Senior Healthcare Advisors/Dr. Marilyn Field

After you are enrolled in Medicare Part B (medical), you can then enroll in a Medicare Cost plan. It is important to know that individuals looking to enroll in a Medicare Cost plan must be accepting new members and it must be offered in your area.

Once you’re enrolled in Part B, you can enroll in a Medicare cost plan. Remember that you can only enroll in a Medicare cost plan in your area that’s accepting new members.

Companies offering Medicare cost plans must offer beneficiaries with a Medicare Cost plan open enrollment period of at least 30 days. Within those 30 days, you will hand in your application for enrollment to the plan’s provider.

The details for enrollment may vary depending on the insurance company that is providing the cost plan. Check with Senior Healthcare Advisors at 888.809.2440 for their details on application materials and enrollment periods.

Eligibility Requirements for Medicare Enrollment into a Medicare Cost Plan

“The simple act of caring is heroic.” – Edward Albert

• Enrolled in Medicare Part B
• Reside in an area where Medicare cost plans are offered
• Acquire a Medicare cost plan that is accepting new members
• Complete your application within the plan’s enrollment period
• You must agree to and accept all rules of the cost plan which are disclosed during the enrollment process

Denied Medicare Cost Plans Enrollment Possibilities

• Not meeting the above-listed requirements
• The Centers for Medicare & Medicaid Services (CMS) has issued a limitation or waiver for a plan’s open enrollment period, restricting who can enroll

How to enroll in a Medicare Cost Plan

Medicare Part B Eligibility and Enrollment

For enrollment into a Medicare Cost plan, enrollment in Medicare Part B must come first. For eligibility in Medicare Part B (Medical), the following criteria must be met:

• Age 65 or older
• Receive Social Security Disability Insurance due to a disability.
• Have amyotrophic lateral sclerosis (ALS) or End Stage Renal Disease (ESRD)
• Individuals who receive disability benefits from the Railroad Retirement Board or the Security Administration (SSA) are enrolled automatically when they are first eligible in Original Medicare, others must apply through the Social Security Administration.

Medicare Cost Plan Enrollment

Once you are enrolled in Medicare Part B, you can enroll in a Medicare Cost plan that is in an area in which you live and that is accepting new members.

To find a Medicare Cost plan you can call us at Senior Healthcare Advisors at 888.809.2440 or you can contact your local State Health Insurance Assistance Program (SHIP) for help.

Private insurance companies that offer Medicare cost plans must give Medicare beneficiaries a 30-day open enrollment period. During the 30-day open enrollment period, you will submit your application for enrollment in the plan’s provider.

Details for enrollment may vary depending on the company offering the cost plan. Make sure you check the specific details on application materials and enrollment periods with the plan’s provider.

Medicare Part D Enrollment

Prescription drug coverage (Medicare Part D) is included in some Medicare Cost plans, however, others provide medical benefits only.

If prescription drug coverage is not included in your plan, you can enroll in a stand-alone prescription drug plan (Medicare Part D). Enrollment in a stand-alone or other prescription drug coverage (Medicare Part D) during specified periods.

Medicare cost plans work together with your Original Medicare insurance to give added flexibility and benefits. You can buy them through private insurance companies.

Medicare cost plans work alongside your original Medicare coverage to provide further benefits and flexibility. They can be purchased through private insurance companies.

Medicare Cost plans provide many of the same benefits that Medicare Advantage plans offer, such as vision, dental, and hearing services. However, the main difference is that Medicare cost plans have greater flexibility than Medicare Advantage plans because you can use out-of-network providers and purchase a separate Medicare Part D plan (prescription drug coverage).

How Medicare Cost Plans Work

Private insurance companies offer additional Medicare-approved healthcare services through Medicare Cost plans.

Many individuals are attracted to Medicare Cost Plans because they offer combined benefits from both Original Medicare Part A and Part B, as well as Medicare Advantage (Medicare Part C).

Like Medicare Advantage plans, enrollment in a Medicare Cost plan has a network of health providers. You can either choose an in-network provider or you can choose an out-of-network provider. If you do choose an out-of-network provider, your Original Medicare (Medicare Part A and Part B) will pick up the cost of the services.

