Medicare Cost Plans: Eligibility, Coverage and Costs

Last Updated : 08/30/20193 min read

Medicare Cost Plans may be more flexible than most Medicare Advantage plans in some ways. Here are some basic facts about Medicare Cost Plan eligibility, coverage and costs.

What is a Medicare Cost Plan?

A Medicare Cost Plan is a special type of Medicare Advantage plan that’s available in some states.

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These plans are provided by private insurance companies Medicare has approved. Medicare Cost Plans can vary in their costs and coverage.

Are you eligible for a Medicare Cost Plan?

You must be enrolled in Medicare Part B before you can enroll in a Medicare Cost Plan. Other types of Medicare Advantage plans require you to have both Medicare Part A and Part B.

In addition, you must:

  • Live in an area where Medicare Cost Plans are available
  • Find a plan that is accepting new members
  • Agree to the rules and guidelines of the plan

You must live in one of the states that offers Medicare Cost Plans to enroll in one. These may include Arizona, California, Colorado, Florida, Illinois, Iowa, Maryland, Minnesota, Nebraska, North Dakota, New York, South Dakota, Texas, Virginia, Wisconsin, and Washington D.C.

When can you enroll in a Medicare Cost Plan?

You can enroll in a Medicare Cost Plan any time the plan is accepting new members, as long as you meet eligibility requirements listed above.

With other types of Medicare Advantage plans, you’re generally limited to certain enrollment periods.   You can also leave a Medicare Cost Plan at any time. If you do, you will still be covered under Original Medicare.

Coverage included with a Medicare Cost Plan

Medicare Cost Plans do not all offer the same coverage. For example, some plans might only pay for Medicare Part B-covered services. In that case, Medicare Part A typically pays for Part A-covered services. In other words, if you’re an inpatient in a hospital, Medicare Part A would generally cover your care up to the usual Part A limits.

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You still may pay the appropriate deductibles, premiums, coinsurance and/or copayments. You’ll still pay your Medicare Part B monthly premium, as well as the plan premium if it charges one.

Some Medicare Cost Plans include prescription drug coverage. You may want to choose your Medicare Cost Plan carefully. Make sure the plan you select has the coverage you need.

Medicare Cost Plans may have networks of providers. Your plan might only cover doctor visits and services in its provider network. However, if you go out of network, you may be covered under Original Medicare. You will pay your deductible or coinsurance for your service using Part A or Part B benefits.

How much does a Medicare Cost Plan Cost?

Each Medicare Cost Plan generally has a monthly premium. That amount may be different depending on your area and the plan you choose. More expensive plans might offer more services. However, that is not always the case. Make sure you look at a plan’s details carefully before you enroll.

Finding the right Medicare Cost Plan for you

Are you ready to start comparing Medicare Cost Plans? Just type your zip code where shown on this page to get started anytime. Remember, these plans are not available in all states. If no Medicare Cost Plan is available in your area, you can compare other Medicare Advantage plans – all with a few clicks.

This article is for general information and may not be updated after publication. Consult your own tax, accounting, or legal advisor instead of relying on this article as tax, accounting, or legal advice.

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