Open Enrollment, PACE & InnovAge: What Seniors and Families Should Know
When it comes to healthcare, choosing the right support can feel complicated. For some, the answer may be PACE.
The answers to the following frequently asked questions (FAQs) apply to both InnovAge PACE and, In Philadelphia, InnovAge LIFE. To speak to an InnovAge senior care expert, call 844-704-9613 TTY:711.
Commonly Asked Questions
Here are some common questions and answers about PACE.
What is the PACE Program?
The PACE program is a comprehensive healthcare option for older adults focused on keeping them in their own homes and communities instead of going to a nursing home or other care facility. PACE providers, like InnovAge, coordinate and provide all needed preventive, primary, acute, and long-term care services to help seniors stay healthy and keep their independence for as long as possible. A team of healthcare professionals partners with each participant and their loved ones to develop, implement, and maintain a personalized care plan. All medically necessary care, including emotional and physical care, as determined by the team, is included. Most care is provided at a local PACE center.
How much does it cost?
With PACE, there are no lifetime limits and no deductibles, or copayments (copays), for any service, medication, or care approved by your interdisciplinary care team.
What you pay for PACE depends on your financial situation. Most people enrolled in the program have Medicare and Medicaid, or are eligible for both, and pay little or nothing.
Read more about costs or talk to one of our senior care experts today by calling 844-211-6178 TTY:711.
What's included in PACE?
People enrolled in PACE receive all Medicare and Medicaid benefits (based on the state in which you live), as well as additional care and services.
InnovAge is responsible for providing care that meets the needs of each participant across all care settings, 24 hours a day, every day of the year. For more information, please see the PACE Benefits and Services page.
How do I join PACE?
PACE is a healthcare option for people over 55 who meet certain eligibility requirements. InnovAge has a team of experts to help you through the enrollment process. They also help determine your eligibility for Medicare and Medicaid. To find out more, take our brief assessment to have someone contact you. You can also call us at 844-218-9476 TTY:711.
What if I join and don't like it?
PACE is a voluntary program, and participants can disenroll at any time.
I have more questions. Who can I call?
To speak with an InnovAge senior care expert, call us today at 844-704-9613 | TTY:711. You can also complete a brief assessment and someone will call or email you to answer your questions.
Eligibility
Read more about the requirements to join PACE.
Who can join InnovAge PACE?
Participants in PACE must meet the following eligibility requirements:
- Be at least 55
- Be rated as eligible for nursing facility level of care as determined by the state in which you live;
- Able to live safely at your home and in your community with the support provided by PACE; and
- Live in a community served by InnovAge.
While most people enrolled in PACE qualify for - or have - Medicare and Medicaid - it is not a requirement.
To find out more, take our brief assessment and one of our senior care team members will call or email you. You can also call us at 844-218-9476 TTY:711.
What happens if I enroll but my health declines?
As your medical needs change, your PACE healthcare team works closely with you and your loved ones to change your personalized care plan so that your needs continue to be met. As long as you maintain your eligibility, you will stay enrolled in PACE regardless of a change in health status. PACE is a voluntary program and you can disenroll at any time.
What does "nursing home level of care" mean?
"Level of care" or "nursing home eligibility" refers to the amount of support or help you need to live safely in your home. It's mostly defined by looking at what challenges you might have with daily activities.
Each state has its own requirements for clinically certifying someone as eligible for nursing facility level of care. As part of the PACE enrollment process, InnovAge's team of experts will help determine if you meet your state's requirement.
In general, this includes reviewing how much help, if any, you need with daily self-care tasks like walking, taking medications, eating, bathing, toileting, or personal hygiene. These are also called activities of daily living (or ADLs).
To find out more, take our brief assessment and one of our senior care team members will call or email you. You can also call us at 844-218-9476 TTY:711.
The PACE Center
Your local PACE center is where most care is provided.
What happens at a PACE center?
Your InnovAge PACE center is where most of your care is coordinated and where you’ll meet with members of your team to receive and discuss your care.
Each InnovAge PACE center has a primary care clinic where you will have medical appointments, adult day rooms where participants enjoy fun activities, entertainment, and catching up with friends, a gym for physical and occupational therapies, spaces for personal care (including showers and restrooms), areas for talking with social workers or behavioral health counselors, and dining rooms where meals are served.
