What Types of Medicare Health Plans Are There?
If you are eligible for Medicare, you can usually get Medicare coverage the traditional way. But you might have some more choices. Let’s take a look at Medicare health plans.
What are Medicare health plans?
You might already be familiar with Medicare Advantage plans. But did you know that’s not the only kind of Medicare health plan?
Medicare health plans give you a way to get your Medicare Part A and Part B benefits differently. If you stay with Original Medicare (Part A and Part B), these benefits come straight from the government. If you sign up for a Medicare health plan, you still get your Part A and Part B coverage.
So what’s different? The main difference is, under a Medicare health plan, a private insurance company contracts with Medicare to deliver your Part A and Part B coverage. But you’re still in the Medicare program. It’s just that your Medicare health plan is usually who you interact with – not the government directly.
Some Medicare health plans may have provider networks, and you might be required to use doctors and facilities within that network or else pay higher out-of-pocket costs. You might pay a premium to your Medicare health plan. You need to pay your Medicare Part B premium as well – but if you’re on Medicaid, that program might pay our Part B premium.
What are the kinds of Medicare health plans?
There are a few different types of Medicare health plans.
- Medicare Advantage plans – Many of these plans offer benefits beyond Part A and Part B, like membership in fitness programs. Most Medicare Advantage plans include prescription drug coverage.
- Medicare Cost Plans – Unlike with Medicare Advantage plans, you can generally sign up for a Medicare Cost Plan if you’re only enrolled in Medicare Part B. (You need to have both Part A and Part B to qualify for Medicare Advantage plans.)
Medicare Cost Plans may have provider networks, just as with other Medicare health plans. However, if you visit a doctor outside the plan network, Medicare Part B may cover the visits when you have a Medicare Cost Plan. A coinsurance or copayment may apply, once you’ve paid the plan deductible.
- Programs of All-inclusive Care for the Elderly (PACE) plans – this special type of Medicare health plan is for qualified people 55 years old and older who are enrolled in Medicare or Medicaid. The PACE program aims to provide and coordinate care in your home or community, so you don’t have to live in an institution like a nursing home.
Not every state has PACE programs. Contact your state’s Medicaid office to find out if your state has this program. You can find your state’s Medicaid office here: https://www.medicaid.gov/about-us/contact-us/contact-state-page.html
- Demonstration or pilot programs – These plans are designed to test improvements in Medicare coverage and other areas. These plans are generally limited to certain groups of people and parts of the country, and are usually temporary.
Some Medicare health plans, such as PACE plans, include prescription drug coverage.
We hope this article helped you understand the different kinds of Medicare health plans. You can compare Medicare Advantage plans with the Browse Plans button on this page.