2025 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 (out-of-area)
- 0 Inpatient admissions
- 3 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)
- 8 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)
- 12 Maintenance Rx (90-day mail order)
- 1 Vision, hearing exam
- 1 Dental prevention visit

Additional Notes

Vision exam average cost of $100 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 $150 is included if not a covered benefit.
Prescriptions based on 67% generic / 33% brand 90-day mail order maintenance prescriptions commonly prescribed for older adults. Drug cost data furnished by the CMS Medicare Plan Finder.