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Other Medicare Health Plans

Aside from Medicare Parts A and B and Medicare Advantage Plan, Medicare offers other options. These plans have some of the same rules however, each type of plan has special rules and exceptions.


Medicare Cost Plans

These are the type of Medicare health plans available in certain, limited areas of the country.

Here's what you should know about it;
  • 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 covered are under Original Medicare.
  • You can join anytime
  • You can leave anytime and return to Original Medicare
  • You can either get your Medicare prescription drug coverage from the Cost Plan or you can join a Medicare Prescription Drug Plan. (You can add or drop Medicare prescription drug coverage only at certain times)

Programs of All-inclusive Care for the Elderly (PACE)

This is a Medicare and Medicaid program offered in many states that allows people who otherwise need a nursing home-level of care to remain in the community. 

 To qualify, you must  be;
  • 55 or older
  • live in the service area of PACE organization
  • certified by your state as needing a nursing-home level of care
  • able to live safely in the community with the help of PACE services

PACE covers all Medicare and Medicaid-covered care and services and other services that the PACE team of health care professionals decides are necessary to improve and keep up your health. 

If you have Medicaid, you won't have to pay a monthly premium for the long-term care part of the PACE benefit. 

If you have Medicare, you'll be charged a monthly premium to cover the long-term care part of the PACE benefit and a premium for Medicare Part D drugs. However, in PACE, there's never a deductible or copayment for any drug, service or care approved by the PACE team. 


Medicare Innovation Projects

Medicare develops innovative models, demonstrations and pilot projects to test and measure the effect of potential changes in Medicare.  These projects help find new ways to improve health care quality and cut costs. 

Examples of current projects include innovations in primary care, care related to specific procedures, Cancer care and care for people with End-Stage Renal Disease.

To learn more about the current Medicare projects, call 1-800-MEDICARE, TTY users can call 1-877-486-2048.


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NCOV -19 and MEDICARE 2020

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Cardiovascular Disease Risk Reduction

Cardiovascular disease generally refers to conditions that can lead to a heart attack or stroke. Cardiovascular disease risk reduction visits can help detect and prevent this disease. How to know if I am Eligible? Medicare   Part B  covers an annual cardiovascular disease risk reduction visit with your primary care  provider . You do not need to show any signs or symptoms of cardiovascular disease to qualify for screening, but you must be considered competent and alert when counseling is provided.  During the screening, your provider may; Encourage aspirin use if the benefits outweigh the risks You are a man  of age 45-79 Or a woman of age 55-79 Screen for high blood pressure if you are age 18+ Provide behavioral counseling and tips to encourage a healthy diet Note: Men under 45 and women under 55 are not encouraged to use aspirin as a tool to reduce cardiovascular disease. How much will it cost? If you are eligible,  Original Medicare  will cover your cardiovascular disease risk red
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Lifetime Reserve Days

There are  90 days of  inpatient  hospital care coverage on Original Medicare for each  benefit period , In addition, you also have an additional 60 days of coverag e , called LIFETIME RESERVE DAYS .   These Lifetime Reserved Days  can be used only ONCE, and you will pay a  coinsurance  for each of it. To have a better understanding of it, let’s imagine an individual who had a 120-day  Medicare -covered inpatient stay, this means that they used 30 lifetime reserve days. After they have been out of the hospital for 60 days in a row, they will be eligible for another 90 days of hospital coverage because they will be in a new  benefit period . However, if they need  inpatient care  beyond the benefit period maximum, they will only have 30 of their 60 lifetime reserve days remaining. The above example illustrates that lifetime reserve days do not have to be applied to the same hospital stay. If you need to stay in the hospital twice for 120 days each time during different benefit
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