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CostShare Report FAQs
Exactly what do the COSTSHARE REPORT findings represent?
The findings do represent
how cost-sharing (out-of-pocket expenses) can vary among Medicare managed
care plans that offer similar benefits and services when adjusted for
enrollee health status.
The findings do represent the
out-of-pocket expenses for the most common services that Medicare
beneficiaries utilize, e.g., physician office visits, emergency/urgent care,
prescriptions, routine preventative care, inpatient hospital care.
The findings do compare plans
based on the applicable annual out-of-pocket expenses (copayments, premiums,
deductibles) that enrollees incur for selected benefits and services
provided under each plan.
The findings do represent each
plan's cost-sharing requirements from the Medicare Compare Database.
What do the COSTSHARE REPORT findings not represent?
The findings do not
represent a guarantee of the actual annual out-of-pocket expenses that
Medicare beneficiaries would incur upon enrolling in a plan.
The findings do not include
other annual out-of-pocket expenses that may apply for other plan benefits
and services that may also be utilized, e.g., mental health care,
chiropractic care, podiatry care, home health visits, medical equipment,
The findings do not compare
provider networks, financial stability, quality of care, enrollee
satisfaction, or other managed care plan performance measurements.
The findings do not represent
the cost-sharing requirements for Medicare beneficiaries enrolled in
employer-sponsored group retirement plans.
What limitations should Medicare beneficiaries take into consideration when using the COSTSHARE REPORT findings?
COSTSHARE REPORT findings have not been verified for accuracy by each plan.
Nevertheless, certain limitations or benefit restrictions may apply that can
affect the annual out-of-pocket expenses shown in the COSTSHARE REPORT
Plan benefits, copayments, deductibles, and monthly premiums are subject to
change by the Centers for Medicare & Medicaid Services (CMS).
Medicare Part B premiums ($104.90 minimum per month in 2013) are not included
in the cost-sharing comparisons but must continue to be paid as a condition
for enrollment in all Medicare managed care plans.
Cost-sharing dollar differences between individual plans may range from as
little as $1 to over $500. Each COSTSHARE REPORT user should decide
whether the annual cost-sharing dollar differences are sufficient for
selecting one plan over another.
Although COSTSHARE REPORT comparisons are important, they should not be the
sole basis for either selecting or not selecting a Medicare managed care