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️ Covered Under Your PACE Insurance Plan

All-Inclusive Coverage Services
for Seniors 55 & Older

Every service listed below is fully covered under your PACE health insurance plan — no surprise bills, no coverage gaps, and no need to coordinate between multiple insurers. One plan. Everything included.

9 services covered under your plan
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Primary Coverage
Medical & Hospital Insurance
Fully Covered — $0 Copay for Eligible Members

Your PACE insurance plan provides complete medical and hospital coverage — from routine primary care visits to complex specialist consultations and extended inpatient hospital stays. Unlike traditional Medicare, which leaves significant gaps in coverage and requires multiple supplemental policies, PACE consolidates all medical insurance into one seamless plan managed by your dedicated care team.

Every covered member has access to a board-certified primary care physician, 24/7 on-call nurse support, and a full interdisciplinary team that coordinates all aspects of your medical care. Emergency room visits, surgeries, and post-acute care are all covered without prior authorization delays.

$0
Copay for eligible members
24/7
On-call nurse access
100%
Hospital stays covered
Inpatient Hospital Care

All hospital admissions, surgeries, and overnight stays are fully covered — no deductibles or co-insurance.

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Primary Care Visits

Unlimited visits to your PACE primary care physician, including same-day appointments when needed.

Specialist Referrals

Cardiology, neurology, orthopedics, and all other specialists — coordinated and covered by your plan.

Emergency Care

Emergency room visits and urgent care are covered anywhere in the country — no network restrictions.

What's Included in Your Coverage
Primary care visits Specialist consultations Hospital inpatient stays Emergency room care Urgent care visits Preventive screenings Chronic disease management Lab tests & imaging Post-surgical follow-up Palliative care
Insurance Note: Dual-eligible members (Medicare + Medicaid) pay $0 out-of-pocket for all medical and hospital services. Private pay members receive a customized cost-sharing arrangement based on income.
Pharmacy Benefit
Prescription Drug Coverage
All Medications Covered — No Formulary Gaps

PACE provides comprehensive prescription drug coverage that goes far beyond standard Medicare Part D plans. Every medication prescribed by your PACE care team is covered under your insurance plan — including specialty drugs, biologics, insulin, and chronic disease medications that often carry high out-of-pocket costs under traditional insurance.

There are no formulary tiers, no prior authorization delays for PACE-prescribed medications, and no coverage gaps (the "donut hole" that affects standard Part D plans). Your medications are dispensed directly at the PACE center or delivered to your home.

100%
Rx coverage rate
$0
Copay at PACE pharmacy
No
Donut hole gaps
All Drug Classes Covered

Generic, brand-name, and specialty medications — all covered with no tier-based cost sharing.

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Insulin & Diabetes Meds

All insulin types and diabetes management medications covered at $0 — no insulin caps or restrictions.

Home Delivery Available

Medications can be delivered directly to your home when you cannot travel to the PACE center.

Medication Management

Your PACE pharmacist reviews all medications for interactions and optimizes your drug regimen regularly.

Drug Categories Covered
Chronic disease medications Specialty biologics Insulin & diabetes drugs Cardiovascular medications Mental health medications Pain management drugs Antibiotics & antivirals Oncology support drugs Respiratory medications Vitamins (medically prescribed)
Insurance Note: PACE replaces your Medicare Part D plan. You do not need a separate Part D policy — all drug coverage is included in your PACE insurance plan at no additional premium.
Behavioral Health
Mental Health Benefits
Unlimited Sessions — No Session Limits

Mental health is an essential part of overall health for older adults, yet traditional Medicare severely limits mental health coverage — capping sessions, requiring high cost-sharing, and often excluding critical services like dementia care support. PACE provides unlimited mental health coverage as a core benefit of your insurance plan.

Our licensed therapists, social workers, and psychiatrists work as part of your interdisciplinary care team — meaning mental health care is fully integrated with your physical health management. Caregiver support and family counseling are also covered under your plan.

Therapy sessions covered
$0
Copay per session
100%
Psychiatric meds covered
Individual Therapy

One-on-one sessions with a licensed therapist — no session limits, no referral required.

Group Therapy

Structured group sessions for depression, anxiety, grief, and social connection — included in your plan.

Dementia Care Support

Specialized cognitive support programs for members with Alzheimer's and other forms of dementia.

Caregiver Counseling

Family members and caregivers receive counseling support — covered as part of the member's plan.

