Plan Basics
Contract Year 2021
Medicare Type Medicare Advantage Plan (Part C)
CMS Plan ID H0934-001-000
Plan Organization Pacific PACE
Plan Type National PACE
Plan Name Pacific PACE (PACE)
Plan Organization Type National PACE
Drugs Covered Yes
Doctors Choice Plan Doctors for Most Services
Special Needs Plan No
Plan Cost Sharing
Premium $Not Available
Total Premium (Includes Part B) $497.00
Monthly Part C Premium $0.00
Monthly Part D Basic Premium $361.50
Monthly Part D Supplemental Premium $0.00
Monthly Part D Total Premium $361.50
Monthly Part D Premium Full Assistance $0.00
Monthly Part D Premium 75% Assistance $337.90
Monthly Part D Premium 50% Assistance $345.80
Monthly Part D Premium 25% Assistance $353.60
Part D Catastrophic Coverage Threshold $6550.00
Plan Drug Info
Official Medicare Contact
Medicare Phone 1-800-MEDICARE (1-800-633-4227)
Medicare TTY User 1-877-486-2048
Plan Available in these Counties
Los Angeles County, California

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