Cost figures reflect the 2024 Genworth/CareScout Cost of Care Survey and National PACE Association enrollment data as of January 2025; private-pay PACE premiums are set by individual programs and states and vary widely by county. Verify current rates with your local PACE organization before making decisions.
TL;DR — Quick Verdict
- Dual-eligible participants (both Medicare and Medicaid) pay $0 monthly premium for PACE — no deductibles, no copays, no coinsurance on approved care.
- Private-pay participants who qualify medically but not financially pay $4,000–$7,000 per month, which includes roughly $1,000/month for the Medicare Part D drug portion.
- Compared head-to-head: PACE private pay ($4,000–$5,000 typical) undercuts a nursing home private room at $10,646/month and roughly matches assisted living at $5,900/month — while delivering far more.
- 84% of the 80,815 people enrolled in PACE as of January 2025 are dual-eligible, meaning most pay nothing.
- Recommendation: If you or a parent meets nursing-home level-of-care criteria and qualifies for Medicaid, PACE is almost always the lowest-cost path. If income is too high, run the private-pay math before defaulting to a facility.
A private room in a nursing home now runs a national median of $127,750 a year — $10,646 every month — according to the 2024 Genworth and CareScout Cost of Care Survey. Against that number, the Program of All-Inclusive Care for the Elderly (PACE) looks almost improbable: 84% of its participants pay nothing at all. The Medicare Payment Advisory Commission’s affiliated MACPAC reported in January 2025 that the overwhelming majority of PACE enrollees are “dual-eligible,” qualifying for both Medicare and Medicaid, and for them the monthly premium is zero.
The catch is eligibility. PACE bundles doctors, prescriptions, adult day care, home aides, transportation, and specialist care into one capitated program — but what you pay depends entirely on whether you clear Medicaid’s income and asset thresholds. This article breaks down the three cost tiers, models the private-pay math against nursing home private room rates by state, names the primary sources behind every figure, and shows exactly who saves money and who doesn’t. Providers like InnovAge and hundreds of local nonprofits operate the 202 programs now running across 33 states and Washington, D.C.
What PACE Actually Costs: The Three Payment Tiers
PACE has no menu of à la carte prices. Instead, your monthly cost is determined by which of three eligibility buckets you land in. Federal regulations at 42 CFR 460.180 require Medicare to pay each PACE organization a fixed monthly “capitation” amount based on Medicare Advantage rates; Medicaid pays a second capitated amount for those who qualify. What’s left over — if anything — is your bill.
Source: National Council on Aging and Medicare.gov cost structure; private-pay range per MedicaidPlanningAssistance.org and Age in Place Health (verify at medicare.gov).
The private-pay range is wide for a reason. Because Medicaid reimbursement is set state by state, the non-Medicare portion of the premium swings dramatically — it might be $3,000 a month in one county and $8,000 in another. High-cost states like California and New York sit at the top of the range. Understanding how Medicaid spend-down asset thresholds by state work is often the deciding factor in whether a family pays $0 or $6,000.
How the Private-Pay Premium Is Built
Consider Margaret, a 78-year-old widow in Pennsylvania who needs nursing-home level of care but has $180,000 in savings and $2,400 monthly Social Security income — too much for Medicaid, not enough to feel comfortable spending $10,000 a month on a facility. Her PACE cost breaks into two stacked components.
First, the Part D prescription drug portion. Private-pay participants cannot route this through a separate insurance plan; it’s paid directly and typically runs about $1,000 per month, according to Age in Place Health’s 2025 breakdown. Second, the long-term-care portion — the amount Medicaid would otherwise pay — which varies by state and often lands between $3,000 and $6,000. Stacked together, Margaret’s premium sits near $4,500 monthly.
That single payment replaces everything: her primary care physician, specialists, physical therapy, adult day center visits, door-to-door transportation, home health aides, and all prescriptions. There are no additional bills. Contrast that with piecing together adult day care vs in-home care costs separately, where each service carries its own invoice and no one coordinates the whole. For families weighing the financial impact of family caregiving, the all-inclusive structure removes both the coordination burden and the surprise-bill risk.
PACE vs. Nursing Home: Which Is Better for a Medicaid-Eligible Senior?
This is the comparison most families actually face, and the math is stark. A private room in a skilled nursing facility carries a 2024 national median of $10,646 per month; a semi-private room runs $9,277, per the Genworth/CareScout survey. PACE, for a dual-eligible participant, costs $0 — and the person keeps living at home.
Source: Genworth/CareScout 2024 Cost of Care Survey, national medians (verify at genworth.com); PACE figures per NCOA and Medicare.gov.
Verdict
For a Medicaid-eligible senior who meets nursing-home level-of-care criteria, PACE wins decisively — it costs nothing and keeps the person at home. Even for a private-pay senior, PACE at $4,000–$5,000 typically beats a nursing home private room by more than $5,000 a month. The nursing home only becomes the better choice when 24/7 skilled clinical supervision is medically unavoidable and cannot be safely delivered at home. Compare the full home health aide vs nursing home comparison before committing.
PACE vs. Assisted Living: A Closer Contest
Against assisted living, the private-pay comparison tightens. Assisted living’s 2024 national median is $5,900 per month — squarely inside PACE’s $4,000–$7,000 private-pay band. On price alone, they can look like a wash. The difference is what each dollar buys.