Mental Health Services Included
Individual psychotherapy Group therapy sessions Psychiatric evaluations Medication management Dementia care programs Grief counseling Anxiety & depression treatment Caregiver support sessions Crisis intervention Social work services
Insurance Note: Traditional Medicare covers only 80% of outpatient mental health after the Part B deductible. PACE covers 100% with no session limits — a significant insurance advantage for seniors with ongoing mental health needs.
Therapy & Recovery
Rehabilitation Coverage
Unlimited Therapy — No Visit Caps

Rehabilitation services are critical for seniors recovering from surgery, stroke, falls, or managing chronic conditions. PACE provides unlimited physical, occupational, and speech therapy — with no visit caps, no prior authorization requirements, and no cost-sharing for eligible members.

Your PACE rehabilitation team works alongside your primary care physician and specialists to create a personalized therapy plan focused on restoring and maintaining your independence, mobility, and quality of life. Therapy is delivered both at the PACE center and in your home when needed.

3
Therapy types covered
No
Visit caps or limits
Home
Therapy available at home
Physical Therapy

Strength, balance, and mobility training to prevent falls and restore function after injury or surgery.

Occupational Therapy

Daily living skills, adaptive equipment, and home safety modifications to support independent living.

Speech Therapy

Communication, swallowing, and cognitive rehabilitation for stroke survivors and those with neurological conditions.

In-Home Therapy

When traveling to the PACE center is not possible, therapists come to your home — all covered under your plan.

Rehabilitation Services Included
Physical therapy Occupational therapy Speech-language therapy Post-surgical rehab Stroke recovery therapy Fall prevention programs Balance & gait training Adaptive equipment Home safety assessment Swallowing therapy
Insurance Note: Medicare limits skilled therapy to situations showing "improvement." PACE covers maintenance therapy too — keeping you functional even when improvement has plateaued — a critical distinction for seniors with chronic conditions.
Long-Term Support
Long-Term & Home Care
Fully Covered — Not Available in Standard Medicare

Long-term care is one of the most significant uninsured risks for older Americans. Traditional Medicare does not cover custodial or personal care services, and private long-term care insurance is expensive and difficult to obtain. PACE includes comprehensive long-term and home care as a core benefit of your insurance plan — at no additional premium for eligible members.

Personal care aides assist with bathing, dressing, grooming, and daily activities — both at the PACE center and in your home. Our goal is to support your independence and help you remain living in your own community for as long as possible.

$0
Added premium for LTC
Daily
Home aide availability
100%
ADL assistance covered
Personal Care Aides

Certified aides assist with bathing, dressing, grooming, and personal hygiene at home or the PACE center.

Home Health Visits

Skilled nurses and therapists visit your home for ongoing health monitoring and care management.

Respite Care

Short-term inpatient or in-home respite care is covered to give family caregivers a needed break.

Nursing Facility Coverage

If nursing facility care becomes necessary, PACE coordinates and covers the cost as part of your plan.

Long-Term Care Services Included
Personal care aide services Activities of daily living (ADL) support Home health nurse visits Respite care Nursing facility placement Wound care management Catheter & ostomy care IV therapy at home Caregiver training Home safety modifications
Insurance Note: The average cost of a home health aide is $27/hour, and nursing home care averages $8,000–$10,000/month. PACE covers all of this under your insurance plan — saving eligible members tens of thousands of dollars annually.
Sensory Health
Dental, Vision & Hearing
Full Coverage Including Devices & Appliances

Dental care, vision, and hearing are three of the most significant coverage gaps in traditional Medicare — yet they are among the most important health needs for older adults. Poor oral health is linked to heart disease and diabetes; untreated vision and hearing loss accelerate cognitive decline. PACE covers all three comprehensively as part of your insurance plan.

Coverage includes not just examinations and basic care, but also corrective devices — eyeglasses, contact lenses, dentures, hearing aids, and cochlear implants — that most Medicare plans exclude entirely.

3
Benefit areas covered
Full
Device coverage included
$0
For eligible members
Comprehensive Dental

Cleanings, fillings, extractions, root canals, dentures, and dental implants — all covered under your plan.

Vision & Eyewear

Annual eye exams, prescription eyeglasses, contact lenses, and treatment for glaucoma and cataracts.

Hearing Aids & Exams

Comprehensive hearing evaluations, hearing aids (all styles), fittings, and ongoing adjustments covered.

Preventive Screenings

Regular screenings for oral cancer, glaucoma, macular degeneration, and age-related hearing loss.

Dental, Vision & Hearing Services Included
Routine dental cleanings Fillings & extractions Dentures & partials Dental implants Annual eye exams Prescription eyeglasses Cataract surgery Glaucoma treatment Hearing evaluations Hearing aids & fittings
Insurance Note: Traditional Medicare (Parts A & B) does not cover routine dental, vision, or hearing. PACE members save an average of $3,200 per year on these services alone compared to seniors on standard Medicare.
Member Benefit
Transportation Benefit
Door-to-Door — All Covered Appointments

Lack of transportation is one of the most common barriers to healthcare access for older adults. PACE eliminates this barrier entirely by providing safe, reliable, door-to-door transportation to the PACE center and all covered medical appointments — fully included in your insurance plan at no additional cost.

