San Francisco PACE Medicare Benefits: Programs, Eligibility, and What Your Parent Gets

San Francisco is an important place for families exploring PACE — the Program of All-Inclusive Care for the Elderly — as a Medicare and/or Medicaid program for an aging parent. The model grew out of On Lok's work in the city's Chinatown-North Beach community, and California lists multiple PACE organizations serving San Francisco County. If your parent lives in San Francisco, is 55 or older, and needs a level of care that could otherwise lead to a nursing home, PACE may be an option worth evaluating.

This article covers the specific PACE programs operating in San Francisco, what they include, who qualifies, what your parent would pay, and how to start the enrollment process.

What PACE Is (Quick Overview)

PACE stands for the Program of All-Inclusive Care for the Elderly. It is a Medicare and/or Medicaid program that provides coordinated medical and social services to older adults who need nursing-home-level care but can still live safely in the community with PACE support.

Participants generally receive their Medicare- and Medi-Cal-covered care and services through the PACE organization rather than through Original Medicare plus Medigap or through a Medicare Advantage plan. If someone with Medicare joins PACE, their Part D-covered drugs come through PACE; enrolling in a separate Medicare drug plan would end their PACE enrollment. For a national overview, see Medicare's PACE page.

PACE Programs Serving San Francisco

San Francisco has particular significance in the history of PACE. The model that became PACE grew out of On Lok Senior Health Services' work in the city's Chinatown-North Beach neighborhood in the 1970s. On Lok developed the community-based, interdisciplinary care model that later became the national PACE template.

Today, California's current Department of Health Care Services listings include On Lok PACE and North East Medical Services (NEMS) PACE for San Francisco County. The state also publishes service-area ZIP codes, so confirm the current list before applying.

On Lok PACE

On Lok is the original PACE provider and continues to operate multiple centers in San Francisco. Its current locator lists four San Francisco centers, including On Lok PACE at the Institute on Aging (IOA). The centers provide access to medical care, rehabilitation, meals, social activities, and support at home. On Lok also advertises language assistance in Cantonese, Mandarin, Vietnamese, Tagalog, and other languages; confirm availability for the center and service your parent would use.

On Lok's current PACE materials describe medical care, therapy, adult day programming, home care, transportation, meals, and dental, vision, and hearing support. The exact services a participant receives depend on the care plan and the PACE team's approvals.

NEMS PACE

NEMS PACE operates a San Francisco Chinatown center at 728 Pacific Avenue. Its current materials describe a dedicated care team and services delivered at the center, in the home, and in the community. Contact NEMS directly to confirm the current service area, availability, and the services in your parent's care plan.

On Lok and NEMS have different center locations and enrollment processes, so families should contact both organizations to determine which has availability and a service area that covers their parent's home address.

What San Francisco PACE Covers Through Medicare and Medi-Cal

PACE benefits in San Francisco generally follow the federal PACE package, but services are individualized through the PACE organization's care plan and interdisciplinary team. Treat the list below as a guide, not a promise that every service is automatic.

A San Francisco PACE plan may cover:

• Primary care and specialty medical visits — coordinated through the PACE team
• Hospital care — when medically necessary, coordinated through the PACE team
• Emergency services — when needed; call 911 for an emergency
• Prescription drugs — Part D-covered drugs and other necessary medication supplied through PACE
• Adult day primary care and activities — including meals, special dietary needs, and recreational therapy
• Home care and personal care/support — help with bathing, dressing, meals, and daily activities at home
• Physical, occupational, and speech therapy
• Dental care — some PACE organizations also describe vision and hearing support; ask what the local program includes
• Nutritional counseling and meals
• Social services and mental health counseling
• Transportation — to and from the day center and medical appointments

"All-inclusive" means PACE coordinates all Medicare- and Medi-Cal-covered care and services, plus other care the team approves; it does not mean every possible service is automatic. A separate Part D plan is not allowed while someone is enrolled in PACE, so ask how existing coverage will be handled before enrolling.

Who Qualifies for PACE in San Francisco

Eligibility for PACE in San Francisco follows the same four federal requirements as any PACE program:

1. Age 55 or older. Your parent does not need to be 65 or already enrolled in Medicare; people 55 and older can qualify if they meet the other conditions.

2. Nursing-facility level of care. The state must certify that your parent needs the level of care provided by a nursing facility. The PACE organization and state use an assessment process to determine this.

3. Residence in the PACE organization's service area. Your parent must live within the geographic area served by the specific PACE program. In San Francisco, DHCS lists both On Lok and NEMS PACE, but their service-area ZIP codes may differ. Contact each provider directly to confirm your parent's address falls within its coverage zone.

4. Ability to live safely in the community. At enrollment, your parent must be able to live at home — either independently with PACE support or with a family caregiver — rather than requiring 24-hour institutional care.

