Medicare Cost Plans reduce your out-of-pocket expenses by providing additional coverage to help pay for expenses that Medicare Part A and Part B don’t cover. Many Medicare Cost plans cover the deductibles, copays and coinsurance from both Part A and Part B. Some Medicare Cost Plans offer optional prescription drug coverage and additional benefits, such as hearing aids and vision services, which aren’t covered by Part A or Part B.

Costs

Premium All Medicare Cost Plans require that you continue to pay your Part B premium, plus a monthly Medicare Cost Plan premium.
Deductible Before a Medicare Cost Plan helps with your medical costs, you must first pay a deductible.
Copays A copay may apply to specific services.
Coinsurance

Coinsurance may apply to specific services.

Limits

The following limits apply to Medicare Cost Plans:

  • You must live in the service area of the plan you select.
  • If you choose an out-of-network provider, you may only receive Original Medicare (Parts A and B) coverage for those services.

Things to Consider

  • Typically, you can see any in-network provider without a referral.
  • Costs incurred under a plan’s travel benefit apply toward your out-of-pocket maximum.

Enrollment

Learn more about Medicare Cost Plan enrollment.


Initial Enrollment Period

The Initial Enrollment Period is a limited window of time when you can enroll in Original Medicare (Part A and/or Part B) when you are first eligible. After you are enrolled in Medicare Part A and Part B or just Part B, you can select other coverage options like a Medicare Cost Plan from approved private insurers that offer these types of plans. Enrollment in a Medicare Cost Plan is allowed anytime the plan is accepting new members.

When to Enroll

When you are first eligible, your Initial Enrollment Period for Medicare Part A and Part B lasts seven months and starts when you qualify for Medicare, either based on your age or an eligible disability.

Individuals Aged 65 or Older

Your Initial Enrollment Period is based on the month in which you turn 65. It begins three months before your birth month and extends until three months after your birth month.

Graphic demonstrating the 7 month window for the Initial Enrollment Period

Example: If you are born on June 18, 1952, your Initial Enrollment Period is from March 1, 2017 until September 30, 2017.

Individuals Aged Under 65 with an Eligible Disability

Your Initial Enrollment Period is based on when you began receiving Social Security or Railroad Retirement Board (RRB) disability benefits. It begins the 22nd month after you began receiving benefits and continues until the 28th month after you began receiving benefits.

Graphic demonstrating the 7 month window for the Initial Enrollment Period

Example: If you are began receiving disability benefits in January 2015, your Initial Enrollment Period is from November 1, 2016 until May 31, 2017.

How to Enroll

You must first enroll in Medicare Part A and Part B or just Part B before joining a Medicare Cost Plan. Contact your local Blue Cross Blue Shield company to see if a Medicare Cost Plan option is available in your area.

Open Enrollment Period

The Open Enrollment Period for Medicare runs from October 15 through December 7 on an annual basis, however, this is not the case for individuals interested in a Medicare Cost Plan as enrollment is only allowed when the plan is accepting new members.

Medicare overview information on this website was developed by the Blue Cross and Blue Shield Association to help consumers understand certain aspects about Medicare. Viewing this Medicare overview does not require you to enroll in any Blue Cross Blue Shield plans. To find out about premiums and terms for these and other insurance options, how to apply for coverage, and for much more information, contact your local Blue Cross Blue Shield company. Each Blue Cross Blue Shield company is responsible for the information that it provides. For more information about Medicare including a complete listing of plans available in your service area, please contact the Medicare program at 1-800-MEDICARE (TTY users should call 1-877-486-2048) or visit www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.

The Blue Cross Blue Shield Association is an association of 36 independent, locally operated Blue Cross and/or Blue Shield companies.