---
kind: "section"
citation: "42 C.F.R. § 460.186"
title: "42"
number: "460.186"
heading: "PACE premiums."
url: "https://uscodex.org/cfr/42/460.186"
---

# §460.186. PACE premiums.


The amount that a PACE organization can charge a participant as a monthly premium depends on the participant's eligibility under Medicare and Medicaid, as follows:

- (a) **Medicare Parts A and B.** For a participant who is entitled to Medicare Part A, enrolled under Medicare Part B, but not eligible for Medicaid, the premium equals the Medicaid capitation amount.
- (b) **Medicare Part A only.** For a participant who is entitled to Medicare Part A, not enrolled under Medicare Part B, and not eligible for Medicaid, the premium equals the Medicaid capitation amount plus the Medicare Part B capitation rate.
- (c) **Medicare Part B only.** For a participant who is enrolled only under Medicare Part B and not eligible for Medicaid, the premium equals the Medicaid capitation amount plus the Medicare Part A capitation rate.
- (d) **Medicaid, with or without Medicare.** A PACE organization may not charge a premium to a participant who is eligible for both Medicare and Medicaid, or who is only eligible for Medicaid.

## Notes

### Authority

Authority: 42 U.S.C. 1302, 1395, 1395eee(f), and 1396u-4(f).

### Source

Source: 64 FR 66279, Nov. 24, 1999, unless otherwise noted.