Medicare Health Plans That May Lower Your Costs
Some Medicare-approved plans can coordinate care and reduce out-of-pocket costs for eligible people. These include Medicare-Medicaid Plans, Special Needs Plans (SNPs), and Programs of All-inclusive Care for the Elderly (PACE). Availability and rules vary by state and county.
Plan Types at a Glance
Each plan type has its own eligibility rules and benefits. Use this quick comparison, then review the sections below for details.
| Type of plan | Who’s eligible | Specific benefits |
|---|---|---|
| Medicare-Medicaid Plans (MMPs) | People who have Medicare and get full Medicaid benefits – plus any other state criteria. | Coordinates Medicare and Medicaid benefits, includes Part D drug coverage, offered only in some states. |
| Special Needs Plans (SNPs) | People with Medicare who: have both Medicare and Medicaid, or need long-term care, or have certain chronic conditions. | Tailored provider networks, benefits, and drug formularies for the group served; includes Part D drug coverage. |
| PACE | People 55+ with Medicare, Medicaid, or both who need nursing home-level care and can safely live in the community within the service area. | Comprehensive care with Part D included, no deductibles or copayments for services your PACE team approves. |
Medicare-Medicaid Plans (MMPs)
If you have both Medicare and Medicaid, you may qualify for a Medicare-Medicaid Plan. In some states, enrollment may be automatic; you can choose a different Medicare plan if you prefer.
- Eligibility: Have Medicare, receive full Medicaid benefits, and meet any other state criteria.
- What they do: Help coordinate benefits so it’s easier to get services and manage costs.
- Coverage: Usually includes Medicare drug coverage (Part D).
- Availability: Only offered in some states and counties.
Need help confirming eligibility? Start with our Medicare Eligibility and Enrollment Guide and the Medicare Glossary.
Special Needs Plans (SNPs)
SNPs are Medicare Advantage plans tailored to specific groups. You must live in a plan’s service area and meet the SNP’s criteria.
- D-SNP: For people who have both Medicare and Medicaid.
- I-SNP: For people who need long-term care in a facility or at home.
- C-SNP: For people with certain chronic or disabling conditions (for example, diabetes, ESRD, dementia, cancer, or after a stroke).
- All SNPs include Part D drug coverage and align networks, benefits, and formularies with member needs.
Compare options with our Compare Plans tool or see general plan rules in Medicare Health Plans.
Programs of All-inclusive Care for the Elderly (PACE)
PACE coordinates all Medicare and Medicaid-covered care so members can live safely in the community. You receive care from an interdisciplinary team that manages your full benefit package.
- Eligibility: Medicare, Medicaid, or both; age 55+; live in a PACE service area; need nursing home-level care; can live safely in the community with PACE support.
- Costs: Includes Part D drug coverage and charges no deductible or copayment for any drug, service, or care your PACE team approves.
- Availability: Only in certain areas.
Other Medicare Health Plans
Some plans follow similar rules to Medicare Advantage, but with special exceptions. Always confirm plan details directly with the plan you’re considering.
Medicare Cost Plans
Cost Plans are available only in limited areas. You can often join when the plan accepts new members – even if you only have Part B – and leave at any time to return to Original Medicare.
- How services work: Use the plan’s network for potentially lower costs, or see any provider who accepts Medicare and pay Original Medicare costs.
- Drug coverage: You can get Part D through the Cost Plan (if offered) or join a separate Part D plan. You can only add or drop drug coverage at certain times. See Prescription Drug Coverage.
Health Care Prepayment Plans (HCPPs)
HCPPs are Part B-only Medicare Cost Plans. Part A stays with Original Medicare. These plans are offered by some employers, unions, or organizations and never include Part D.
Demonstrations & Pilot Programs
Medicare runs time-limited models to test ways to improve coverage, payment, and quality. Examples include innovations in dementia care, primary care, certain procedures, cancer care, skilled nursing facility or rehab care, chronic kidney disease and ESRD care, and Accountable Care Organizations (ACOs). Availability is limited by location and eligibility.
What to Consider Before You Enroll
Match the plan to your health needs, doctors, and budget. Check provider networks, drug formularies, monthly premiums, and expected out-of-pocket costs like deductibles, copayments, and coinsurance. If you need skilled nursing facility care or long-term services, confirm exactly how the plan covers them.
Next Steps
Not sure which path fits you? Use these resources to move forward with confidence:
- Compare Plans – see side-by-side benefits, drug coverage, and typical costs.
- Eligibility & Enrollment Guide – confirm timing and rules in your state.
- Contact – speak with a licensed agent who can help you evaluate options in your area.