Some of our PACE centers have dental suites and designated spaces for specialists from the community to meet you for your appointments. This may include podiatrists and acupuncture.
How do I get to the PACE center?
When you’re scheduled to be at the center, an InnovAge driver picks you up at your home and brings you to the center, escorting you inside. We also transport you to any specialty medical appointments in the community. When your day is done at the center, or after your medical appointments, an InnovAge driver returns you to your home and escorts you inside.
Some participants use other transportation to get to and from the center, such as a family member or friend who drives them.
Can I join without going to a PACE center?
Your attendance at the PACE center is based on your medical, physical, emotional, and social needs as outlined in your personalized care plan. Some participants only visit the center for medical appointments. Others come more often to socialize, eat meals, and enjoy activities.
Are PACE centers open 24/7?
No. While InnovAge is responsible for providing and coordinating your care 24 hours a day, every day of the year, our PACE centers are not open 24/7. To make sure you get the care you need, your care is provided at your center, in your home, and in the community, through a network of specialty providers. InnovAge's PACE centers are open 8 a.m. to 5 p.m. local time, Monday through Fridays; we are closed on weekends and holidays.
Does anyone live at a PACE center?
No. When your day is done at the center, or after your medical appointments, an InnovAge driver returns you to your home and escorts you inside. Because our focus is on keeping you independent for as long as possible, no one stays overnight at a PACE center.
Insurance
Learn more about PACE, insurance plans, and Medicare Advantage.
How do I know if my doctor or specialist is in-network with InnovAge?
Primary and preventive care is provided at your InnovAge PACE center by members of your care team.
InnovAge has a network of specialists in each community. If your specialist is already in the InnovAge network, and the care is coordinated through PACE, you may be able to see the same specialist. If the care is approved by your medical team but your specialist is not in the InnovAge network, you have the right to request an out-of-network provider.
Please note that InnovAge PACE participants must receive all needed healthcare, including primary care and specialist physician services (other than emergency services) from InnovAge or a person or company authorized by InnovAge. InnovAge PACE participants may be fully and personally liable for the costs of any out-of-network services.
Does my insurance cover InnovAge PACE?
When you join InnovAge PACE for your healthcare needs, we are responsible not only for providing your care, but also coordinating it - meaning scheduling, payments, and claims are all handled by InnovAge. You'll receive all of your care from our providers on staff or we will coordinate it with our network of specialty providers. InnovAge PACE replaces your insurance and become your provider as well as your payer.
Most seniors enrolled in PACE have both Medicare and Medicaid or they are eligible for both.
Read more on Eligibility and Cost or call our team of experts today to talk through your specific situation: 844-893-0947 TTY:711.
Please note that InnovAge PACE participants must receive all needed healthcare, including primary care and specialist physician services (other than emergency services) from InnovAge or a person or company authorized by InnovAge. InnovAge PACE participants may be fully and personally liable for the costs of any unauthorized or out-of-network services.
Is PACE a Medicare Advantage Plan?
While PACE and Medicare Advantage (MA) plans both serve similar populations and have similar funding, they are not the same.
Participants in PACE must meet their state's eligibility requirements for "nursing home level of care." This means the senior is at risk for institutionalization if they don't receive long-term services and supports to be able to stay in their home and community.
With PACE, the benefits available include all of those offered by Medicare Advantage plans and Medicaid, as well as additional benefits and services specific to PACE.
There are also additional requirements of PACE providers like InnovAge, including the professionals who are part of the interdisciplinary team, how health assessments are conducted, and the individualized care plans.
To find out more, call us today at 844-893-0947 TTY:711 or fill out a brief assessment and one of our senior care experts will call or email you to answer your questions.
To read more about PACE requirements, see the Centers for Medicare & Medicaid Services (CMS) PACE Manual. Note that clicking this link will take you to the CMS website and away from InnovAge's site.
What happens to my Medicare/Medicaid coverage if I join?
When you enroll in PACE, you keep the benefits offered by Medicare and/or Medicaid and become eligible for the additional benefits and services offered by InnovAge PACE.
If you need more information on how PACE works with Medicare or Medicaid, call us today at 844-893-0947 TTY:711 or fill out a brief assessment and one of our senior care experts will call or email you to answer your questions.
Page Updated 10/19/23
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