Medicare and Medi-Cal reimburse PACE providers directly for your care. If you are enrolled in Medicare and Medi-Cal, you will pay nothing or you will pay your Medi-Cal “share of cost” to your PACE provider. If you are not enrolled, when you apply to become a PACE participant, your local PACE provider can help you apply for Medicare and Medi-Cal.
PACE providers also accept people enrolled only in Medicare, and people who want to pay privately. If you have long-term care insurance, your carrier may pay for part of the premium as well. You are always in control and can opt-out of PACE at any time.
|If a person is…||Then…|
|Eligible for Medi-Cal||Medi-Cal pays for the program*|
|Eligible for Medicare only||Participant pays the Medi-Cal portion plus Medicare Part D|
|Eligible for Medicare and Medi-Cal||Medicare and Medi-Cal pay for the program*|
|Not eligible for Medi-Cal or Medicare||Participant pays the self-pay rate|
* Medi-Cal beneficiaries who have a share of cost remain responsible for their individual share of cost to maintain their Medi-Cal benefits. If the individual lives in or moves to supportive housing (a nursing home), there may be a co-pay for that facility.
Please note: Participants must receive all needed healthcare services (other than emergency services), including primary care and specialist physician services, from the PACE provider or from an entity, person or company authorized by the PACE provider. Participants may be fully and personally liable for the costs of unauthorized or out-of-network services. Medi-Cal beneficiaries who have a share of cost remain responsible for their individual share of cost. Participants without Medi-Cal pay a monthly premium to cover long term care and a premium for Medicare Part D drugs. PACE organizations are regulated by the Centers for Medicare and Medicaid Services and the California Department of Health Care Services (DHCS).
To learn more about services and share of cost, contact your local PACE provider.