka “nursing home” care for elders with significant frailty. Medicaid is a joint federal and state program that provides certain healthcare services for elders. Useful Links for Understanding and Navigating Medicare / sheets This is an additional, optional election that must be made during the “open enrollment” period as basic insurance is being chosen. Medicare prescription drug benefit covering self-administered prescription drugs. They provide BOTH Medicare Part A and Part B services of a similar scope to “traditional Medicare” under the name “Medicare Advantage Plans” Medicare Part D This is care provided by a PRIVATE insurance company authorized by the US Government. WITH STIPULATIONS Part B may cover things such as: Preventive services e.g., Medicare Annual Wellness, flu vaccine, colonoscopy Medically necessary e.g., most out-patient care to diagnose and treat chronic and acute illnesses. Most, but not all, physician groups and major health systems accept Medicare This is care that does not require you to stay away from home overnight Out-patient care from a provider who “accepts Medicare” Hospital care coverage - pays for care at a hospital, skilled nursing facility, or nursing home, and for limited home health services immediately after the acute care event or other acute illness. ![]() There are premiums for other parts of Medicare B, C, and D as explained below Medicare Part A Anyone who paid – or was married to someone who paid - Medicare taxes during their working years are eligible and does not pay premiums for Medicare Part A once they're 65 years old. The main social service program provides certain healthcare services for elder Americans. Policies vary greatly so you will need to review it carefully. In some cases, privately purchased “long-term care” insurance will provide coverage for some of these needs. ![]() Some medical equipment and supplies are covered, and some aren’t Private duty, ongoing services of care aid at home Home care other than immediately post hospitalization or illness NO maintenance Nursing Homes – see below that is covered by Medicaid within certain financial requirements What is NOT covered by any form of Medicare-based insurance includes the following: While Medicare provides a significant portion of the healthcare needs of elders, it is limited in coverage to specific aspects of healthcare. In addition, we will discuss the basic categories of care most often needed by elders and payment options available. We will discuss what Social Security and Medicare “covers” and what it doesn’t. There is a misconception that a combination of Social Security and Medicare will provide coverage for most needs. ![]() ![]() One of the most confusing aspects of helping care for an aging relative can be understanding how to pay for the care they need.
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