Anyone familiar with the Medicare program knows that it comes in different parts, each one covering different health care services.
- Medicare Part A covers many of your inpatient care needs.
- Medicare Part B covers your outpatient services.
- Medicare Part C, also called Medicare Advantage, combines Part A and B into a single plan and sometimes includes prescription drug coverage.
- Medicare Part D offers coverage for prescription drugs and pairs with Medicare Parts A and B.
But are there other parts of the Medicare program? Depending on how deeply you search, you may find mentions of a Medicare Part E. This more obscure part of the Medicare program can refer to different things. Let’s take a look at some of the references of Medicare Part E!
What is the Choose Medicare Act?
The first way people sometimes use Medicare Part E is in reference to creating a new part of the Medicare program that would be available to the general public. In this case, the “E” can be used to refer to “Everyone.” The most recent attempt to create this new part of the Medicare program was in 2021, when the Choose Medicare Act was introduced to both the Senate and House of Representatives. The bill would create a Medicare Part E, effectively acting as a Medicare Advantage for those who wouldn’t traditionally qualify for Medicare, among other changes. Both bills were introduced to Congress before being referred to their respective committees.
This isn’t the first time an official Medicare Part “E” for everyone has been discussed.
There hasn’t been much movement since 2021, so it likely won’t be created anytime soon, but this isn’t the first time an official Medicare Part “E” for everyone has been discussed. As far back as 2005, there have been studies calling for the creation of a supplemental Medicare Part E. Keep in mind, this is only two years after the creation of Medicare Part D! In 2007, this was followed up by a study from the prestigious Brookings Institute that backed up the need for a Medicare Part E. Every so often, attempts to create a Medicare Part E will return, and it likely will continue to be proposed until it or something like it becomes a reality.
The Unofficial Medicare Part E
If that’s the official Medicare Part E, the other and probably more common use of “Medicare Part E” is in reference to the Medicare insurance products that don’t fall under one of the already established parts of the Medicare program. This is largely used by professionals and business experts as an umbrella term to group those plans. You’ll often hear them referred to separately, with some more common than others. Generally, the colloquial Medicare Part E refers to three different types of Medicare insurance plans that aren’t one of the other types of plans.
Medicare Supplements
The most common form of Medicare Part E you’ll experience is a Medicare Supplement. These privately offered insurance plans cover the gaps in your Original Medicare coverage. This is why they’re sometimes called Medigap plans. There are currently eight different Medigap plans available to Medicare-eligible beneficiaries, though there are two more (Plans C and F) that are available to beneficiaries who were eligible prior to January 1, 2020.
Since plans are offered by private companies, the costs can differ.
Each plan covers similar costs of Original Medicare like a Part A and Part B coinsurance, the Part A deductible, and a Part A hospice care coinsurance or copayment. Some plans even offer an out-of-pocket cost limit and coverage for foreign health emergencies. Since plans are offered by private companies, the costs can differ. They may also change based on health and personal factors like your age, where you live, tobacco use, and the plan you are enrolling in.
PACE
Another type of insurance plan that you may encounter that can fall under the Part E umbrella are Medicare PACE plans. Programs of All-Inclusive Care for the Elderly (PACE) is a type of plan that is run by both Medicare insurance and Medicaid. The goal of this program is to help seniors receive care in their community, often in their own home, instead of a care facility. As part of the program, you’ll receive a team that must include, at a minimum:
- Dietician
- Driver
- Home care liaison
- Nurse
- Occupational therapist
- PACE center supervisor
- Personal care attendant
- Physical therapist
- Primary care physician
- Recreational therapist or activity coordinator
- Social worker
Generally, PACE will cover any service or care that’s normally covered by Medicare insurance or Medicaid as long as your team authorizes the medical need. Your costs may differ if you’re enrolled in Medicare insurance and Medicaid, only one of the two, or neither. To be eligible for PACE, you must be at least 55, live in a PACE service area, be certified to need nursing home-level care, and be able to live safely in your home when your team isn’t there to help you. You can learn more in our article on PACE.
Medicare Cost Plans
Medicare Cost plans are a rare type of health plan offered alongside Medicare insurance. That are available in a limited number of places throughout the United States. Currently, they are only available in five states and partially available in three. You can join a Medicare Cost plan if you live where one is available, the plan is accepting new members, and you’re enrolled in at least Medicare Part B. You can leave at any time and return to Original Medicare. You may also join a separate Medicare Part D plan or get your drug coverage directly from the Cost plan if it’s offered.
A main difference between Advantage and Cost plans is that if you use an out-of-network service with a Cost plan, Original Medicare can cover the costs of the service.
If you are living in one of the areas Medicare Cost plans are available, it can pair with your Original Medicare to expand your coverage. Cost plans are similar to Medicare Advantage plans in that they can offer additional benefits beyond Original Medicare, have coverage networks, and are offered by private insurers. A main difference between Advantage plans and Cost plans is that if you use an out-of-network service with a Cost plan, Original Medicare can cover the costs of the service.
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It may be confusing to hear about Medicare Part E, especially when it can refer to different things. We hope we were able to give you a little insight into the different possible mentions of this lesser-known part of the Medicare program!
