“Every strike brings me closer to a home run.” — Babe Ruth
What does a Medicare Cost plan cover?
Enrollment in Medicare Cost Plan
Enrollment into a Medicare Cost Plan
Enrollment and Eligibility for Medicare Part B
If there is not a Medicare Cost plan available where you reside, here are your options:
Medicare cost plans offer extra benefits and more flexibility while working together with your Original Medicare coverage. Very similar to Medicare Advantage plans, Medicare cost plans offer added coverage by picking up areas that your Original Medicare plan doesn’t cover. They are not Medicare Advantage plans (Part C).
Private companies offering Medicare cost plans must issue an open enrollment period for at least 30 days for beneficiaries. Senior Healthcare Advisors will help you during this time with your submission of an application to the plan you chose to enroll with. Each company offering Medicare cost plans may provide different enrollment details.
You have to check and see if Medicare Cost plans are available in your area. If you’re not quite sure where to start. We can walk you through the process of learning more about Medicare cost plans and let you know if they are available in your area. It is a free no-obligation call to speak to one of our licensed Medicare specialists. Call now 888.809.2440.
You must have Medicare Part B and an available Medicare Cost plan in your area that is accepting new members.
With Medicare Cost plans, you as the beneficiary will keep your Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance) coverage. And if you use your Medicare Cost plan to visit an out-of-network physician, once you pay, whatever is left over Original Medicare covers. You just have to pay your Part A or Part B deductible and coinsurance, unless it is urgent care or emergency services.
You may find yourself attracted to a Medicare cost plan as they offer a variety of benefits from both Original Medicare Part A and Part B and Medicare Part C (Medicare Advantage).
Once you enroll in a Medicare cost plan, you have the choice of picking from a network of health providers. You can choose a provider inside or outside of the network. Original Medicare covers the healthcare services, if you choose a provider outside of the network.
Also, you have the choice to enroll in a Medicare cost plan bundled with Medicare Part D (Prescription drug coverage. If you choose a Medicare Cost plan without prescription drug coverage (Part D), you can enroll in a stand-alone Prescription drug plan (Part D) that best satisfies your needs.
You will have added flexibility if you choose to switch plans. Let’s say you’re not happy with the Medicare Cost plan you applied for. You can then go back to your Original Medicare at any time; you don’t have to wait for a Medicare Open Enrollment.
What does a Medicare Cost plan cover?
Medicare Cost plans vary largely between counties and states, as does what is covered. For instance, in certain counties in California, some plans offer chiropractic services and a dental allowance. Meanwhile in Iowa, one of a small group of plans covers fitness club membership that offers access to over 20,000 gyms across the country.
Some other benefits that a Medicare Cost plan may cover include:
- Dental care.
- Vision care and eyewear.
- Hearing aids.
You must meet the following requirements for enrollment into a Medicare Cost plan:
- To be already enrolled in Medicare Part B (medical)
- To reside in an area that offers Medicare Cost plans.
- You must locate a Medicare cost plan that new members are accepted
- Apply within the plan’s enrollment period
- During the enrollment, you must agree to policies and procedures for all Medicare Cost plans.
Medicare Cost plans sometimes deny enrollment for individuals applying. This can happen if:
- You fail to meet the above-listed requirements.
- You are restricted by the Centers for Medicare & Medicaid Services (CMS) because of a limitation or waiver for the Medicare cost plan’s open enrollment period.
People who receive retirement or disability benefits from the Social Security Administration (SSA) or the Railroad Retirement Board are automatically enrolled in original Medicare when they’re first eligible. Others will have to apply through the SSA.
Medicare Cost Plan Coverage
- Medicare Part A and Medicare Part B, with some cost sharing, are covered by Medicare Cost plans.
- Medicare Cost plans cover some of the costs not covered by Original Medicare, such as deductibles, copays, or coinsurance.
- Most of the time there is an annual limit applied by Medicare Cost plans.
- Financial protection using an out-of-pocket maximum is offered by most Medicare Cost plans.
- You can gain peace of mind by knowing the limit on your annual payment for covered services with most Medicare Cost plans. It is a form of financial protection.
