Cost Employer Group Health Plans (EGHP)

60 - Cost Employer Group Health Plans (EGHP) (Rev. 77, Issued: 10-28-05, Effective Date: 10-28-05) (42 CFR.440(b)) In general, since enrollment in a Medicare cost plan is at the organizational (not the plan) level, therefore, all enrollees of Medicare cost plan must receive the same basic package for the same cost-sharing or copayment amounts. However, employer groups can negotiate privately an EGHP on behalf of employer group members. An EGHP: • May elect only some, but not all of the optional supplemental benefits offered by Medicare cost plan for its members; • May “buy-down” premium and cost-sharing for its members; and • May negotiate for benefits not covered by Medicare. Such privately negotiated non-Medicare benefits (with their associated premiums and copays) are deemed “outside” the CMS Medicare contract.