Medicare Cost Plans
A Medicare Cost Plan is a Medicare health plan that gives members access to a provider network, set copays or coinsurance, and an annual out-of-pocket maximum.
A Cost Plan is not a Medicare Supplement, and it is not the same as Medicare Advantage. When a
person enrolls in a Medicare Cost Plan, they retain Original Medicare Parts A and B. Their Medicare is not replaced or privatized by the plan.
The Medica Cost Plans available in select Nebraska Panhandle counties are called Medica Prime Solutions 1876 (Cost) Plans. These are medical-only plans. They do not include prescription drug coverage. Members who want prescription drug coverage generally need to enroll in a separate Medicare Part D plan. Members must also continue to pay their Medicare Part B premium.
These plans also include routine dental, vision, hearing, over-the-counter allowances, and fitness membership benefits.
The key difference is flexibility. Members may use the Medica Cost Plan network, but they may also receive Medicare-covered care outside the network through providers or facilities that accept Medicare, subject to Medicare and plan rules.
One of the most valuable features of these plans is access to care beyond the local area. This is especially important in the Nebraska Panhandle, where many specialized medical services are often sought outside the immediate area. Members are not limited only to emergency care when they leave Nebraska.
For Medicare-covered services, members may generally receive care outside Nebraska — including, but not limited to, Colorado or Wyoming, for example — as long as the provider or facility accepts Medicare.
This flexibility can be especially valuable for residents who may seek specialty care, surgery, second opinions, or other medical services outside the Panhandle. In our experience, Medica has consistently worked alongside Original Medicare in these situations under the plan’s travel and snowbird provisions.
When receiving care, members should show both their Original Medicare Red, White, and Blue card and their Medica Cost Plan card.
Cost Plans in our area typically allow year-round enrollment and are not medically underwritten, although standard eligibility rules apply.
Next Steps
Our Medicare-certified agents are happy to help you navigate the Medicare system. If you’re interested in discussing Medicare and what will work best for you, contact us or schedule an appointment.