US · guidance
CMS Pub. 100-16, ch. mc86c17f, § 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.
History
(Rev. 77, Issued: 10-28-05, Effective Date: 10-28-05)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
31dc308f4c06788839fec2032790255d6dac5351a9d51c84535bc454ccebff31
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