Depending
on where you live, Medicare Cost plans may
offer the “best of both worlds” for older adults who want the flexibility of
keeping their traditional Medicare benefits while simultaneously having access
to out-of-network health care providers.
“The
key difference between Medicare Cost plans and other types of Medicare plans is
that enrollees are not restricted to the plan’s network of providers. They can
go outside the network to receive Medicare-covered services,” says David
Lipschutz, senior policy attorney at the Center for Medicare Advocacy, a
nonprofit in the District of Columbia.
Medicare
is the federal health insurance program
for people who are age 65 and older and for certain individuals with
disabilities. You may qualify for Medicare at any age if you have end-stage
renal disease requiring dialysis or a kidney transplant, or amyotrophic lateral
sclerosis (also known as ALS or Lou Gehrig’s disease).
Medicare
Part A covers inpatient hospital stays, while Part B covers doctor services.
Medicare Part C refers to Medicare
Advantage plans offered by private insurance companies,
and Medicare Part D offers prescription drug coverage.
In some
parts of the country, beneficiaries have the option to enroll in Medicare Cost
plans offered by private insurance companies. People with Medicare Cost plans
maintain their traditional Medicare Part A and Part B coverage to allow them to
go to non-network providers.
According
to Gerald Kominski, director of the Center for Health Policy Research at the University
of California–Los Angeles, Medicare Cost plans are a “hybrid” between health
maintenance organizations, or HMOs, which restrict enrollees to a network of
providers, and preferred provider organizations, or PPOs, that have a broader
network of providers.
“Medicare
Cost plans are essentially an HMO with the option to opt out of the limited
network and see any doctor using traditional fee-for-service Medicare,”
Kominski says. “It’s like an HMO with an escape clause.”
Some
Medicare Cost plans include
prescription drug coverage, or individuals can
purchase a stand-alone Medicare prescription drug plan. Beneficiaries who seek
out-of-network care pay the Part A and Part B coinsurance and deductible. To
access services, enrollees must show their Original Medicare card and cost plan
card. People with Medicare Cost plans can return to Original Medicare at any
time, even outside the Medicare open enrollment period.
Historically,
Medicare Cost plans provided a managed care option in areas of the country that
traditionally had few Medicare Advantage plans, Lipschutz explains. Medicare
Cost plans pay based on the reasonable cost of delivering services, while
Medicare Advantage plans accept the financial risks if costs exceed fixed
payments per enrollee. With Medicare Cost plans, Original Medicare steps
in only when the enrollee goes
out-of-network for care, not when costs are exceeded.
That’s
why consumers deciding between Medicare Cost and Medicare Advantage plans —
which are both offered by private insurance companies — should consider whether
they want access to out-of-network doctors and hospitals. People with Medicare
Cost plans can see out-of-network providers because traditional Medicare kicks
in at that point, and the enrollee pays the deductible for Part A and Part B.
It’s one of the main reasons why Medicare Cost plans are convenient for those
who travel during their retirement. Depending on the type of Medicare Advantage
plan, consumers must see providers in-network and either pay out-of-pocket or a
higher premium if they happen to be traveling outside of their coverage area.
In
2017, a total of 612,054 Americans in 14 states and the District of Columbia
have Medicare Cost plans, according to the Kaiser
Family Foundation. That’s significantly less than the 19
million Americans enrolled in Medicare Advantage plans.
Overall,
Minnesota has the nation’s largest
concentration of people with Medicare Cost
plans, according to KFF: 380,195 in 2017.
Jean
Wood, executive director of the Minnesota Board on Aging, attributes the
popularity of Medicare Cost plans to the large number of “snow birds” — older
adults who move to a warmer climate for several months during the year. “People
can leave Minnesota and their Medicare Cost plan reverts to original Medicare
Part A and B, which they can use fairly easily when they are out of state,”
Wood says. “They appreciate having that flexibility.”
Periodic
discussions by federal officials to abolish Medicare Cost plans have concerned
Minnesotans throughout the years, she says, “but our citizenry has been able to
persuade Congress [to keep the plans] every time the subject has come up.”
No comments:
Post a Comment