Where Are Medicare Cost Plans Available? (2026)

Quick Answer: Where Medicare Cost Plans Still Exist in 2026

It depends on where you live. In 2026, a Medicare Cost Plan is available only in parts of Minnesota (Blue Cross Blue Shield's PlatinumBlue plan and Medica's Prime Solution plan) and Wisconsin (HealthPartners' Cost Plan). A 2015 federal law forces Medicare to stop renewing Cost Plans wherever two or more competing Medicare Advantage plans reach minimum enrollment, so the footprint keeps shrinking every year.

What a Medicare Cost Plan Actually Is

Medicare Cost Plans operate under Section 1876 of the Social Security Act, a cost-reimbursement model that predates Medicare Advantage. Enrollees keep Original Medicare Part A and Part B while adding the Cost Plan's network for lower cost-sharing. Unlike Medicare Advantage, a Cost Plan enrollee who sees an out-of-network provider without a referral still has that visit paid by Original Medicare rather than denied, and emergency or urgently needed care is covered by the plan itself. This dual-access design is the single biggest reason Cost Plans built a loyal following in rural Minnesota and Wisconsin decades ago, long before Medicare Advantage networks matured.

Congress stopped chartering new Cost Plans years ago, and the program now functions as a legacy benefit. CMS's most recent Cost Plan enrollment reports, covering 2025 into 2026, count about 11 Cost Plan contracts left nationwide, and 7 of those are closed group plans that only retired railroad and union workers can join. That leaves a small handful of Cost Plans, mainly in Minnesota and Wisconsin, open to the general Medicare population in 2026.

Where Medicare Cost Plans Are Available in 2026

Minnesota is the last real stronghold for Medicare Cost Plans in 2026. Blue Cross Blue Shield of Minnesota's PlatinumBlue Medicare Cost Plan covers 21 counties, including Aitkin, Carlton, Cook, Itasca, Koochiching, Lake, St. Louis, and Yellow Medicine, with annual premiums ranging from about $492 to $2,820 depending on the option selected. Medica Insurance Company sells the Prime Solution Medicare Cost Plan in a separate set of Minnesota counties, including a $0 standard premium option in some service areas, with annual costs ranging from roughly $588 to $2,436.

Wisconsin residents near the Minnesota border have one option: HealthPartners Insurance Company's Medicare Cost Plan, sold in a limited set of western Wisconsin counties that overlap with HealthPartners' Minnesota service area. Outside these two states, a Medicare Cost Plan is essentially unavailable in 2026 unless you belong to one of the 7 closed railroad or union retiree contracts CMS still administers nationwide.

Why Medicare Cost Plans Are Disappearing: The MACRA Competition Rule

Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015, and it changed the rules for Cost Plans permanently. Under MACRA, CMS must stop renewing a Cost Plan in any county where two or more competing local or regional Medicare Advantage coordinated care plans meet minimum enrollment thresholds for a full prior contract year. Congress delayed enforcement to give carriers time to transition members, but the rule has applied broadly since 2019.

Medicare Advantage enrollment has grown in nearly every U.S. county since 2019, which means most counties that once had a Cost Plan now fail the two-competitor test and lose the option automatically. Minnesota and parts of Wisconsin have survived longest because Medicare Advantage penetration in some rural counties there stayed below the competition threshold longer than in the rest of the country, though that gap keeps narrowing every renewal cycle.

What a Medicare Cost Plan Costs and Covers in 2026

Blue Cross Blue Shield of Minnesota's PlatinumBlue Medicare Cost Plan runs about $41 to $235 a month ($492 to $2,820 a year) in 2026, depending on the plan option and county. Medica's Prime Solution Medicare Cost Plan runs about $49 to $203 a month ($588 to $2,436 a year), with a $0 standard premium option available in some Minnesota counties. Every Cost Plan must cover the full Original Medicare Part A and Part B benefit package, and most add extra benefits like routine dental, vision, or hearing exams similar to Medicare Advantage, though the specific extras vary by carrier and county.

Prescription drug coverage under Medicare Part D works differently than Medicare Advantage. Cost Plan enrollees can accept the plan's built-in Part D coverage if it offers one, or enroll in a separate standalone Part D drug plan instead, a flexibility Medicare Advantage enrollees generally do not have. Medicare Part B premiums ($202.90 a month standard in 2026) and the Part B deductible ($283 in 2026) still apply on top of the Cost Plan premium, the same as they would under Original Medicare.

Who Can Enroll in a Medicare Cost Plan

Residency inside the plan's approved service area is the first requirement: only beneficiaries living in one of the specific Minnesota or Wisconsin counties a Cost Plan serves in 2026 can join. Beneficiaries need at least Medicare Part B to enroll, unlike Medicare Advantage, which generally requires both Part A and Part B. Most Cost Plans exclude beneficiaries with End-Stage Renal Disease at the time of enrollment, mirroring the historical Medicare Advantage rule, though exceptions exist for people who develop ESRD after joining.

Enrollment timing is the biggest practical difference from Medicare Advantage. Beneficiaries can join a Medicare Cost Plan any time the plan is accepting new members, not just during the Annual Enrollment Period (October 15 to December 7, 2026) or the Medicare Advantage Open Enrollment Period (January 1 to March 31, 2026). Beneficiaries can also leave a Cost Plan at any time and return to Original Medicare, with no lock-in period.

