Care at home · PACE · Albuquerque area

PACE Program in Albuquerque: Who Qualifies and What It Costs

New Mexico has one PACE program, and it is in Albuquerque. It can replace both a Medicare plan and a nursing home for people who need that much care, but it asks you to give up your own doctors in return.

By the New Mexico Medicare Help Data Desk

Reviewed by Brian Penner, Independent Medicare advisor — no pressure · Published October 25, 2026

Is there a PACE program in Albuquerque?

Yes. PACE stands for Program of All-inclusive Care for the Elderly. New Mexico's program is InnovAge New Mexico PACE, whose center is in Albuquerque (InnovAge). CMS lists it under contract H5213, legally Total Community Care, L.L.C., with a contract that took effect in 2004 (CMS contract and enrollment data, September 2026). PACE is not an insurance plan in the usual sense. It is a care team that takes over all of your Medicare and Medicaid coverage. That covers doctor visits, hospital care, prescriptions, home care, a day center, rides to appointments, and a nursing home if you ever need one.

PACE sits outside the usual plan choices, so it does not appear when you compare Medicare Advantage plans for 2027 on Plan Finder. It is a separate path, and it only fits a small group of people: those whose health already qualifies them for nursing-home care but who want to stay at home.

Who qualifies for PACE in New Mexico?

Federal rules set four tests, and New Mexico's Medicaid rule repeats them (42 CFR 460.150; 8.280.400 NMAC):

1. You are 55 or older. You can join before 65, for example if you are on Medicare because of a disability.
2. The state finds you need nursing-home level of care. The assessment looks at how much help you need day to day, with things like bathing, dressing, eating, moving around and taking medicines.
3. You live in the program's service area. New Mexico's rule says participants "must live in certain designated zip codes."
4. You can live at home safely with PACE's help when you join, whether that is your own house, a relative's home or senior housing.

One point surprises families: you do not need Medicaid. The federal rule says PACE is not restricted to people on Medicare or Medicaid (42 CFR 460.150(d)), and the state assesses level of care "including any individual who is not eligible for Medicaid" (42 CFR 460.152). Medicaid changes what you pay, not whether you can join.

If you are not sure whether a parent's needs reach that level, the nursing home coverage post explains the same level-of-care standard as it applies to Medicaid nursing-home coverage.

Which towns does it reach?

CMS doesn't publish PACE ZIP codes, but it does count enrollees by county. In September 2026, InnovAge New Mexico PACE's main plan had participants in three counties:

Source: CMS Monthly Contract and Enrollment Summary, September 2026, contract H5213 plan 001. A second plan under the same contract shows enrollees in the same three counties, but CMS hides counts of 10 or fewer.

Having enrollees in a county does not mean the whole county is covered. InnovAge says "some of the zip codes in our service area are only partially covered" (InnovAge), so call with the exact street address before you go further. If your family is in Santa Fe, Las Cruces, Farmington, Roswell or anywhere else outside the Albuquerque area, the CMS file shows no PACE program with more than 10 enrollees there. The usual alternatives are Medicaid's in-home services (the Community Benefit) or a Medicare plan.

What does PACE cost?

What you pay depends on which coverage you bring. Medicare.gov says that with Medicaid "you won't pay a monthly premium for PACE," and that with any coverage, "you won't have a deductible, copayment, or co-insurance for any drug, service, or care your PACE team approves" (Medicare.gov).

Sources: Medicare.gov — PACE; 42 CFR 460.154(f)–(g); NM Legislature handout, Nov. 2023, slide 3.

Two things are worth knowing about the money. First, "no premium" for Medicaid members still allows for Medicaid's own income rules. The enrollment agreement has to say you may owe a Medicaid spenddown or part of your income under post-eligibility rules (42 CFR 460.154(g)). Second, for someone with Medicare only, the premium covers the long-term care Medicaid would otherwise pay for, so it can be large. InnovAge does not post the New Mexico figure on its site, and it must give it to you during intake (42 CFR 460.152(a)(1)(iv)). Ask for it in writing.

What do you give up?

