CenterLight Healthcare PACE

Frequently Asked Questions

What Is CenterLight Healthcare PACE?

The Program of All-Inclusive Care for the Elderly (PACE) coordinates and provides the care of each person enrolled in the program based on his or her individual needs, with the goal of enabling older adults to enjoy the highest possible quality of life while living safely in their homes and communities.

Am I eligible for CenterLight Healthcare PACE?

The eligibility requirements for PACE include:

Being 55 years or older

Currently Medicaid eligible and/or entitled to Medicare Part A and/or enrolled in Medicare Part B or able to pay privately

Living in our service area including the Bronx, Kings (Brooklyn), New York (Manhattan), Queens, Richmond (Staten Island), Nassau, Suffolk and Westchester counties

In need of nursing home level of care, but able to remain living safely in your home. You must need the long-term care services of the plan for a minimum of 120 days

Are prescription drugs covered under PACE?

Yes. All prescription and non-prescription drugs deemed necessary by your CenterLight Healthcare PACE care team are paid for by the CenterLight Healthcare PACE program. There are no co-pays and no coverage gaps.

If I do not qualify for Medicaid, can I still enroll in CenterLight Healthcare PACE?

Yes. If you do not qualify for Medicaid, you can enroll by paying the monthly premium Medicaid would pay. In addition, you will also be responsible for a monthly Medicare prescription drug premium. If you do not think you qualify, we would explore Medicaid eligibility under the spend down and spousal enrichment program.

How do I join CenterLight Healthcare PACE?

To learn more about CenterLight Healthcare PACE and explore if it’s the right choice for you, please call 1-877-226-8500 (TTY 711) from 8:00 a.m. to 8:00 p.m. EST, 7 days a week.

If I enroll in PACE can I keep my own doctor?

If your doctor is part of our provider network, you can keep your own doctor. If not, CenterLight Healthcare will provide you with a primary care physician who is part of a healthcare team that includes: a physician, clinic and home care nurses, social worker, rehab specialists, recreational therapists, home health aide/personal care aide and transportation representative. Your primary care physician works closely with other members of the team to coordinate all services. If your doctor is not part of our provider network, but is willing to contract and collaborate with CenterLight Healthcare, you can keep your own doctor.

Does CenterLight Healthcare provide transportation?

CenterLight Healthcare PACE provides transportation to and from our day health centers. As part of the CenterLight Healthcare PACE benefit, transportation is also provided to and from appointments with specialists and other activities.

Do I need to go to the day center every day?

No, your participation at the CenterLight Healthcare PACE day center is based on individual needs and preferences.

What is an average day like at one of CenterLight Healthcare’s day centers?

The day health center offers opportunities for individuals to socialize, enjoy nutritious meals, participate in CenterLight Healthcare’s recreational activities, and enjoy entertainment. Because your primary care physician and some specialists may have their offices at the center, your day may also include visits to your medical appointments.  Therapies are also provided at the center.

What happens if my needs change and I need nursing home care?

If ever it is in your best interest to receive care in a nursing home, the CenterLight Healthcare team will continue to manage your care and help you with finding a nursing home within our network. Your care team will continue to manage and pay for your care.

What if I want to leave CenterLight Healthcare PACE?

PACE is a voluntary program.  You may request disenrollment at any time, and CenterLight Healthcare will work with you to transition to other programs.

Are medications covered?

Yes, all prescriptions and non-prescription drugs deemed necessary by your CenterLight Healthcare PACE healthcare team are paid by CenterLight Healthcare PACE, with no co-pays.

Who may benefit from CenterLight Healthcare PACE?

In order to benefit from CenterLight Healthcare PACE, individuals must be in need of nursing home level of care, but able to remain living safely in your home.  Those who may benefit:

Want to live at home, but require the support of others to do so

Have frequent doctor’s visits, calls or emergency room visits, hospital admissions, or short-term nursing home stays

Have deteriorated health or medical problems that are interfering with daily functioning

Looking for something to make it easier for to manage your care

Having trouble getting to medical appointments or day center

Have frequent falls

Don’t understand your medications or how to take them

Are frequently at home alone and don’t feel safe

May become a burden on family due to health condition(s)

If I am already enrolled in another managed care plan, can I also enroll in the CenterLight Healthcare PACE service plan?

No. You can only enroll in one managed care plan. By enrolling in the CenterLight Healthcare PACE plan, your current Medicare and/or Medicaid coverage will automatically end when your new coverage begins.

Members may be liable for the cost of services not authorized by your CenterLight Healthcare program.

We are here to assist you 24/7!