Medicare Cost PlanA Medicare Cost plan has similar characteristics to a Medicare Advantage plan, in that you will have access to a network of providers to choose from for medical services and may enjoy additional benefits that are not available with traditional Medicare Part A and B coverage. Another similarity is that the premium for the Medicare Cost plan can be as little as $0, which could be a consideration when choosing a plan. Additionally, the Medicare Cost plans may or may not come with a prescription drug plan, but the Medicare Cost plan has an option to add in the Medicare Part D prescription drug coverage.
In a Medicare Cost plan, private insurance companies contract with Medicare in order to provide coverage of the original Medicare Part A and B benefits, in the same way a Medicare Advantage operates to bring you your Medicare benefits. One important distinction of a Medicare Cost plan is that it is not necessarily available nation-wide. This plan is only available in certain areas of the country. The states which are eligible for the Medicare Cost plans in 2020 are Colorado, Iowa, Illinois, Maryland, Minnesota, Nebraska, North Dakota, South Dakota, Texas, Virginia, and Wisconsin. Get in touch with us our team at Senior Medicare Grand Junction to find out of you qualify for this unique type of Medicare plan! |
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Medicare Cost Plan Characteristics
There are a few other items that make a Medicare Cost plan different from other types of Medicare plans which are available to you.
Unlike the Medicare Advantage plan, you are eligible for the Medicare cost plan even if you are only currently enrolled in Medicare Part B.
If you are currently enrolled in Medicare Part A and B, and choose to use the Medicare Cost plan in conjunction with them, and you go to an out-of-network provider for your medical services, the services are still covered under your Medicare Part A and B, and you would be responsible for making the coinsurance and deductible payments for Part A and B.
Anytime that the plan is accepting new members, you can join – you do not have to wait for the designated Medicare annual enrollment period! And since the Medicare Cost plan works alongside the original Medicare plan, instead of as a replacement for it, you can also choose to leave the Medicare Cost plan at any time (again, no need to wait for the annual open enrollment period that is required with original Medicare plans) and go back to the original Medicare Part A and B plan. Providers of Medicare Cost plans are required to have an enrollment period that lasts at least 30 days when accepting new members.
Another type of Medicare Cost plan, which is sponsored by an employer or union health plan or by companies that don’t offer Medicare Part A services, allows for coverage only of Medicare Part B. The Medicare Part A services would be covered under the original Medicare plan. This Medicare Cost option DOES NOT include Medicare Part D coverage.
Unlike the Medicare Advantage plan, you are eligible for the Medicare cost plan even if you are only currently enrolled in Medicare Part B.
If you are currently enrolled in Medicare Part A and B, and choose to use the Medicare Cost plan in conjunction with them, and you go to an out-of-network provider for your medical services, the services are still covered under your Medicare Part A and B, and you would be responsible for making the coinsurance and deductible payments for Part A and B.
Anytime that the plan is accepting new members, you can join – you do not have to wait for the designated Medicare annual enrollment period! And since the Medicare Cost plan works alongside the original Medicare plan, instead of as a replacement for it, you can also choose to leave the Medicare Cost plan at any time (again, no need to wait for the annual open enrollment period that is required with original Medicare plans) and go back to the original Medicare Part A and B plan. Providers of Medicare Cost plans are required to have an enrollment period that lasts at least 30 days when accepting new members.
Another type of Medicare Cost plan, which is sponsored by an employer or union health plan or by companies that don’t offer Medicare Part A services, allows for coverage only of Medicare Part B. The Medicare Part A services would be covered under the original Medicare plan. This Medicare Cost option DOES NOT include Medicare Part D coverage.
Medicare Part D Prescription Drug Coverage With Medicare Cost Plans
Unlike Medicare Advantage, which only allows you to have prescription drug coverage through the Advantage plan, and disqualifies you from being able to use Medicare Part D for your prescriptions, you have two options for your prescription drug coverage with a Medicare Cost plan. You may either get coverage for your prescription drugs through the Medicare Cost plan (if it is offered in the plan you choose), or through the Medicare Part D plan.
The cost of the prescription drug plan can either be included in the cost of the Medicare Cost plan (depending on the plan) or the cost of the stand alone Medicare Part D prescription plan will have its own separate premium.
It is important to note that the enrollment into, or disenrollment out of, the Medicare Part D option that may be offered with the Medicare cost plan must be done during the normal open enrollment period for Part D plans. If a standalone Part D plan is what you are selecting, the same enrollment requirements apply.
The cost of the prescription drug plan can either be included in the cost of the Medicare Cost plan (depending on the plan) or the cost of the stand alone Medicare Part D prescription plan will have its own separate premium.
It is important to note that the enrollment into, or disenrollment out of, the Medicare Part D option that may be offered with the Medicare cost plan must be done during the normal open enrollment period for Part D plans. If a standalone Part D plan is what you are selecting, the same enrollment requirements apply.
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Medicare Cost Plan BenefitsThe keyword in Medicare Cost plans is “flexibility.” This plan offers you the best of both worlds in terms of having access to a specific network of providers, as with the Medicare Advantage plan, but also having the option to go out-of-network if you so choose, with your original Medicare still providing coverage. This is something to keep in mind if you are a senior who travels frequently as part of enjoying your retirement. With a Medicare Cost plan, you are not restricted to the in-network doctors or hospitals and are able to seek medical treatment from out-of-network providers if you happen not to be at home when a medical event occurs.
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Medicare Advantage Competition Clause
There is a reason that the Medicare Cost plan is not as widely available as other Medicare options.
This is because the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 implemented a rule which states that Medicare Cost plans cannot be made available in areas in which they will have significant competition with Medicare Advantage plans. The legislation for this rule was delayed, but finally put into action and took effect in 2019
This is because the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 implemented a rule which states that Medicare Cost plans cannot be made available in areas in which they will have significant competition with Medicare Advantage plans. The legislation for this rule was delayed, but finally put into action and took effect in 2019
Let Us Help!
Being a resident of Colorado, you have the option of enrolling in a Medicare Cost plan, where many others around the country do not. In this case, we understand that this can add an additional level of stress when attempting to determine which plan is the right fit for you.
Let our team at Senior Medicare Grand Junction walk you through your options, as we know they are numerous. It is important that you choose a plan that fits your budget and your healthcare costs for the long term.
Let our team at Senior Medicare Grand Junction walk you through your options, as we know they are numerous. It is important that you choose a plan that fits your budget and your healthcare costs for the long term.
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970-236-7770!
970-236-7770!
