PACE is the Right Program for our Family. Why Can’t We Access It? 

Linda Henderson and her husband, both 68, live in the suburbs of Seattle. LInda’s husband is facing a medical diagnosis which makes him an ideal candidate to enroll in the Program of All-Inclusive Care for the Elderly (PACE). There is a PACE program near their home. 

PACE allows people who require a nursing home level of care to live at home, with all of their healthcare needs met by an interdisciplinary team. LInda and her husband live comfortably but do not consider themselves wealthy; they are Medicare beneficiaries who do not qualify for Medicaid. 

"I came across the PACE program and I really like the model,” Linda says. "In so many ways it is exactly what is needed in terms of the best way to care for people.”

But there is a hitch. 

Enrolling in PACE today, without Medicaid, means accepting the PACE plan and fee structure for Part D prescriptions. While other Medicare beneficiaries have access to plans that allow for choice in Part D plans, Medicare-only PACE enrollees do not. And in PACE the Part D differential in costs can reach more than $1,000/month. It’s the difference between having access to PACE, and not being able to enroll. 

"I was like 'holy smokes,' that’s crazy!” Linda said.

“it just doesn't seem reasonable. I started looking at other programs that aren’t as good, but that aren’t asking me to make that change to our medication coverage.”

Her message to legislators on Capitol Hill is “this program, it’s a great program, it’s the best way to take care of people. It should be accessible and available to everybody and having a little bit extra income shouldn’t affect your ability to participate.”

“We should make the program more accessible by changing the PART D requirement for working class families.”

The National PACE Association is actively urging passage of the PACE Part D Choice Act, which would set PACE prescription costs on a level playing field with other Medicare prescription drug plan costs.