Our accessible vehicles are equipped for members with mobility limitations, wheelchairs, and walkers. Drivers are trained in senior care and safety protocols. Transportation is scheduled in advance and can be arranged on short notice for urgent appointments.

$0
Cost per ride
ADA
Accessible vehicles
All
Covered appointments
PACE Center Rides

Daily round-trip transportation to and from the PACE center for all scheduled programs and care.

Medical Appointment Rides

Transportation to specialist visits, hospital appointments, labs, imaging, and pharmacy pickups.

Wheelchair Accessible

All vehicles are ADA-compliant with ramps, lifts, and securement systems for wheelchairs and scooters.

Flexible Scheduling

Advance scheduling and same-day urgent ride requests accommodated by our transportation coordinators.

Transportation Services Included
Daily PACE center transport Specialist appointment rides Hospital visit transport Lab & imaging rides Pharmacy pickup transport Wheelchair-accessible vehicles Trained senior drivers Door-to-door assistance
Insurance Note: Most Medicare Advantage plans offer limited transportation (typically 24–48 rides per year). PACE provides unlimited transportation to all covered appointments — a significant benefit for members who attend the PACE center multiple days per week.
Nutritional Support
Nutrition & Meal Benefits
Daily Meals Included — Dietitian-Supervised

Proper nutrition is a cornerstone of health for older adults — yet it is completely absent from traditional Medicare coverage. PACE includes daily nutritious meals at the PACE center, home meal delivery programs, and individualized nutritional counseling from a registered dietitian as part of your comprehensive insurance plan.

Meals are prepared fresh daily by our culinary team under the supervision of a registered dietitian, accommodating all dietary restrictions, cultural preferences, and medical nutrition therapy needs. Members with diabetes, heart disease, kidney disease, or dysphagia receive specially tailored meal plans.

Daily
Fresh meals at center
RD
Registered dietitian on team
$0
Meal cost for members
Daily Center Meals

Fresh, balanced breakfast and lunch served daily at the PACE center — included in your coverage.

Home Meal Delivery

Meals delivered to your home on days you don't attend the center — hot or frozen options available.

Medical Nutrition Therapy

Individualized nutrition plans for diabetes, heart disease, kidney disease, and weight management.

Cultural & Dietary Preferences

Meals accommodate religious, cultural, and personal dietary preferences — including halal, kosher, and vegetarian.

Nutrition Services Included
Daily center meals Home meal delivery Dietitian consultations Medical nutrition therapy Diabetic meal planning Renal diet support Dysphagia-modified meals Nutritional supplements
Insurance Note: Traditional Medicare covers medical nutrition therapy only for diabetes and kidney disease. PACE covers comprehensive nutritional support for all members as a standard benefit — preventing malnutrition, a leading cause of hospitalization in older adults.
Community & Wellbeing
Social & Wellness Programs
Included in All PACE Plans — No Extra Cost

Social isolation is one of the greatest health risks facing older adults — equivalent in impact to smoking 15 cigarettes a day. PACE addresses this through a rich calendar of social activities, wellness programs, and community events that keep members engaged, connected, and thriving. All programs are included in your PACE insurance plan.

The PACE center serves as a vibrant community hub where members gather daily for activities, exercise classes, arts and crafts, music, games, and celebrations. Our social workers and activity coordinators ensure every member has meaningful engagement tailored to their interests and abilities.

Daily
Activities at center
98%
Member satisfaction
$0
Activity fees
Arts & Creative Programs

Painting, crafts, music therapy, and creative writing — promoting cognitive health and self-expression.

Fitness & Exercise Classes

Chair yoga, gentle aerobics, strength training, and balance classes — adapted for all ability levels.

Social Events & Celebrations

Holiday parties, cultural celebrations, birthday events, and community outings — keeping life joyful.

Educational Programs

Health education workshops, technology classes, and lifelong learning opportunities for curious minds.

Social & Wellness Activities Included
Daily activity programs Chair yoga & fitness classes Arts & crafts sessions Music & dance therapy Social games & trivia Holiday celebrations Community outings Health education workshops Technology assistance classes Volunteer & intergenerational programs
Insurance Note: Social and wellness programs are not covered by any standard Medicare or Medicaid plan. PACE includes them because research shows that social engagement reduces hospitalizations, slows cognitive decline, and improves overall health outcomes — making it a smart insurance investment.