Obscure Plans we get tested on or misc. but don’t apply in CA or to our specific practice.

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

Medicare works with private insurance companies to offer you ways to get your health care coverage. These companies can choose to offer a consumer-directed Medicare Advantage Plan, called a

Medicare MSA Plan

These plans are similar to Health Savings Account Plans available outside of Medicare. You have flexibility in choosing your health care services and providers.

Medicare MSA Plans have 2 parts

Medicare MSA Plans combine a high-deductible insurance plan with a medical savings account that you can use to pay for your health care costs.

  1. High-deductible health plan: The first part is a special type of high-deductible Medicare Advantage Plan (Part C). The plan will only begin to cover your costs once you meet a high yearly deductible, which varies by plan.
  2. Medical Savings Account (MSA): The second part is a special type of savings account. The Medicare MSA Plan deposits money into your account. You can choose to use money from this savings account to pay your health care costs before you meet the deductible.

How do MSA Plans work?

Read about basic steps for using a Medicare MSA Plan.

What’s covered?

In addition to the Medicare services that all Medicare Advantage Plans must cover, some plans may cover extra benefits for an extra cost, like:

  • Dental
  • Vision
  • Long-term care not covered by Medicare

Contact plans in your area for more information on what extra benefits they cover, if any.

Medicare MSA Plans don’t cover Medicare Part D prescription drugs

If you join a Medicare MSA Plan and need drug coverage, you’ll have to join a Medicare Prescription Drug Plan. To find available plans in your area, visit the Medicare Plan Finder, call 1-800-MEDICARE (1-800-633-4227), or look at the back of your “Medicare & You” handbook. *  copied from medicare.gov   * 

 

Links & Resources

Medicare.Gov MSA  

CMS.Gov Fact Sheet  

Medicare and You 2020 #10050  
Everything you want to know - Read Along

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Private Fee-for-Service (PFFS) plan

Can I get my health care from any doctor, other health care provider, or hospital?

You can go to any Medicare-approved doctor, other health care provider, or hospital that accepts the plan’s payment terms and agrees to treat you. If you join a PFFS plan that has a network, you can also see any of the network providers who have agreed to always treat plan members. You can also choose an out-of-network doctor, hospital, or other provider, who accepts the plan’s terms, but you may pay more.

Are Part D Rx Prescriptions covered?

Sometimes. If your PFFS plan doesn’t offer drug coverage, you can join a Medicare Prescription Drug Plan to get coverage.

Do I need to choose a primary care doctor?

No.

Do I have to get a referral to see a specialist?

No.

What else do I need to know about this type of plan?

• PFFS plans aren’t the same as Original Medicare or Medigap.
• The plan decides how much you pay for services.
• Some PFFS plans contract with a network of providers who agree to always treat you, even if you’ve never seen them before.
• Out-of-network doctors, hospitals, and other providers may decide not to treat you, even if you’ve seen them before.
• For each service you get, make sure to show your plan member card before you get treated.
• In a medical emergency, doctors, hospitals, and other providers must treat you.
• If you need more information than what’s listed on this page, check with the plan.  CMS.Gov * Read more in Medicare & You – link in side panel

2 comments on “Obscure Medicare Health Plans – Not in CA

  1. With this plan does medicare (medicare advantage msa) pay for 80% of the bill and I pay the full 20% of whats left?

    I am confused.

    I know I pay the 100% until my deductible is reached, but is that the 100% of the 20% that medicare does not pay?

    • We don’t have Medicare MSA’s in California, so let me just cut and paste the answer from Medicare.Gov

      10 steps to use a Medicare MSA Plan

      Choose and join a high-deductible Medicare MSA Plan.

      You set up an MSA with a bank the plan selects.

      Medicare gives the plan an amount of money each year for your health care.

      The plan deposits some money into your account.

      You can use the money in your account to pay your health care costs, including health care costs that aren’t covered by Medicare. When you use account money for Medicare-covered Part A and Part B services, it counts towards your plan’s deductible .

      If you use all of the money in your account and you have additional health care costs, you’ll have to pay for your Medicare-covered services out-of-pocket until you reach your plan’s deductible.

      During the time you’re paying out-of-pocket for services before the deductible is met, doctors and other providers can’t charge you more than the Medicare-approved amount.

      After you reach your deductible, your plan will cover your Medicare-covered services. Read information from the plan for details about out-of-pocket costs .

      Money left in your account at the end of the year stays in the account, and may be used for health care costs in future years.

      If you use funds from your account, you must include this special form [PDF, 89.4 KB] with information on how you used your account money when you file taxes.

      If you have further questions, we will need you to send us ALL the information from your plan.

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