Some types of Medicare health plans that provide health care coverage aren't Medicare Advantage Plans but are still part of Medicare. Some of these plans provide Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, while most others provide only Part B coverage. Some also provide Medicare prescription drug coverage (Part D) .
These plans have some of the same rules as Medicare Advantage Plans. However, each type of plan has special rules and exceptions, so you should contact any plans you're interested in to get more details.
Medicare Cost Plans
Medicare Cost Plans are a type of Medicare health plan available in certain areas of the country.
Here's what you should know about Medicare Cost Plans:
- You can join even if you only have Part B.
- If you have Part A and Part B and go to a non-network provider, the services are covered under Original Medicare . You would pay the Part A and Part B coinsurance and deductible .
- You can join anytime the plan is accepting new members.
- You can leave anytime and return to Original Medicare.
- You can either get your Medicare prescription drug coverage from the plan (if offered), or you can join a Medicare Prescription Drug Plan (Part D) .
Another type of Medicare Cost Plan only provides coverage for Part B services. These plans never include Part D. Part A services are covered through Original Medicare. These plans are either sponsored by employer or union group health plans or offered by companies that don't provide Part A services.
For more information about Medicare Cost Plans, contact the plans you're interested in.
Demonstrations and pilot programs, (also called “research studies”) are special projects that test improvements in Medicare coverage, payment, and quality of care. They usually operate only for a limited time for a specific group of people and/or are offered only in specific areas. Check with the demonstration or pilot program for more information about how it works. To find out about current Medicare demonstrations and pilot programs, call 1-800-MEDICARE.
Programs of All-Inclusive Care for the Elderly (PACE)
PACE (Program of All-inclusive Care for the Elderly) is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other care facility. PACE covers adult day primary care, dentistry, emergency services, home care, hospital care, laboratory/x-ray services, meals, medical specialty services, nursing home care, nutritional counseling, occupational therapy, physical therapy, prescription drugs, Part D covered drugs, preventive care, social services, caregiver training, support groups, respite care, social work counseling, and transportation if medically necessary.
Medication Therapy Management programs
If you're in a Medicare Prescription Drug Plan and you have complex health needs, you may be eligible to participate in a Medication Therapy Management (MTM) program. These programs help you and your doctor make sure your medications are working.