How to Find and Enroll in a Medicare Cost Plan

Medicare's Plan Finder tool at medicare.gov/plan-compare is the fastest way to check whether a Medicare Cost Plan serves your specific county in 2026; enter your ZIP code and filter results by plan type. Beneficiaries in Minnesota and Wisconsin can also call the carrier directly (Blue Cross Blue Shield of Minnesota, Medica, or HealthPartners) or 1-800-MEDICARE to confirm current service-area boundaries before applying, since county lists can change from one contract year to the next.

• Step 1: Confirm you have Medicare Part B (Part A is not always required to join a Cost Plan).
• Step 2: Search medicare.gov/plan-compare by ZIP code to see if a Cost Plan serves your county in 2026.
• Step 3: Compare the Cost Plan's premium, extra benefits, and drug coverage option against Original Medicare plus Medigap plus a standalone Part D plan.
• Step 4: Contact the carrier directly or call 1-800-MEDICARE to apply once you confirm the plan is accepting new members.
• Step 5: Keep proof of enrollment, and remember you can disenroll at any time and return to Original Medicare.

Alternatives if No Medicare Cost Plan Serves Your County

Medicare Advantage is the closest substitute for most beneficiaries. HMO and PPO Medicare Advantage plans are sold in nearly every U.S. county in 2026 and often bundle dental, vision, hearing, and drug coverage the way many Cost Plans do, though networks tend to be stricter and enrollment is limited to specific windows.

• Medicare Advantage (Part C): available in nearly every county in 2026; bundles extra benefits but generally locks you into a network and a fixed enrollment period (medicare.gov).
• Original Medicare plus Medigap plus Part D: works nationwide with no network restrictions, but Medigap medical underwriting can apply outside your 6-month Medigap open enrollment window, so a preexisting condition could raise your premium or trigger a waiting period.
• Employer or union retiree group coverage: some retirees keep employer-sponsored group coverage instead of joining any individual Medicare plan; check with your former employer's benefits office.
• Medicare Savings Programs and Extra Help: beneficiaries with limited income can lower Part B premiums and Part D drug costs through their state Medicaid office, regardless of which Medicare plan type they choose. See the [Medicare Savings Program glossary entry](/glossary/medicare-savings-program) for details.

Does Original Medicare cover the same doctors as a Medicare Cost Plan?

Yes, mostly. A Medicare Cost Plan lets you use its network for lower cost-sharing, but if you see a provider outside that network without a referral, Original Medicare pays for the covered service instead of denying it, the same providers accepted anywhere in the country. Emergency and urgently needed care outside the network is paid by the Cost Plan itself. This dual-access design is unique among Medicare private plan types in 2026.

Is Medicare Advantage replacing Medicare Cost Plans in 2026?

Largely, yes. A 2015 law, MACRA, forces CMS to stop renewing a Cost Plan in any county where two or more competing Medicare Advantage plans reach minimum enrollment for a full year, and Medicare Advantage now meets that bar almost everywhere. CMS enrollment data shows roughly 11 Cost Plan contracts left nationwide heading into 2026, down from hundreds two decades ago.

How much does a Medicare Cost Plan cost in 2026?

In Minnesota, Blue Cross Blue Shield's PlatinumBlue Medicare Cost Plan runs about $492 to $2,820 a year depending on the option, and Medica's Prime Solution Medicare Cost Plan runs about $588 to $2,436 a year, with a $0 standard option in some counties. You still pay the standard 2026 Part B premium ($202.90 a month) and Part B deductible ($283) on top of the Cost Plan premium.

What are my options if no Medicare Cost Plan serves my county in 2026?

Medicare Advantage is sold in nearly every U.S. county in 2026 and often bundles similar extra benefits. Original Medicare paired with a Medigap policy and a standalone Part D drug plan works nationwide with no network at all. Retirees may also have employer or union group coverage available instead of an individual Medicare plan.

Are Medicare Cost Plans available outside Minnesota and Wisconsin in 2026?

Almost never. CMS still administers a handful of closed Cost Plan contracts for retired railroad and union workers in other parts of the country, but those are limited to members of specific retiree groups. For the general Medicare population, Minnesota and Wisconsin are the only states with an open-enrollment Medicare Cost Plan in 2026.

When does CMS stop renewing a Medicare Cost Plan in a county?

Under MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, CMS must non-renew a Cost Plan in any county where two or more competing local or regional Medicare Advantage coordinated care plans meet minimum enrollment requirements for the entire prior contract year. That rule took full effect in 2019 and has steadily shrunk Cost Plan service areas every year since.

Can I keep a standalone Part D drug plan if I join a Medicare Cost Plan?

Yes. Unlike Medicare Advantage, a Medicare Cost Plan lets you choose a separate standalone Part D drug plan even if the Cost Plan itself offers drug coverage. This is one of the features that makes Cost Plans more flexible than Medicare Advantage for people who want to keep a specific Part D plan.

What is the difference between a Medicare Cost Plan and Medicare Advantage?

A Medicare Cost Plan lets you keep Original Medicare Part A and Part B and use its network only for lower cost-sharing, with Original Medicare paying for out-of-network care. Medicare Advantage replaces Original Medicare entirely and generally restricts you to its network except for emergencies. Cost Plans also let you join or leave anytime the plan accepts members, while Medicare Advantage enrollment is limited to specific enrollment periods like the Annual Enrollment Period (October 15 to December 7, 2026).