Assisted living covers housing, meals, and help with daily activities, but medical care, prescriptions, and specialists are billed separately and coordinated by no one. PACE folds all of that into a single premium and assigns an interdisciplinary team to manage it. A resident paying $5,900 for assisted living may spend another $1,500–$3,000 monthly on physicians, drugs, and therapy that PACE would have included. When those hidden costs surface, PACE’s effective value pulls ahead even where the headline premiums match. Families comparing assisted living costs and included services should price the medical add-ons, not just the rent.
One structural caveat: PACE requires you to use its provider network exclusively. Care obtained outside the program — except emergencies — can leave you personally liable. Assisted living lets you keep your own doctors. That trade-off, not price, is often the real deciding line.
What Most People Get Wrong About PACE Costs
Three expensive misconceptions recur when families evaluate PACE.
Mistake 1: Assuming “all-inclusive” means free for everyone. The zero-premium figure applies only to dual-eligible participants. A senior with $200,000 in savings will pay the full private-pay premium. Consequence: sticker shock and abandoned applications. Correct action: check Medicaid eligibility first, because qualifying for Medicaid — not the PACE application itself — is what unlocks the $0 cost.
Mistake 2: Skipping the spend-down analysis. Many families with modest assets assume they’re disqualified and never apply. Consequence: they pay $5,000+ a month out of pocket when a legal spend-down could have made them eligible for free care. Correct action: review the Medicaid 5-year lookback and transfer penalties before gifting or moving assets, since improper transfers trigger penalty periods.
Mistake 3: Ignoring the network lock-in. Enrollees sometimes seek outside specialists and get billed the full cost. Consequence: thousands in unexpected liability. Correct action: confirm every needed provider is inside the PACE network before enrolling, and understand that veterans may have separate options worth checking through Veterans Aid and Attendance rates and eligibility.
Who Should Enroll in PACE — And Who Shouldn’t
PACE is not universal. As of January 1, 2025, only 80,815 people were enrolled nationwide, per Health Dimensions Group’s analysis of National PACE Association data, and the program operates in just 33 states plus D.C. Geography alone disqualifies many.
Enroll if you meet these conditions: you’re 55 or older, live in a PACE service area, need a nursing-home level of care, and can safely remain at home with support. If you’re also dual-eligible, the decision is nearly automatic — comprehensive care at no premium is hard to beat. Even as a private payer, PACE makes sense when your alternative is a $10,646/month nursing home and you value staying home.
Reconsider if: you need round-the-clock skilled nursing that can’t be delivered at home, you want to keep specialists outside the PACE network, or no program operates near you. In those cases, weigh long-term care insurance premiums by age and facility-based options instead. Families anticipating future needs may also compare a hybrid life insurance with LTC rider vs standalone policy to fund private-pay care down the road, or evaluate CCRC entry fees and monthly charges for a continuum-of-care setting.
Frequently Asked Questions
Does Medicare alone cover PACE?
Medicare covers its portion of PACE through a capitated payment set under 42 CFR 460.180, but it does not cover the long-term-care portion. A Medicare-only participant must pay that piece — typically $4,000–$7,000 monthly, including roughly $1,000 for Part D drugs. Only Medicaid eligibility eliminates that out-of-pocket premium entirely, according to Medicare.gov and NCOA.
How many people use PACE, and where?
As of January 1, 2025, 80,815 individuals were enrolled, per Health Dimensions Group’s review of National PACE Association data. The National PACE Association now cites more than 95,500 participants across 202 programs in 33 states and Washington, D.C. Enrollment concentrates heavily in California, New York, and Pennsylvania, which together hold over half of all participants.
Is PACE cheaper than a nursing home?
For dual-eligible participants, dramatically — PACE costs $0 versus a $10,646 monthly median for a nursing home private room (2024 Genworth/CareScout data). Even private-pay PACE at $4,000–$5,000 typically undercuts a nursing home by more than $5,000 monthly while keeping the participant at home rather than in a facility.
Can I keep my own doctor in PACE?
Generally no. PACE becomes your sole provider of Medicare and Medicaid services, and care obtained outside its network — except in emergencies — can make you personally liable for the full cost. This network lock-in is the most common reason otherwise-eligible seniors decline enrollment, so confirm your key providers participate before signing up.
How We Researched This Article
Cost figures in this article draw on three categories of primary and institutional sources, verified before publication. Long-term care comparison costs — nursing home private and semi-private rooms, assisted living, home health aide, and adult day care — come from the 2024 Genworth and CareScout Cost of Care Survey, which contacted more than 140,000 providers and completed over 15,000 surveys nationwide between July and December 2024. These are national median figures; state-level and county-level costs vary substantially and were noted as such where relevant.
PACE cost structure and the three eligibility tiers were confirmed against the federal regulatory framework at 42 CFR 460.180 and 460.182, the U.S. Centers for Medicare & Medicaid Services PACE guidance, and consumer-facing explanations from Medicare.gov and the National Council on Aging. Private-pay premium ranges ($4,000–$7,000, with the Part D drug portion near $1,000) reflect provider-reported figures compiled by MedicaidPlanningAssistance.org and Age in Place Health; because states set Medicaid reimbursement individually, these are ranges rather than fixed prices, and program-specific quotes were unavailable at the national level.
Enrollment and program-count data come from the National PACE Association and Health Dimensions Group’s 2025 year-in-review analysis, with the 84% dual-eligible share drawn from a January 2025 MACPAC presentation. Where private-pay figures could not be pinned to a single national primary source, we report defensible ranges and name the segment average used. Cost comparisons are modeled from published medians, not measured against any single participant’s actual bill. This research was last conducted in July 2026. All figures were verified against named primary sources before publication.