2020 CostShare Report Details

The COSTSHARE REPORT comparisons estimate annual out-of-pocket costs for Medicare plan members based on overall health status - EXCELLENT, FAIR, POOR - and the corresponding use - Low, Moderate, High - of the most common plan benefits during one year (physician office visits, emergency or urgent care, inpatient hospital care, home health visits, prescriptions). The comparisons rank the Medicare plans from the lowest to highest out-of-pocket costs based on the approved member copayments and premiums that appear in the Medicare Plan Finder database (www.medicare.gov).

Health Status: EXCELLENT
Requiring occasional routine care
Health Status: FAIR
Requiring episodic care for non-chronic conditions
Health Status: POOR
Requiring chronic disease
care and management

Low annual utilization

- 4 Doctor office visits (in-network)
- 1 Urgent care visit 
- 0 Inpatient admissions
- 2 Maintenance Rx
(90-day mail order)
- 1 Vision, hearing exams
- 1 Dental prevention visit

Moderate annual utilization

- 12 Doctor office visits (in-network)
- 1 ER & 1 urgent care visits
- 1 Inpatient admission 
(5 days)
- 4 Maintenance Rx (90-day mail order)

- 1 Vision, hearing exam
- 1 Dental prevention visit

High annual utilization

- 24 Doctor office visits (in-network)
- 2 ER & 1 urgent care visits
- 3 Inpatient admissions 
(15 days)
- 8 Maintenance Rx (90-day mail order)

- 1 Vision, hearing exam
- 1 Dental prevention visit


Additional Notes

Vision exam average cost of $75 is included if not a covered benefit.
Hearing exam average cost of $75 is included if not a covered benefit.
Dental prevention visit average cost of $125 is included if not a covered benefit.
Prescriptions based on 50% generic / 50% brand 90-day mail order maintenance prescriptions commonly prescribed for older adults.  Drug cost data furnished by the CMS Medicare Plan Finder.

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*Annual estimated costs (out-of-pocket expenses) include applicable 2020 plan copayments, deductibles, and premiums as posted on Medicare Plan Finder (www.Medicare.gov). Medicare Part B monthly premiums ($144.60 in 2020 for most beneficiaries) are not included.  Estimated costs may be greater for beneficiaries who are late enrolling for Medicare Part D (prescription drug) coverage or lower for beneficiaries with limited income and resources who may be eligible for low-income subsidies.  Estimates do not include cost-sharing for additional popular benefits provided by some plans, e.g., eyewear, hearing aids, transportation.  

The information contained herein is neither guaranteed nor intended to represent actual enrollee experiences for any Medicare plan.  HealthMetrix Research Inc. does not endorse or recommend specific Medicare plans. 

Medicare has neither reviewed nor endorsed this information.  The Senior Choice Gold Award is not given by Medicare.

This is not a complete listing of plans available in your service area.  For a complete listing, please contact 1-800-MEDICARE or consult www.Medicare.gov

(TTY users should call 1-877-486-2048, 24 hours a day/7 days a week or consult www.Medicare.gov.) 

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