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In addition to Medicare Advantage plans, consumers in some states are enrolled in other private Medicare health plans, such as Cost plans, demonstration plans, or PACE plans. The definitions below explain some of the other types of Medicare health plans available to some consumers.
Program of All-Inclusive Care for the Elderly (PACE)
Medicare and Medicaid plan for frail elderly designed to help people stay in the community rather than going to a nursing home. To enroll in a PACE plan an individual must be certified as having a need of care that would require admission to a nursing home. In 2015, about 30,000 beneficiaries were in PACE plans.
A health plan available in select parts of the country that is paid differently than a Medicare Advantage plan. Unlike Medicare Advantage plans that are paid on a per member per month basis, Cost plans are reimbursed based on their medical costs. Because current law restricts new entrants of cost plans, these plans are only available in certain geographic areas. Cost plans include out-of-network coverage and may or may not include prescription drug coverage. Cost plans do not bid and their payments are not adjusted based on Star Ratings. In 2015, about 600,000 beneficiaries were in Cost plans.
A plan that is part of a program designed to test improvements in Medicare coverage, payment, and quality of care for specific populations. Demonstration plans usually operate only for a limited period (e.g., three years). An example is the Medicare/Medicaid dual demonstration plans being offered in a number of states. In 2015, about 300,000 beneficiaries were in demonstration plans.
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Note: In addition to Medicare Advantage plans, consumers in some states are enrolled in other private Medicare health plans, such as Cost plans, demonstration plans, or PACE plans. The map above does not count these other plans toward a state's overall Medicare Advantage participation. For more information on the types of other private Medicare health plans,