Posted in Triplett & Carothers on April 3, 2025

Let’s start with Medicare Advantage plans, if only because there is so much about them on television and so many flyers in your mail. We’ll then turn to other Medicare plans — some that you may never have heard of.

Medicare Advantage plans (Part C)
Medicare Advantage plans are offered not by the federal government but by private insurance companies that are approved and regulated by Medicare. These plans may enter or leave the Medicare market yearly. If a company withdraws or if a plan is no longer available in your area, you’ll need to switch plans or return to original Medicare during a special enrollment period.

Medicare Advantage plans combine Part A (hospital) and Part B (medical) coverage, often including additional benefits such as drug coverage (Part D); vision, hearing or dental services; fitness programs; and even transportation services. These plans consolidate coverage into a single plan and typically have lower premiums compared to original Medicare combined with a separate Medigap plan. However, they may involve network restrictions and higher out-of-pocket costs for some services. Electing a Medicare Advantage plan may also cause you to lose your employer or union health coverage with no option to restore it, which might affect your spouse and dependents,

Other Medicare health plans
Some health plans aren’t Medicare Advantage but operate under similar rules. Examples include Medicare Cost plans, which are only available in specific regions or areas, typically where traditional Medicare Advantage plans are not widely offered or where certain needs are better served by Cost plans. Cost plans allow you to use network providers at lower costs or providers that accept Medicare at the same cost as original Medicare. You can join or leave a Medicare Cost plan anytime (without waiting for open enrollment). Some offer drug coverage, though it can also be added through a separate plan.

Health Care Prepayment plans are another option. HCPPs are typically sponsored by employer or union group health plans to provide Medicare Part B coverage for their members. They leave Part A coverage under original Medicare and typically don’t include drug coverage (Part D).

Special projects and programs
Medicare occasionally tests new approaches through its demonstrations and pilot programs. These projects last for a limited time in specific areas and focus on specific populations or conditions, such as dementia care, joint replacements and chronic illnesses. Programs such as Accountable Care Organizations aim to improve care quality and reduce costs. To learn about ongoing projects, call 1-800-MEDICARE (1-800-633-4227).

Program of All-Inclusive Care for the Elderly
PACE is a joint Medicare-Medicaid program providing comprehensive care for people aged 55 and older who require nursing home-level care but can live safely in the community. Coverage includes a wide range of services such as doctor visits, emergency care, physical therapy, meals and transportation. If you have Medicaid, there’s no monthly premium for long-term care; otherwise, you’ll pay premiums for care and drugs. Joining a separate Medicare drug plan while enrolled in PACE will disenroll you from the program.

Navigating Medicare options is complicated. Consult with financial and tax advisers to ensure that you understand the choices and select the options best suited to your health needs and financial situation.