PACE is one of the few long-term care programs where the sticker price genuinely depends on which government program you already have. Get the pairing right and the monthly bill is zero. Get it wrong, or fall into the gap between Medicare and Medicaid, and you are looking at a five-figure monthly bill for the exact same care.
This guide breaks down the three payment situations PACE participants actually run into, prices them using a real, dated state Medicaid rate schedule, and covers eligibility, drug coverage and where to find a program near you as of September 2026.
What Does PACE Cost in 2026?
PACE (Program of All-Inclusive Care for the Elderly) is paid for through a monthly capitation, a flat fee per participant, rather than by billing for each visit or service. Who pays that capitation, and how much of it, depends entirely on whether you have Medicare, Medicaid, both or neither.
| Payment situation | Frail elderly rate cell | Physically disabled rate cell | Developmentally disabled rate cell |
|---|---|---|---|
| Dual eligible (Medicare and Medicaid) | $0 | $0 | $0 |
| Medicare only, no Medicaid (pays the Medicaid share) | $5,061.63 | $6,219.34 | $6,619.04 |
| No Medicare and no Medicaid (Wisconsin “Medicaid only” rate) | $7,398.30 | $8,629.38 | $9,070.56 |
Figures are Table 6 of the Wisconsin Department of Health Services’ calendar-year 2026 PACE capitation rate report, prepared by the actuarial firm Milliman and dated November 26, 2025. Wisconsin sets three acuity-based rate cells (frail elderly, physically disabled and developmentally disabled) rather than one price, so what a program charges depends heavily on your care needs, not just your ZIP code. The projected average across the whole Wisconsin PACE program for CY 2026 is $5,564.19 per member per month, up 7.3% from $5,183.41 in CY 2025. Note that the report also prints slightly higher “final AWOP” figures ($5,285.72 to $6,847.17 and $7,628.46 to $9,305.06); those are an intermediate step in the rate build, and Table 6 explains that the actual capitation rates are lower to comply with 42 CFR 460.182. The Table 6 numbers above are the rates Wisconsin actually pays.
Wisconsin publishes two sets of PMPM figures because of how it splits enrollees by Medicare status. The “dual eligible” rate cells cover the Medicaid share only, because Medicare separately pays the PACE organization for the acute and primary care portion of a dual eligible’s care. The “Medicaid only” rate cells are for people who have Medicaid but no Medicare, so Medicaid’s payment has to cover the acute care as well as the long-term care. Nobody in either group is paying that money themselves. The reason the figures matter to a self-pay reader is that they are the closest thing to a published price list for PACE: a Medicare-only enrollee is charged the Medicaid share, and someone with neither program is charged both shares, which is what the “Medicaid only” cell represents.
Sources disagree about the private-pay number, and the gap is wide enough to state plainly. The National Council on Aging puts the average cost of PACE at $4,000 to $5,000 a month for someone enrolled in neither Medicare nor Medicaid, well below Wisconsin’s $7,398.30 to $9,070.56 Medicaid-only capitation. Both figures are defensible and they measure slightly different things: NCOA is describing what PACE organizations typically charge a private payer, while Wisconsin is publishing what its Medicaid program actually pays for a nursing-home-eligible enrollee, across rate cells that include people with developmental and physical disabilities as well as the frail elderly. Across the two sources the honest range for a private payer is roughly $4,000 to $9,071 a month. Every PACE organization’s rate is set through its own state’s process, so ask the program near you for its current premium rather than assuming either figure.
Who Qualifies, and What “All-Inclusive” Means
To enroll in PACE, per Medicare.gov and CMS, you generally must:
- Be at least 55 years old
- Live in the service area of a PACE organization (PACE is not available everywhere; it operates only in the counties a specific PACE center serves)
- Be certified by your state as needing a nursing-home level of care
- Be able to live safely in the community with help from PACE’s services
Once enrolled, PACE covers everything Medicare and Medicaid would otherwise cover, plus anything the PACE care team decides you need to stay healthy, including transportation, adult day services, meals, physical and occupational therapy, home care, and prescription drugs. Medicare.gov is explicit that “regardless of your financial situation, you won’t have a deductible, copayment, or co-insurance for any drug, service, or care your PACE team approves,” which is why the entire cost story comes down to that flat monthly capitation rather than a bill for each visit.
What Drives the Price
Your assigned acuity or target group. States that use tiered rates, like Wisconsin’s frail elderly, physically disabled and developmentally disabled categories, set a different capitation for each, because expected long-term-care costs differ substantially by group.
