42 CFR § 460.186 - PACE premiums.

---
identifier: "/us/cfr/t42/s460.186"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 460.186 - PACE premiums."
title_number: 42
title_name: "Public Health"
section_number: "460.186"
section_name: "PACE premiums."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "E"
subchapter_name: "PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)"
part_number: "460"
part_name: "PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)"
positive_law: false
currency: "2026-04-05"
last_updated: "2026-04-05"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302, 1395, 1395eee(f), and 1396u-4(f)."
regulatory_source: "64 FR 66279, Nov. 24, 1999, unless otherwise noted."
cfr_part: "460"
---


# 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.