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Medicare Made Easy
Other Government Plans

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 Plans.

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), or
     
  • You can join a Medicare Prescription Drug Plan to add prescription drug coverage.

There 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/Pilot Programs

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)

PACE combines 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 care.

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 home-level care.
     
  • At 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)

Health coverage 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.

Veterans Benefits

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.

Medicaid

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.

States 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 persons.

Contact your state for more information on all Medicaid groups in your state.


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