Cost And HCPP

Cost Plans

General Information

Cost plans are Medicare managed care plans that may elect to provide coverage for both Medicare Part A (inpatient care) and Part B services (e.g. physician services, Durable Medical Equipment) or only Medicare Part B services. If a Medicare enrollee elects to be part of a Cost plan, any Medicare covered services not paid for by the Cost Plan may be covered through traditional Medicare.

To learn more about Cost Plans select "Cost Plan Page" to be linked directly to the page in the CMS web site that provides useful industry and program information. Select "CMS Medicare Managed Care Manual" for CMS program and policy guidance to Cost plans.

Health Care Prepayment Plans (HCPPs)

HCPPs are Medicare managed care plans that only provide coverage for Medicare Part B services. A HCPP does not need to offer coverage for all Part B services.

To learn more about HCPP's select "HCPP Page" to be linked directly to the page in the CMS web site that provides useful industry and program information. Select "CMS Medicare Managed Care Manual" for CMS program and policy guidance to HCPPs.

Appeal Information

The appeal process for both the Cost Plans and HCPP's are governed by federal regulations found at 42 CFR Part 417. Cost Plans and HCPP's must send all denied enrollee appeals (Reconsiderations) to an Independent Review Entity (MAXIMUS Federal Services). Cost plans and HCPP's should carefully review and follow the instructions in the "MAXIMUS Federal Services Reconsideration Process Manual for Medicare Cost Plans and HCPPs."

The "MAXIMUS Federal Services Reconsideration Process Manual for Cost Plans and HCPPs" contains required forms for creating and submitting a case to MAXIMUS Federal Services. Select "Cost Plan and HCPP Forms" to download these forms and the relevant instructions.

MAXIMUS Federal Services Reconsideration Process Manual for Cost Plans and HCPPs

Cost Plan Page

HCPP Page

CMS Medicare Managed Care Manual

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