Medicare Cost Plans are private Medicare HMO plans that are available in some parts of the country. These plans usually require you to use in-network providers for Medicare-covered services, but also give you the flexibility to go out-of-network and be covered through Original Medicare. If you’re in a Medicare Cost Plan, you’re still enrolled in Medicare and part of the Medicare program.
Unlike traditional HMOs, Medicare Cost Plans give members the option to use out-of-network providers and have those health-care services covered through the traditional fee-for-service program. If you see a non-network provider, you’ll pay Original Medicare cost sharing, such as Medicare Part A and Part B coinsurance, copayments, and deductibles.
Medicare Cost Plans vs. Medicare Advantage plans
Medicare Cost Plans are different from Medicare Advantage (Medicare Part C ) plans in a few key ways:
- You can join a Medicare Cost Plan even if you’re only enrolled in Medicare Part B.
- You can enroll in a Medicare Cost Plan at any time, as long as the plan is accepting new members.
- You can disenroll from a Medicare Cost Plan at any time and return to Original Medicare for your Medicare coverage.
- If your Medicare Cost Plan doesn’t include Medicare prescription drug coverage, you can join a stand-alone Medicare Part D prescription drug plan.
- Some Medicare Cost Plans only cover Medicare Part B (medical insurance) benefits and don’t cover Medicare Part A (hospital insurance) or prescription drug benefits.
- Unlike Medicare Cost Plans, Medicare Advantage requires you to have Medicare Part A and Part B, and you’re generally limited in the times you can join, switch, or disenroll from a Medicare Part C plan.
- Medicare Advantage plans must provide the same Medicare Part A and Part B benefits as Original Medicare; these plans never cover Medicare Part
B only. If you want prescription drug coverage, you’ll need to get it through a Medicare Advantage Prescription Drug plan, not a stand-alone Medicare Part D plan.
- Some Medicare Advantage HMO plans have a Point-of-Service option that lets you see out-of-network providers for some services. However, unlike Medicare Cost Plans, these services would still be covered through your Medicare Advantage plan, not Original Medicare.
Is a Medicare Cost Plan right for me?
One advantage of Medicare Cost Plans is they offer the lower costs of a managed-care plan, but the flexibility to go out-of-network and still be covered through Medicare. In contrast, a Medicare Advantage HMO generally won’t cover the cost for non-network health-care services.
A Medicare Cost Plan could be a good option if you travel frequently or if you live out of your plan’s service area for a large part of the year. With a Medicare Cost Plan, you can still get Medicare-covered services outside of your plan’s provider network.
Keep in mind that Medicare Cost Plans aren’t available in every part of the country, and plan rules, costs, and benefits may vary. To find out if there’s a Medicare Cost plan in your location or to learn about some of your other private Medicare options, including Medicare Advantage:
- Contact the Medicare plan directly.
- Call 1-800-MEDICARE (1-800-633-4227), TTY users 1-877-486-2048; 24 hours a day, 7 days a week.
- Contact a licensed insurance agency such as eHealth Medicare.
- Call eHealth Medicare’s licensed sales agents at 1-888-391-2659, TTY users 711; Monday through Friday, 8AM to 8PM ET, Saturday, 9AM to 6PM ET.
- Or visit eHealthMedicarePlans.com and enter your zip code where requested to see a quote.
Medicare has neither reviewed nor endorsed this information.