Eligibility, cost and service area

Who’s eligible?

To be eligible to enroll in Fallon Health Weinberg-PACE you must:

  • Be at least 55 years old
  • Live in Erie County, NY
  • Be certified as needing the nursing facility level of care as determined by the NYS scoring tool
  • Require Fallon Health Weinberg-PACE long-term care services for more than 120 days
  • Be able to live safely in the community, as defined by the New York State Health and Safety Criteria;
  • Be Medicaid and/or Medicare eligible or willing to pay privately
  • Meet other eligibility requirements (eligibility addendum)

Fallon Health Weinberg-PACE may be a good fit for:

  • Caregivers and family members who want to keep their loved one at home as long as possible with supportive services and home care

  • Individuals who want to have all their medical care provided or coordinated by a team consisting of geriatric specialists (Interdisciplinary Team)

  • Individuals who want to engage in recreational and social activities and receive personal care and supervision during the day in an adult day health center

Premiums and cost-sharing

We accept Medicare, Medicaid and private pay. If you do pay a premium, the cost is less than a nursing home and includes so much more. You won’t require additional health insurance.

Depending on your level of Medicaid eligibility, as determined by Erie County Department of Social Services, you may pay a share of your premium costs or no premium.  

All services that are recommended by the Fallon Health Weinberg-PACE Interdisciplinary Team are covered with no deductibles, no coinsurance and no copayments.

Service area

Fallon Health Weinberg-PACE service area includes all of Erie County, NY.

Insurance coverage

All program services that are recommended and approved by the Fallon Health Weinberg-PACE Interdisciplinary Team are covered. Once a participant is enrolled in our PACE program, there is no paperwork or claim forms to worry about. There are no insurance copayments, coinsurance or deductibles.

Medically necessary prescription drug coverage

Covered in full

On-going care management and support for participants and caregivers

Covered in full

24-hour telephone access to a member of the participant’s geriatric team

Covered in full

In-home nursing, rehabilitation and other support services as needed

Covered in full

Physical, occupational, recreational and other therapies

Covered in full

Nutrition evaluations and guidance

Covered in full

Medication management

Covered in full

Adult day health services

Covered in full

Medical supplies and equipment

Covered in full

Inpatient hospitalization care

Covered in full

Specialty care services such as cardiology, ophthalmology, podiatry

Covered in full

Dental and vision care, including eyeglasses

Covered in full

Other services as prescribed by the Interdisciplinary Team

Covered in full

 

 

In some cases, there may be a monthly premium required based on your income or assets.

All services must be provided by or authorized by the PACE Interdisciplinary Team (except emergency services). PACE participants may be held liable for costs for unauthorized or out-of-PACE program agreement services.

H6596_W_2015_1 Approved 02122016
The information on this page was last updated on 7/17/2015.

Contact us

► Before you enroll, call:

 1-855-665-1113 (TTY 711) 
8:30 a.m.–5 p.m.,
Monday–Friday

Members may call:

1-855-665-1113 (TTY 711)
8:30 a.m.–5 p.m.,
Monday– Friday

 

Come see us

You are welcome to tour our PACE center at 461 John James Audubon Parkway, Amherst, NY, before making the decision to enroll yourself or your loved one in Fallon Health Weinberg-PACE.

Schedule a tour online
or
Call us at 1-716-810-1895 or
1-855-665-1113
(TTY 711) 
8:30 a.m.–5 p.m.,
Monday–Friday