Some people who have or are eligible for Medicare get their coverage
from other types of Medicare health plans, or from other government
or private insurance. Some types of Medicare plans that provide
health care coverage aren’t Medicare Advantage Plans but
are still part of Medicare. Some of these plans provide Part A
(Hospital Insurance) and/or Part B (Medical Insurance) coverage,
and some also provide Part D (Medicare Prescription Drug) coverage.
These plans have some of the same rules as Medicare Advantage
Medicare Cost Plans
Medicare Cost Plans are a type of Medicare
health plan available in
certain areas of the country. You should know the following about
Medicare Cost Plans:
- You can join even if you only have Part B.
- If you go to a non-network
provider, the services
are covered under Original
Medicare. You would pay the Part B premium, and the Part
A and Part B coinsurance and deductibles.
- You can join any
time the plan is accepting
new members. You can leave any time and return to Original Medicare.
- You can either get your Medicare prescription drug coverage
from the plan (if offered),
- You can join a Medicare Prescription Drug Plan to add prescription
is another type of Medicare
Cost Plan that 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. You can
also visit www.medicare.gov.
Your State Health Insurance Assistance Program (SHIP) can also
give you more information.
Demonstrations and pilot programs,
sometimes 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.
For more information about current Medicare demonstrations
and pilot programs, visit
www.medicare.gov. You can also call 1-800-MEDICARE (1-800-633-4227)
and say “Agent.” TTY
users should call 1-877-486-2048.
Programs of All-Inclusive Care for the Elderly (PACE)
medical, social, and long-term
care services, and prescription drug coverage for frail elderly
and disabled people. This program provides community-based care
and services to people who otherwise need nursing home-level of
To qualify for PACE, you must meet the following conditions:
- You are age 55 or older.
- You live in the service
area of a PACE organization.
- You are certified by
your state as meeting
the need for nursing
the time you join, you
are able to live safely
in the community with
the help of PACE services.
PACE is only available
in states that have chosen
it as an optional Medicaid
benefit. Call your State
Medical Assistance (Medicaid)
office to find out if you are eligible and if there is a PACE
site near you. For more information, you can also visit www.medicare.gov to view the fact sheet “Quick
Facts about Programs
of All-inclusive Care
for the Elderly (PACE).”
Federal Employee Health Benefits Program (FEHBP)
for current and retired
Federal employees and covered family members. Prescription drug
coverage under FEHBP is considered creditable, and, in most cases,
it will be to your advantage to keep your current coverage. If
you join a Medicare drug plan, you can keep your FEHBP plan, and
your plans will let you know who pays first. For more information,
contact the Office of Personnel Management at 1-888-767-6738,
or visit www.opm.gov. TTY users should call 1-800-878-5707.
Health coverage for veterans and people who
have served in the U.S.
military. You may be able to get prescription drug coverage through
the VA program. This coverage is considered creditable. You may
join a Medicare drug plan, but if you do, you can’t use both types of coverage at the same time. In
most cases, it will be to your advantage to keep your current
coverage. For more information, call the U.S. Department of Veterans
Affairs (VA) at 1-800-827-1000, or visit www.va.gov. TTY users
should call 1-800-829-4833.
Military Benefits (TRICARE)
Health care program for active-duty
service members, retirees,
and their families. All people with TRICARE are eligible for TRICARE
pharmacy benefits. Most people keep their TRICARE pharmacy benefits
because they are considered creditable prescription drug coverage.
You may also add Medicare prescription drug coverage. If you do,
your Medicare drug plan pays first and TRICARE pays second. In
most cases, it will be to your advantage to keep your current
coverage. For more information, call the contractor that handles
TRICARE claims at 1-866-773-0404, or visit www.tricare.osd.mil.
TTY users should call 1-866-773-0405.
Indian Health Services
Health care for people who are American
Indian/Alaska Native through
an Indian health care provider. If you get health care from one
of these providers, you have creditable prescription drug coverage.
If you get prescription drugs through an Indian health pharmacy,
you pay nothing and your coverage won’t
be interrupted. Joining a Medicare drug plan may help your Indian
health provider with costs, because the drug plan pays part of
the cost of your prescriptions. For more information, contact
your local health care provider to find out how Medicare works
with your health care.
The Medicaid Program provides medical benefits to groups
of low-income people, some
who may have no medical insurance or inadequate medical insurance.
Although the Federal government establishes general guidelines
for the program, the Medicaid program requirements are actually
established by each State. Whether or not a person is eligible
for Medicaid will depend on the State where he or she lives.
are required to include
certain types of individuals or eligibility groups under their
Medicaid plans and they may include others. States’ eligibility groups
will be considered one of the following: categorically needy,
medically needy, or special groups.
The medically needy have too
much money (and in some
cases resources like savings) to be eligible as categorically
needy. If a state has a medically needy program, it must include
pregnant women through a 60-day postpartum period, children under
age 18, certain newborns for one year, and certain protected blind
Contact your state for more information on all Medicaid
groups in your state.
GO TO ==> Other
Private Insurance Plans or
Back to Main