Also, you can pick a Medicare Cost plan that includes a Medicare Part D (prescription drug coverage) that best meets your needs and your finances.

Also, if you choose to switch plans, you can be more flexible with your benefits. You can go back to your Original Medicare at any time without having to wait for an open enrollment.

Medicare Cost Plan Coverage

1. Medicare Cost plans cover Original Medicare (Medicare Part A and Part B) with some sharing of the cost.
2. Medicare Cost plans cover copays, deductibles, and coinsurance that are not covered by Original Medicare.
3. Most of the time, Medicare Cost Plans apply a yearly limit.
4. Most Medicare Cost Plans offer an out-of-pocket maxim, which provides financial protection.
5. Medicare Cost plans apply a yearly limit, most of the time.
6. Most Medicare Cost plans do offer financial protection by offering an out-of-pocket maximum.
7. Most Cost plans have an out-of-pocket maximum so you get financial protection. This means you get peace of mind knowing there is a limit on how much you pay each year for covered services.

Medicare Cost Plans Prescription Coverage

1. Medicare prescription drug coverage (Medicare Part D) provides coverage to Medicare Cost plans for outpatient prescription drugs.
2. If you choose a Medicare Cost plan that only has medical coverage, you can choose to enroll in a stand-alone prescription drug plan (Medicare Part D) for your outpatient prescription drugs.
3. If you decide not to enroll in Medicare Part D (prescription drug coverage) when you become eligible, you may receive a late enrollment penalty.

Keeping your Doctors

In general, Medicare Cost plans, similar to Medicare Advantage plans, use a network of a planned group of doctors, clinics, and hospitals. So keep in mind to check with your providers (doctors, specialists, chiropractors) if they are in the plan’s network of providers. The reasoning behind this is that usually, you pay less for services covered by your insurance from doctors and hospitals in the plan’s network of providers. If you decide to go to an out-of-network provider, your service fees are covered by Original Medicare (Medicare Part A and Part B), and then submit your payment from the cost-sharing requirement of the bill on your own.

Summary of Medicare Cost Plans

• Medicare Cost Plans are available only in limited areas of the country.
• Generally, you can enroll in a Medicare Cost Plan if you are only enrolled in Medicare Part B.
• If you have Medicare Part A and Part B and visit a doctor or other provider who is not in the network, Original Medicare will cover the cost. You pay Medicare Part A and Part B the deductible and the coinsurance.
• You can enroll in a Medicare Cost Plan at any time they are accepting new members. You do not have to wait for open enrollment.
• You can disenroll in a Medicare Cost Plan at any point in time and return to your Original Medicare plan.

You can enroll in a Medicare Part D (prescription drug plan) or if the Medicare Cost Plan offers prescription drug coverage you can join it. Even if your Medicare Cost Plan offers prescription drug coverage, you can still choose a prescription drug plan from a separate Medicare drug program. However, you only add or drop Medicare Part D, prescription drug coverage at certain times.

A different type of Medicare Cost A Plan only offers Medicare Part B coverage. These types of Medicare Cost Plans never offer prescription drug coverage (Medicare Part D). Original Medicare covers Medicare Part A services. These types of plans are either offered by a union group health plan, by an employer or offered by companies that don’t offer Medicare Part A services.

PACE: A Different Type of Coverage

PACE (Program of All-inclusive Care for the Elderly) is a Medicare/Medicaid program that helps people meet healthcare needs in the community.

What your cost is for PACE depends on your financial situation.

1. You do not pay a monthly premium, if you have Medicaid, for the long-term care portion of the Pace benefit
2. If you have Medicare but do not qualify for Medicaid, you will be charged for these:
3. A monthly premium coverage for the long-term care portion of the PACE benefit
4. Medicare Part D (prescription drug coverage) premium
5. There is no copayment or deductible for any care, drug, or service approved by your team of healthcare workers.
6. You pay privately for the PACE program if you don’t have Medicaid or Medicare.

***Disclaimer: A Senior Healthcare medical specialist has reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.