Whether Medicare is contributing. For a dual eligible, Medicare pays PACE separately for acute and primary care, which is why the Medicaid share alone can be lower than the full private-pay rate. Without Medicare, the PACE organization has to be paid for both halves of care.
Your state’s underlying Medicaid cost-of-care benchmarks. Capitation rates are built from each state’s actual spending on comparable Medicaid long-term-care programs, which vary by regional wages, nursing-home rates and home-care reimbursement levels, so the same PACE benefit package prices very differently state to state.
Prescription drug coverage. Medicare.gov notes that Medicare-only PACE participants owe a separate premium for Part D drug coverage on top of the capitation, since drug costs are financed through a distinct Medicare funding stream even inside PACE. See our Medicare Part D cost guide for how that premium is typically set.
Direct-care workforce funding. Recent state minimum-payment-rate initiatives for home care and residential aides have pushed capitation rates upward nationally, since PACE organizations are required to pass wage increases through to the workers delivering hands-on care.
Cash Price vs. Relying on Medicaid
Unlike most services on this site, there is not really a “cash discount” version of PACE; the capitation is the capitation, whether Medicaid pays it or you do. The real financial decision is timing and eligibility, not negotiation.
If you are Medicare-eligible and think you might also qualify for Medicaid based on income and assets, it is almost always worth applying before enrolling in PACE privately, since a successful Medicaid application eliminates the entire monthly capitation retroactively to your Medicaid eligibility date in many states. If your income or assets are just above your state’s Medicaid limit, a Medicaid spend-down may bring you into range faster than paying the private-pay rate for months while you wait.
If you need care immediately and cannot wait for a Medicaid decision, some PACE organizations will enroll you as a private-pay participant and adjust your monthly rate once Medicaid coverage is approved, but you should get that arrangement in writing before you sign up, since capitation rates and enrollment effective dates are set at the state level and not always retroactive.
How to Pay Less
Apply for Medicaid, and don’t assume you’re over the limit. Medicaid long-term-care income and asset rules are more generous than regular Medicaid, and many states allow a spend-down. Start with our Medicaid spend-down guide and Medicaid vs. Medicare comparison before assuming you don’t qualify.
Check whether you already qualify for a Medicare Savings Program. A Qualified Medicare Beneficiary (QMB) or other Medicare Savings Program can eliminate your Part B premium and cost sharing even if you don’t qualify for full Medicaid, which lowers your overall out-of-pocket load while you sort out PACE eligibility. See our Medicare Savings Programs guide.
Ask the PACE organization directly about financial counseling. PACE organizations are required to help applicants navigate Medicaid enrollment as part of intake, and many have staff dedicated to exactly this; ask before assuming you’ll be billed the full private-pay rate.
If you’re billed for care outside your capitated PACE coverage, don’t just pay it. Errors happen, and unrelated medical bills that land outside PACE’s umbrella (from a hospital stay before enrollment, for instance) can sometimes be reduced through hospital charity care or a documented medical bill assistance program.
Compare PACE against the alternative you’re actually facing. For many families the real comparison isn’t “PACE vs. nothing,” it’s PACE vs. a nursing home, assisted living or paid home health care, all of which typically cost more per month than even PACE’s private-pay rate and are less likely to be covered by Medicare at all.
If PACE isn’t available in your county, look at the coverage it would have replaced. Our guides to how to pay for a nursing home and whether Medicaid pays for assisted living cover the next-best options when a PACE service area doesn’t reach you.
How Many PACE Programs Exist, and How to Find One
PACE has grown steadily since it became a permanent, nationally available Medicaid and Medicare option. The National PACE Association announced on February 26, 2026 that the program had reached its 200th site nationwide (PACE Northeast Michigan, in Alpena), serving more than 91,000 older adults across 33 states and the District of Columbia. That growth means PACE reaches far more communities than it did a decade ago, but coverage is still far from universal; most rural counties and roughly a third of states have no PACE organization at all.
To find a program, use Medicare’s plan finder at medicare.gov, search the National PACE Association’s directory at npaonline.org, or call your state Medicaid office directly and ask whether PACE operates in your county. If you are also weighing whether a Medicare Advantage D-SNP makes more sense than PACE for your situation, both programs are built around dual-eligible enrollees but work very differently: a D-SNP is insurance you use with outside providers, while PACE is a direct-care program built around its own interdisciplinary team and, usually, an adult day center.
Bottom line: if you have both Medicare and Medicaid, PACE should cost you nothing beyond what you already pay for those programs. If you have only one, or neither, expect a real monthly bill in the thousands, roughly $5,000 to $9,300 a month based on Wisconsin’s published 2026 Medicaid rate schedule, and apply for Medicaid before you assume you have to pay the private-pay rate.