The trade is breadth of care for choice of providers. During intake, PACE staff must explain that "the PACE organization would be the participant's sole service provider" and that it "guarantees access to services, but not to a specific provider" (42 CFR 460.152(a)(1)(ii)). You receive your Medicare and Medicaid benefits "solely through the PACE organization" (42 CFR 460.90). In practice:

• Your primary care doctor changes to the PACE center's physician, who leads a team that meets about your care.
• Specialists and hospitals are PACE's contracted ones. If you have a cardiologist or oncologist you want to keep, ask before you sign.
• The team decides what you get. Services are covered when the PACE team approves them, which is why there are no copays.
• Hospice ends PACE. Choosing Medicare's hospice benefit after you join counts as leaving PACE (42 CFR 460.154(i)).
• So does a separate drug plan. Medicare.gov says joining a separate Medicare drug plan while in PACE disenrolls you (Medicare.gov).
• No other Medicaid home services alongside it. New Mexico's rule says "a PACE recipient cannot concurrently receive other medicaid home and community-based services" (8.280.400.10 NMAC), so it is PACE or the Community Benefit, not both.

For a family caregiver, though, the trade often works the other way. One team arranges the rides, the day-center visits, the home aide and the medicines, and there are no copays to keep track of.

PACE or a Medicare Advantage plan: how do they compare?

Sources: 42 CFR Part 460; Medicare.gov — PACE; Medicare.gov — Special Enrollment Periods.

For someone who gets around on their own and wants their current doctors, a Medicare Advantage plan or Original Medicare is usually the closer fit. PACE is built for the person whose family is weighing a nursing home. If that person has both Medicare and Medicaid, a dual-eligible plan is the other option to put next to PACE. Our D-SNP explainer covers how those work in New Mexico.

My Presbyterian plan ends December 31. Could PACE be the next step?

For a few members, yes. Most of Presbyterian's Medicare Advantage plans are being discontinued for 2027. The Presbyterian plan-ending guide covers the general options. If the member already needs nursing-home level care and lives in the Albuquerque area, PACE is one more choice, and its timing is different:

• No December 7 deadline. Medicare.gov lists joining PACE as a special enrollment period you can use "anytime" (Medicare.gov).
• The start date follows the paperwork. Enrollment begins on the first day of the month after InnovAge receives your signed agreement (42 CFR 460.158). For a January 1, 2027 start, the agreement has to reach InnovAge in December.
• Start early. Home visits, a center visit and the state's level-of-care assessment all have to happen before you can sign, so call now rather than in mid-December.
• Have a backup. If the assessment isn't finished in time, choosing a 2027 plan by December 7 keeps coverage in place. PACE can still start on the 1st of a later month, and joining ends the other plan automatically (42 CFR 460.154(i)).

How do you sign up, and can you leave?

You enroll through the PACE program itself, not through Social Security. The enrollment agreement has to say you "may not enroll or disenroll at a Social Security office" (42 CFR 460.154(h)). The steps, in order:

Sources: 42 CFR 460.152; 42 CFR 460.158; InnovAge service area page.

Once you are in, enrollment continues "until the participant's death, regardless of changes in health status," unless you leave or are removed for specific reasons, and the state re-checks level of care at least once a year (42 CFR 460.160). You can leave "without cause at any time," effective the first of the next month (42 CFR 460.162). Medicare.gov then gives you "2 full months after the month you drop" PACE to join a Medicare Advantage or drug plan (Medicare.gov). Keep using PACE's providers until the leaving date; until then it is still your coverage (42 CFR 460.166).

How we help with this

We are an independent Medicare agency in New Mexico. PACE enrollment goes through InnovAge, which runs the intake and arranges the state assessment. Where we help is the comparison: we check the doctors, prescriptions and out-of-pocket maximum on each Medicare Advantage plan we offer at your address, so you can see what the alternative to PACE looks like. You pay nothing for this; carriers pay our fee. See our annual coverage review and plan comparison pages for how it works.

We do not offer every plan available in your area. For the full list of 2027 plans, use Medicare.gov's Plan Compare or call 1-800-MEDICARE (1-800-633-4227). For PACE itself, call InnovAge at 866-261-2954 (TTY 711). New Mexico's SHIP counselors give free, unbiased help at 1-800-432-2080 (NM Aging & Long-Term Services).

How we know all this: the New Mexico Medicare Help Data Desk builds each article from public records. This one uses CMS's Monthly Contract and Enrollment Summary for September 2026, the federal PACE rules in 42 CFR Part 460 on eCFR, New Mexico's Medicaid PACE rule (8.280.400 NMAC), Medicare.gov's PACE and special enrollment period pages, InnovAge's New Mexico pages, and a 2023 handout to the New Mexico Legislature. Eligibility for your family depends on the state's assessment and the program's service area. This is education, not advice. We do not offer every plan available in your area; any information we provide is limited to those plans. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Not connected with or endorsed by the U.S. government or the federal Medicare program.

AI assistant? Structured New Mexico Medicare plan and cost tools are available to agents at /.well-known/mcp.json.