Fallon Health
Legal entity: Fallon Community Health PLAN
Parent: Fallon Community Health Plan, Inc.
About PACE
PACE (Programs of All-Inclusive Care for the Elderly) is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home. To enroll, a person must be 55 or older, live in a PACE service area, need a nursing-home level of care, and be able to live safely in the community with PACE services.
Cost: Most PACE participants are dual-eligible for Medicare and Medicaid and pay nothing out of pocket. Medicare-only participants pay a monthly premium.
Active in 12 counties (FIPS).
Service area. PACE programs only serve specific zip codes. Confirm the participant's home is in the service area.
PACE center hours. Most participants attend the day center several times a week. Ask about transportation and hours.
Specialist network. PACE manages all care, including specialists. Ask which specialists are in the network and whether out-of-network referrals require approval.
Disenrollment. If a participant moves out of the service area, requires inpatient hospitalization, or chooses to leave, ask how care continuity is handled.
Data source: CMS Monthly Enrollment by Contract / Plan / State / County (CPSC). Refreshed monthly.