What Is a Medicare Cost Plan?

May 28, 2022 | 0 comments

What Is a Medicare Cost Plana

Medicare Cost plans are private insurers’ health insurance plans through the federal government. These plans are attractive because beneficiaries can continue to have Original Medicare coverage, allowing them to access out-of-network providers.

Medicare cost plans combine Medicare Advantage and Original Medicare. These plans are available in rural areas where Part C is limited. These plans are being phased out.

Where can I find Medicare Cost Plans?

The most important thing about Medicare Cost Plans is that they are not available in all 50 states.

In 2019, Medicare Cost Plans were discontinued in all counties with two or more Medicare Advantage Plans.

Today, Medicare Cost Plans are only offered in a few states. These individuals were enrolled in Medicare Cost Plans in these states, according to data from the Centers for Medicare & Medicaid Services. They have mainly been phased out across most of the country.

  • California.
  • Illinois.
  • Minnesota.
  • New York.
  • Wisconsin.

These states also confirmed that they offer Medicare Cost Plans in certain counties to qualifying individuals:

  • Iowa.
  • Nebraska.
  • Virginia.

Use the Medicare plan finding tool to see if Medicare Cost Plans are available in your area, but you don’t see them listed here.

What are Medicare Cost Plans?

Private insurance companies with contracts with the federal government can offer Medicare Cost Plans. These plans are authorized by Section 1876 of the Social Security Act. They provide beneficiaries additional benefits and coverage beyond what is already covered under Original Medicare.

These plans allow beneficiaries to keep their Medicare Part A (hospital coverage) and Medicare Part A (medical insurance). Original Medicare will pay any remaining costs if you visit an outside-network doctor as long as you have paid your Part A or B deductibles and coinsurance.

Medicare Cost plans are very similar to Medicare Advantage plans. Both programs are offered by private insurance companies and offer at least the same benefits that Original Medicare. These plans often provide additional benefits not covered by Original Medicare, such as vision and dental benefits.

What is the difference between Medicare Advantage and Medicare Cost plans?

Although Medicare Advantage and Medicare Cost plans have many similarities, the most significant differences are the maintenance of Original Medicare and the network.

Beneficiaries can see doctors outside of their network under a Medicare Cost Plan. Original Medicare will still cover the cost, provided that they accept Medicare. Suppose you have a Medicare Cost Plan and visit an outside-of-network doctor that accepts Medicare. In that case, Original Medicare will cover any expenses not covered by your Medicare Cost Plan. Except for emergency or urgent services, you would have to pay the Part A and B deductibles and coinsurance. )

This wouldn’t be possible for someone who has a Medicare Advantage plan. It effectively replaces Original Medicare coverage. They get the majority of these same benefits through private insurance companies. Still, They are not able to leave their network for care.

What is a Medicare Cost Plan?

With a Medicare Cost Plan, beneficiaries can keep their Medicare Part A or Medicare Part B coverage. Still, they also have access through the Cost plan to a network that includes providers.

Benefits can differ significantly between states. Your Medicare Cost plan will cover you, but it all depends on the state and county where you live. Some programs, such as those in Minnesota, offer acupuncture coverage. Iowa has a few plans that offer acupuncture coverage and access to over 20,000 gyms.

Other benefits that might be covered under a Medicare Cost Plan include:

  • Dental care.
  • Eyewear and vision care.
  • Hearing aids.

Some Medicare Cost Plans offer the option of combining Medicare Part D. This helps cover prescription drug costs. To find out if Part D is covered, check with your plan.

Is it possible to get a Medicare Cost Plan?

You should be eligible for a Medicare Cost Plan if you meet the following criteria as determined by the Centers for Medicare & Medicaid Services:

  • If you qualify for Medicare Part A and are enrolled under Part B, only Part B may be required in some cases.
  • Either you are a U.S citizen or a lawful permanent resident.
  • You are a county resident, and you will be signing up for the Cost Plan.

If you have end-stage kidney disease, you may not be eligible for Medicare Cost Plan coverage.

How can I enroll in a Medicare cost plan?

Because Medicare Cost plans can vary from one county to the next, you must verify that your county offers Cost plans. Enter your ZIP code to shop online at private insurers. Medicare’s plan finder tool can help you determine if Medicare Cost Plans are available in your region and compare the information between available programs.

Alternatives to Medicare Cost Plans

You have two choices if you live in a country where Medicare cost plans have been eliminated.

  1. You can join a Medicare Advantage program during a limited enrollment period.
  2. Original Medicare will not cover you if you do nothing.

Suppose you want to continue with Original Medicare. In that case, you will need to join a Medicare Advantage plan that includes prescription drug coverage or a standalone Medicare Part D plan.

You will likely be eligible to buy a Medicare supplement plan or Medigap policy during a particular enrollment period. This will help to cover your costs.

It is essential to get a new Medicare plan if you lose your Medicare cost plan.

Resources are available to assist you in finding new health insurance coverage.


Medicare cost plans are available in addition to your Medicare coverage and provide additional benefits and flexibility. These plans can be purchased through private insurance companies.

People with Medicare cost plans are more flexible than those with Medicare Advantage plans. They can choose to use outside-network doctors or a separate Part D plan. These plans include many of the same benefits as Medicare Advantage plans, such as vision, hearing, and dental care.