2019 CostShare Report Details

The COSTSHARE REPORT comparisons estimate annual out-of-pocket costs for Medicare plan members based on overall health status - GOOD, 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: GOOD
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
- 6 Prescriptions 
(30 day supply)
- 1 Vision, hearing exams
- 1 Dental prevention visit

Moderate annual utilization

- 12 Doctor office visits (in-network)
- 1 Emergency room visit
- 1 Inpatient admission 
(5 days)
- 24 Prescriptions 
(2 per month)
- 1 Vision, hearing exam
- 1 Dental prevention visit

High annual utilization

- 24 Doctor office visits (in-network)
- 2 Emergency room visits
- 3 Inpatient admissions 
(15 days)
- 72 Prescriptions 
(6 per month)
- 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 $45 average cost for up to a 30-day generic prescription ($135 for 90-day mail order); $250 average cost for up to a 30-day brand prescription ($750 for 90-day mail order)


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*Annual estimated costs (out-of-pocket expenses) include applicable 2019 plan copayments, deductibles, and premiums as posted on Medicare Plan Finder (www.Medicare.gov). Medicare Part B monthly premiums ($135.50 in 2019 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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