Is a Medicare Cost plan available to me? - Medicare Changes Is a Medicare Cost plan available to me? - Medicare Changes

Is a Medicare Cost plan available to me? Medicare Cost plans are available in limited areas. They include benefits beyond Original Medicare and can include Part D.

Planting is a great way to perk up our yards and neighborhoods. My favorite part is figuring out which seeds will work best with the sunlight, soil and short Midwestern growing season. In other words, I need the right plants based on where I live.

Medicare plans are a bit like that, too. Some are only available in certain counties, like Medicare Cost plans. So my options depend on where I live. That’s why it’s helpful to learn about all your Medicare options.

Want more coverage than Original Medicare?

Original Medicare includes Part A (hospital coverage) and Part B (doctor visits, outpatient care and supplies). But most people want more coverage. Learn about these reasons in Why buy a private plan.

People who enroll in Medicare can choose from different options, depending on the county where you live.

Medicare Cost plans are available in select counties. If you live in one of those counties and enroll, Medicare Cost plans provide extra health benefits. You can add Part D prescription drug coverage to Cost plans. Let’s highlight some reasons you might like a Medicare Cost plan:

  • You want a plan to fill the gaps Original Medicare doesn’t cover
  • You want a plan with a lower monthly premium, fixed cost-sharing and a maximum amount on how much you pay each year for covered medical services
  • You like the flexibility of knowing you can use your Original Medicare benefits if you get care outside the network
  • You want extra benefits Original Medicare doesn’t cover (like routine hearing and vision exams or a fitness program)

To help you understand a bit more about these plans, we created this chart. Compare Medicare Cost to Original Medicare coverage and see if it’s the best fit for you.

Coverage & Costs

 Original MedicareMedicare Cost Plan
Are you eligible?

  • You are eligible when you turn 65, are permanently disabled at any age, or have End-Stage Renal Disease.


  • You must be enrolled in both Medicare Part A and Part B, or Part B only.

  • You also must live in a county where the plan is offered.

When can you enroll?

  • You have seven months to enroll when you first get Medicare. Enroll three months before you turn age 65, the month you turn 65, or the three months after you turn 65.

  • You can sign up during the General Election Period between Jan. 1 – March 31 if you didn’t sign up when you were first eligible and not eligible for a Special Enrollment Period

  • You may have other chances to sign up using a Special Enrollment Period.


  • You have seven months to enroll when you first get Medicare. Enroll three months before you turn age 65, the month you turn 65, or the three months after you turn 65.

  • You can enroll during the Annual Election Period between Oct. 15 – Dec. 7 each year.

  • You may have other chances to sign up using a Special Enrollment Period.

Monthly premium

  • Most people do not pay a Part A premium. Part B has a monthly premium that is based on income.


  • You pay your Medicare Part B monthly premium (and Part A premium if applicable).

  • You pay a monthly premium for a Medicare Cost plan.

What it covers

  • Medicare Part A pays some costs for care from a hospital, skilled nursing facility, home health, or hospice. It has deductibles and copays.

  • Medicare Part B pays some costs for doctor visits, lab tests, X-rays, outpatient care and medical supplies. It has an annual deductible and 20% coinsurance for covered care.


  • Plans cover Medicare Parts A and B benefits.

  • They also cover some Original Medicare costs, like copays, coinsurance or deductibles.

  • The plans usually have a limit on how much you pay each year.

Prescription drug coverage

  • Does not cover outpatient prescription medicines.


  • You can add Part D coverage for outpatient prescription medicine to Cost plans. (You’ll pay a penalty if you don’t enroll in a Part D plan when you are eligible.)

Convenience & Perks

 Medicare Cost Plan
Convenience

  • You have the option to add drug coverage to your plan, or you have the flexibility to get a separate Part D plan

  • If you get a Cost plan with both medical and drug coverage, you manage one plan and one ID card

  • You can use your Original Medicare benefits if you get care outside the network.

Extra perks and benefits

  • Many plans include coverage of gym membership, routine eye and ear exams, worldwide emergency care, and disease and health management programs.

  • Some plans have a U.S. travel benefit. For a limited period, you can get in-network benefits when you travel out of the plan’s service area.

Need more help? Check out these resources:

The State Health Insurance Assistance Program offers free, independent counseling services and local workshops to help with your health care benefit decisions.

Visit medicare.gov, or talk to a Medicare expert, like an agent, broker or health plan sales rep.

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