The nursing-facility-level-of-care requirement is central. Your parent does not need to be currently in a nursing home, but their care needs must meet the state's assessment standard. A diagnosis by itself does not guarantee eligibility; the state certification and PACE assessment control.

What Your Parent Pays for PACE in San Francisco

The cost depends on your parent's Medicare and Medicaid status:

Dual-eligible (Medicare + Medi-Cal): If your parent has Medi-Cal, Medicare says they won't pay a monthly premium for PACE. Medicare also says there is no deductible, copayment, or coinsurance for care, services, or drugs that the PACE team approves. Ask the program to explain the parent's exact Medi-Cal eligibility and any services outside the approved care plan.

Medicare only (no Medi-Cal): If your parent has Medicare but not Medicaid, the amount depends in part on whether they have Medicare Part A and/or Part B. It includes a monthly premium for the long-term-care portion of PACE and a premium for Part D drug coverage. Even without Medi-Cal, there are no deductibles, copayments, or coinsurance for services the PACE team approves.

Neither Medicare nor Medi-Cal: Someone without either type of coverage may be able to pay the PACE premium privately. Ask the organization for the current amount and eligibility details.

For families who have been paying out of pocket for home care, medication copays, specialist visits, or transportation, PACE may reduce some costs. Compare the program's current premium and approved services with the parent's existing coverage and local private-care costs.

How PACE Works Day-to-Day in San Francisco

The practical experience of PACE often includes the day center, but attendance and services vary by care plan. At the center, your parent may see members of the primary care team, receive therapy, eat meals, participate in social activities, and get personal care assistance as needed.

For adult children, the day center model addresses several challenges at once:

• Medical coordination: The PACE team coordinates PACE providers, medications, and specialist referrals, which can reduce the need to manage multiple offices yourself.
• Supervision and socialization: The day center can provide structured, supervised time and social contact during the day.
• Transportation: PACE provides transportation to and from the center and medical appointments. In San Francisco, where driving and public transit can be difficult for some seniors with mobility limitations, this can be useful.

When hospitalization is needed, the PACE organization coordinates with the hospital and helps plan the discharge and transition back home, including arranging approved skilled nursing or home health services during recovery.

How to Explore PACE for Your Parent in San Francisco

If you think your parent might qualify, here is the practical path:

1. Check the service area. Contact On Lok PACE and NEMS PACE directly to confirm that your parent's home address falls within a service area. You can also check the current California DHCS PACE plan list.

2. Request an eligibility assessment. The PACE organization will explain and schedule an assessment of your parent's functional level, medical history, and care needs. The state certification and assessment determine whether they meet the nursing-facility-level-of-care threshold.

3. Tour the day center. Before committing, visit the PACE center your parent would attend. Observe the environment, meet the care team, and ask about the languages spoken, the daily schedule, and the ratio of staff to participants.

4. Understand the trade-offs. Enrolling in PACE changes how your parent receives covered care — their current primary care physician may not be part of the PACE team, and care outside the PACE network may not be covered unless it is an emergency, urgent care, or authorized service. For parents with a strong attachment to an existing doctor, this is an important question to resolve before enrolling.

5. Contact your local HICAP office. California's Health Insurance Counseling and Advocacy Program (HICAP) provides free, unbiased Medicare counseling for beneficiaries and families. A HICAP counselor can help you compare PACE with your parent's other Medicare and Medi-Cal choices without sales pressure. The statewide number is (800) 434-0222.

PACE vs. Other San Francisco Senior Care Options

Families in San Francisco often weigh PACE against several alternatives:

• Medicare Advantage: MA plans offer managed care with network restrictions and may offer supplemental benefits such as transportation or in-home support, but those benefits vary by plan and are not the same as PACE's integrated nursing-home-level-of-care model.
• Original Medicare + Medigap + Part D: This combination offers broader provider choice but generally does not include ongoing custodial personal care or adult day services.
• Private home care: Hiring home care aides privately in San Francisco can be expensive and may not include PACE's integrated medical team, therapy, transportation, or day-center services.
• Assisted living or nursing home: A different living arrangement that can be costly and may move your parent away from their home and community.

PACE is not the right fit for every family. But for seniors who meet the eligibility criteria and live within a service area, it combines medical care, long-term services, social supports, and transportation in one coordinated program. San Francisco's long history with PACE also means families can compare more than one local organization.

Getting Help with the Full Medicare Picture

PACE is one piece of the Medicare decision for your parent, and it may or may not be the right answer depending on their care needs, geographic location, and preferences. Understanding where PACE fits alongside Original Medicare, Medicare Advantage, Medigap supplements, and Part D requires looking at the full landscape of options.

Our Medicare Enrollment Guide walks adult children through core Medicare enrollment decisions — including how to evaluate specialized programs like PACE, how to compare coverage costs, and how to navigate enrollment windows for your parent's situation.

Get the Medicare Enrollment Guide