What are Medicare Pilot Programs?

With something as important as health care, you want to make sure whatever you’re doing is safe and effective. This is especially true for a program with as many moving parts as Medicare. The consequences of getting something wrong could harm citizens or bankrupt them. With the stakes so high, it’s essential that Medicare and Medicaid have practices that can adapt and change as the health care landscape evolves. It’s only through growing and tweaking the programs that they remain effective for beneficiaries.

What are Medicare Pilot Programs?

This is where Medicare Pilot Programs come into play. Also called demonstrations or models, pilots are run by the Centers for Medicare & Medicaid Services (CMS) as smaller-scaled tests of new programs, payment methods, quality of care, or updates to the way Medicare works. They may also evaluate programs like Medicaid and the Children’s Health Insurance Program (CHIP).

At any given time, there are dozens of models trying to find ways to improve Medicare coverage or health care usage. These are often followed by evaluation reports, which are used to check and validate the findings of the demonstrations.

Generally, pilot programs run for a limited amount of time and focus on a specific issue. They will also often be limited to a specific region or population group for highly targeted results. To give you an example of this, let’s look at one that’s been running for a little while. The Pennsylvania Rural Health Model was launched in 2017 to explore which methods can increase hospital access, quality of care, and general health for rural Pennsylvanians. The model is scheduled to run until the end of 2024, with 18 local hospitals participating.

Where Can I Learn More?

If you’re curious about seeing what models are currently running, CMS has created a dedicated hub where you can learn more. The main page is at https://innovation.cms.gov. From there, you see the latest updates and milestones, data and reports, and webinars to inform you on what’s been happening with the various demonstrations.

If you’re more curious about what models are happening near you, CMS has an Innovation Map that shows you the different models running at the state level, participating health care facilities, and more. You can even break it down by state. You can also go to the Innovation Models site, where you can search through current and past demonstrations to read full details on both the backgrounds and current findings that are available.

Can I Get Involved in Demonstrations?

Let’s say you’ve found a current pilot program that really interests you. Maybe there’s one testing out expanded coverage for a health condition and you think it may help you. Whatever your reason, your first step will be to make sure the model is covering your geographic location and is looking for enrollee applications.

You can use the Innovation Map to see which programs are near you, but your best bet is the Innovation Models site. Under Category Descriptions, you can filter the results to include your state or region and only those currently accepting applications or are about to enter that stage. Once you find the pilot you’re looking for, you can submit an application to see if you’re accepted. A final option is to call 1-800-MEDICARE (TTY 711), where you can call 24/7 to learn about Medicare pilot programs that are available to you.

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The medical world is always changing, with new treatments and discoveries popping up almost daily. To offer enrollees affordable and sufficient assistance, CMS needs to make sure they can match those changes with new efficiencies and programs. It’s only through proper testing and refinement that these programs can effectively rise to meet the challenges of a shifting medical and insurance landscape. With Medicare pilot programs and models, CMS is able to test out their programs before rolling them out to the broader public.