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’ll pay the Part A and Part B coinsurance and deductibles.
• You can join anytime the Cost 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 Cost Plan (if offered) or you can join a Medicare Prescription Drug Plan. Even if the Cost Plan offers prescription drug coverage, you can choose to get drug coverage from a different plan.

Note: You can add or drop Medicare prescription drug coverage only at certain times. See pages 74–75.

For more information about Medicare Cost Plans, visit the Medicare Plan Finder at Medicare.gov/find-a-plan. Your State Health Insurance Assistance Program (SHIP) can also give you more information. See pages 109–112 for the phone number.

Read more in Medicare & You – Link is in one of the side panels

Medicare.Gov ssa.gov/title18/1876

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

PACE 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 for PACE, you must meet these conditions:

• You’re 55 or older.
• You live in the service area of a PACE organization.
• You’re certified by your state as needing a nursing home-level of care.
• At the time you join, you’re able to live safely in the community with the help of PACE services.

PACE provides coverage for many services, including prescription drugs, doctor or other health care practitioner visits, transportation, home care, hospital visits, and even nursing home stays whenever necessary.

If you have Medicaid, you won’t have to pay a monthly premium for the long-term care portion of the PACE benefit. If you have Medicare but not Medicaid, you’ll be charged a monthly premium to cover the long-term care portion 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 of health care professionals.
Visit Medicare.gov/find-a-plan, to see if there’s a PACE organization that serves your communityRead more in Medicare & You – see link in side panel

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