Soon you can buy Medicare Advantage plans at Costco. What you need to know.
Costco is expanding its member services into Medicare, giving shoppers a new place to compare and enroll in Medicare Advantage (MA) plans. Rather than creating its own insurance, Costco is partnering with a licensed insurance marketplace to let members browse plans online or by phone and enroll during eligible windows. Here’s how that works, what doesn’t change, and how to shop smart so you pick the right coverage.
What Costco will actually offer
– Access to Medicare Advantage plans from multiple private insurers, depending on your ZIP code.
– Likely access to related options, such as stand-alone Medicare Part D drug plans and Medicare Supplement (Medigap) policies.
– Licensed agents who can explain plan details and process enrollments by phone or online.
What Costco is not offering
– A “Costco-branded” Medicare Advantage plan. You’ll still enroll in plans from insurers like the ones you already know.
– Special pricing. Federal rules require Medicare Advantage premiums and benefits to be the same no matter where you enroll. A broker or retailer can’t discount your premium or change benefits.
Do you need a Costco membership?
– You may need membership to use Costco’s portal or member services. But membership cannot change your Medicare plan’s premium or benefits.
– You can always compare plans for free at Medicare.gov, and you can enroll directly with an insurer or through an independent broker if you prefer.
How Medicare Advantage works (in 60 seconds)
– Private alternative to Original Medicare: MA plans bundle hospital (Part A) and medical (Part B), and most include drug coverage (Part D).
– Networks and rules: HMOs and PPOs use provider networks and often require referrals or prior authorization for certain services.
– Caps on spending: Each plan sets an annual in-network maximum out-of-pocket (MOOP) limit for Part A/B services; once you hit it, covered services are $0 for the rest of the year.
– Extras: Many plans add routine dental, vision, hearing, fitness, transportation, or OTC allowances. These extras vary widely and come with limits.
What won’t change if you shop at Costco
– Plan availability and benefits are set by each insurer in your county and approved by Medicare. The plan’s premium, copays, network, and drug formulary are identical whether you enroll via Costco, a local agent, Medicare.gov, or the insurer directly.
– Your Part B premium still applies, and late-enrollment rules and penalties (especially for drug coverage) remain the same.
What could be different
– Convenience and support: One-stop shopping with a call center or online comparison tool.
– Selection: You’ll only see plans from insurers that have contracted with Costco’s partner. That could be many—but not necessarily all—carriers in your area.
When you can enroll
– Annual Enrollment Period (AEP): Oct 15–Dec 7. Switch between MA and Original Medicare, or change MA/Part D plans for coverage starting Jan 1.
– Medicare Advantage Open Enrollment (OEP): Jan 1–Mar 31. If you’re already in an MA plan, you can switch to a different MA plan or back to Original Medicare.
– Initial Enrollment: Around your 65th birthday or when you first enroll in Part B.
– Special Enrollment Periods: Life events like moving, losing other coverage, qualifying for Medicaid/Extra Help, or access to a 5‑star plan can open a window to change.
How to shop smart (wherever you buy)
1) List your must-haves
– Doctors and hospitals you want to use.
– Your medications, dosages, and preferred pharmacies.
– Health needs you anticipate (e.g., specialists, physical therapy, insulin, DME).
2) Check the fit
– Provider networks: Confirm your doctors and hospitals are in-network for the specific plan and service location. Call the offices to verify for the coming plan year.
– Medications: Make sure every drug is on the plan’s formulary, note the tier, and check for prior authorization, step therapy, or quantity limits.
– Costs: Look at premium, deductible, copays/coinsurance for common services, and the plan’s MOOP. Calculate what you’d pay in a heavy-use year, not just in a typical month.
– Extras: For dental, vision, and hearing, check benefit caps, networks, waiting periods, and what procedures are actually covered (cleanings vs. crowns, basic lenses vs. progressive).
– Travel and snowbird use: See if there’s nationwide access or visitor travel programs; PPO out-of-network costs can be high, and HMOs generally don’t cover routine care out-of-area.
3) Quality and rules
– Star ratings: Medicare’s 1–5 star system reflects quality and member experience.
– Prior authorization: Ask which services need approval and how often. High prior-auth use can mean delays if you need scans, DME, home health, or post-acute care.
4) Compare at least three plans
– Include your current plan, a strong alternative from a different insurer, and (if you travel or see many specialists) a PPO option to benchmark access and costs.
Medicare Advantage vs. Original Medicare + Medigap
– Medicare Advantage
– Pros: Lower or $0 premiums in many areas; bundled extras; MOOP protection.
– Trade-offs: Networks, prior auth, and variable cost-sharing as you use care.
– Original Medicare + Part D + Medigap
– Pros: Broadest provider access nationwide; predictable costs; no MA network rules.
– Trade-offs: Higher monthly premium for Medigap; separate Part D plan; extras like dental/vision usually not included.
– Important: If you start in MA and later want Medigap, you may face medical underwriting in most states unless you have a guaranteed-issue right. There is a one-time 12‑month trial right if you first joined MA at 65 and want to move to Medigap.
Buying through Costco vs. other channels
– Potential advantages
– Convenient comparison and licensed agents.
– Multilingual support and extended hours (common at large marketplaces).
– Potential limitations
– May not show every insurer in your county.
– Agents are paid commissions; ask if they represent all major carriers locally.
– Bottom line: Use Costco as one comparison tool. Cross-check results on Medicare.gov Plan Finder and, if needed, talk to an independent local broker and your State Health Insurance Assistance Program (SHIP) for free, unbiased counseling.
Red flags and protections
– Don’t share your Medicare number until you’re ready to enroll with a licensed agent.
– Be cautious about unsolicited calls or “too good to be true” extra benefits; Medicare bans gifts or cash beyond small, nominal items for marketing.
– Get a Summary of Benefits and the Evidence of Coverage. Save screenshots or plan PDFs.
– Re-verify your doctors in December for January coverage; networks can change.
What to bring to a Costco (or any) enrollment call
– Medicare card (Parts A and B effective dates).
– List of providers with addresses and NPI if available.
– Prescription list with exact names, strengths, and dosing.
– Preferred pharmacies, including mail order, and any cost-saving programs you use.
– Budget range and must-have benefits.
Key 2025 drug benefit note
– For plans that include Part D, federal changes are capping annual out-of-pocket spending for prescription drugs in 2025, with an option to spread costs over the year. Ask how your drugs will price under each plan.
If you’re happy with your current plan
– Still check during AEP. Formularies, premiums, and networks change every year. Even if you keep the same insurer, your 2025 plan details may differ.
Where to get unbiased help
– Medicare.gov Plan Finder: side-by-side comparisons with drug cost estimates.
– SHIP counselors: free, local, unbiased help (find yours at shiphelp.org).
– Your doctors’ billing offices: can confirm plan participation and referral rules.
The takeaway
Costco’s entry gives you one more storefront to shop Medicare Advantage—convenient, but not a shortcut around the rules or costs. The right plan depends on your doctors, medications, travel, and risk tolerance. Use Costco as a starting point, verify everything that matters to you, and cross-check with Medicare.gov or SHIP before you enroll. That way you get the convenience without compromising on fit.
