jimo said:
I am trying to figure out what Medicare "Cost Plans" are.
These plans are described, somewhat, on page 79 of the 2013 Medicare and You publication. Various such plans are listed under the Health Care Plan section for the state I live.
How do "Cost Plans" differ from "Advantage Plans"? What might be an individual's needs that would make either type of plan the better choice?
Thanks.
Below is the AHIP description for Cost Plans. AHIP offers Medicare training to agents.
Medicare 1876 Cost Plans
Cost plan enrollees can choose to receive Medicare covered services:
• Under the plan’s benefits by going to plan network providers
- Plan cost sharing applies
• Under Original Medicare by going to non-network providers
- Original Medicare cost sharing applies
Cost plans may offer Part D prescription drug coverage as
an optional benefit.
Cost plans may offer other optional supplemental benefits.
Basically, if you are Out of Network your coverage defaults back to your Original Medicare coverage. The good news is that you have coverage in or out of network. The bad news is that your have the deductibles and
NO out of pocket max that goes along with Original Medicare. Since many Cost Plans are HMO's they make more sense than HMO MA plan. The HMO MA plan does not allow for any coverage outside of the network. Also, you are eligible to enroll in a separate Medicare Part D drug plan while you are enrolled in the Cost plan. You just can't have both their drug plan and the separate Part D plan. I hope this helps you
Sincerely,
matt
mattspits said:
jimo said:
I am trying to figure out what Medicare "Cost Plans" are.
These plans are described, somewhat, on page 79 of the 2013 Medicare and You publication. Various such plans are listed under the Health Care Plan section for the state I live.
How do "Cost Plans" differ from "Advantage Plans"? What might be an individual's needs that would make either type of plan the better choice?
Thanks.
Below is the AHIP description for Cost Plans. AHIP offers Medicare training to agents.
Medicare 1876 Cost Plans
Cost plan enrollees can choose to receive Medicare covered services:
• Under the plan’s benefits by going to plan network providers
- Plan cost sharing applies
• Under Original Medicare by going to non-network providers
- Original Medicare cost sharing applies
Cost plans may offer Part D prescription drug coverage as
an optional benefit.
Cost plans may offer other optional supplemental benefits.
Basically, if you are Out of Network your coverage defaults back to your Original Medicare coverage. The good news is that you have coverage in or out of network. The bad news is that your have the deductibles and
NO out of pocket max that goes along with Original Medicare. Since many Cost Plans are HMO's they make more sense than HMO MA plan. The HMO MA plan does not allow for any coverage outside of the network. Also, you are eligible to enroll in a separate Medicare Part D drug plan while you are enrolled in the Cost plan. You just can't have both their drug plan and the separate Part D plan. I hope this helps you
Sincerely,
matt
Here's a great excerpt from the Observations About Medicare Cost Plans put out by the GAO (Government Accountability Office)
"Some of the differences between cost plans and MA plans that affect
beneficiaries are out-of-network coverage, enrollment periods, and
prescription drug coverage. Cost plans’ quality scores, on average, were
higher than the average of competing MA plans’ scores in the county with the
cost plan’s highest enrollment. Estimated out-of-pocket costs varied between
cost plans and other options depending on the self-reported health status of
the beneficiary. In general, beneficiaries reporting poor health had lower
estimated average out-of-pocket costs in most cost plans compared to
competitor MA plans and FFS, while beneficiaries reporting good or excellent
health had relatively higher estimated costs in most cost plans compared to
MA plans and FFS. "