Enrollment in Medicare Cost Plan
You can enroll in a Medicare Cost plan, once you have enrolled in Medicare Part B. Don’t forget, the area you live in must be accepting new members for you to be able to enroll in a Medicare Cost plan.
A professional licensed Medicare specialist can help you find a Medicare Cost plan near you by calling 888.809.2440 TTY/ Senior Healthcare Advisors.
Medicare enrollment periods must last for at least 30 days and be provided by a company that offers Medicare Cost plans. It is during these open enrollment periods that you will apply to the plan’s provider.
The details for enrollment may vary by private companies that are off the cost plan. Make sure the company’s agent checks with the plan’s provider for the specified application materials and other important details.
Medicare Part D enrollment
Some Medicare Cost plans may provide medical benefits only, others provide Medicare Cost plans that include Medicare Part D, and prescription drug coverage.
If the Medicare Cost plan you choose does not have prescription drug coverage, you can apply for a separate Part D plan. During specific periods, you can enroll in a separate Medicare Part D plan.
Enrollment into a Medicare Cost Plan
Here’s the breakdown:
Enrollment and Eligibility for Medicare Part B
- You must have the following requirements to be eligible for Medicare Part B:
- Be of the age 65 or older
- Be on Social Security disability and receive Social Security Disability Insurance
- Have End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS)
When they first become eligible, people receiving Railroad Retirement Board or SSA (Social Security Administration) benefits are automatically enrolled in Original Medicare. Others need to submit their application to the Social Security Administration (SSA).
Medicare Cost plans provide further flexibility and benefits by working alongside their Original Medicare. You can purchase them through Senior Healthcare Advisors at 888.809.2440 or other private insurance companies.
These Medicare Cost plans supply many of the extra benefits, such as vision, hearing, and dental care, much like Medicare Advantage (Medicare Part C) plans. The difference is that those with Medicare Cost plans have more access to out-of-network providers and choose a stand-alone prescription drug plan (Medicare Part D) because Original Medicare picks up what is left of the bill. Medicare Advantage plans do not work with Original Medicare.
You must be enrolled in a Medicare Part B plan to enroll in a Medicare Cost plan, in the area within which you reside, and that is accepting new members.
If there is not a Medicare Cost plan available where you reside, here are your options:
- Stick with your Original Medicare
- Apply for a Medicare Part C plan (Medicare Advantage)
- Buy a Medicare Supplemental Insurance Plan (Medigap)
- Call Senior Healthcare Advisors for information regarding all of your Medicare services
Keeping your Doctors
In general, Medicare Cost plans have a selected group of clinics, doctors, and hospitals. Also, with Medicare Cost plans you can choose an out-of-network doctor and Original Medicare will cover the costs not covered by the Medicare Cost plan. So, make it a plan to ask if your primary care doctor is in your plan’s network. This is why most of the time you pay less for the covered services with in-network doctors and hospitals.
Presently, Medicare Cost plans are only available in a small number of states. According to data from the Centers for Medicare & Medicaid Services (2022), Medicare Cost plan enrollees reside in these states:
- California.
- Illinois.
- Minnesota.
- New York.
- Wisconsin.
In addition, Medicare has confirmed that certain counties in these states offer Medicare Cost plans for individuals who qualify:
- Iowa.
- Nebraska.
- Virginia.
Senior Healthcare Advisors offer Medicare Cost plans to Medicare beneficiaries during open enrollment of at least 30 days.
Note*** Medicare Cost plans, most of the time, have worldwide emergency coverage, and urgent care services.
Senior Healthcare Advisors specializes in maximizing your Medicare benefits. They will guide you in understanding the enrollment process, and take you through it step by step.
***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.
Resources
Healthline.com. (2022). What is a Medicare cost plan? https://www.healthline.com/health/medicare/what-is-a-medicare-cost-plan
Medicare.gov. (2022). Other Medicare Health Plans. https://www.medicare.gov/sign-upchange-plans/types-of-medicare-health-plans/other-medicare-health-plans
Medicare Health Partners.com. (2022). What’s a Medicare Cost Plan? https://medicarehelp.healthpartners.com/blog/whats-a-medicare-cost-plan/
Smith, C.(2022 ). What Is a Medicare Cost Plan? https://www.nerdwallet.com/article/insurance/medicare/medicare-cost-plan
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