Medicare Advantage Plans in Colorado

If you don't like the coverage provided by Original Medicare, the alternative is a private health plan through the Medicare Advantage program. In most areas of Colorado there are multiple options to choose from, but options vary between each Colorado County. As a result, you can only choose a plan that's available where you live.

You can compare all the available plans in your area by using our zip code lookup tool above or by clicking on your county below. Continue reading to find out more about Colorado's Medicare Advantage program and how it compares to other options.

Compare the Best Medicare Advantage Plans in Colorado by County

What are Medicare Advantage Plans and Can I Get One in Colorado?

Traditional MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. covers about 80% of all major medical costs. It does not cover minor medical, including vision, hearing, and dental, and it does not offer prescription drug coverage. The Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). available in Colorado can include minor medical benefits but are not required to. Most do include coverage for your prescriptions. To get a Medicare Advantage health plan (also known as Part C of Medicare), you must first have both Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. benefits.

While it is nice to have coverage for minor medical costs, such as a prescription drug plan, you must understand exactly what you get when you join a Medicare Advantage plan in Colorado. In particular, you need to know that these plans have complete control over your access to doctors and other healthcare providers. If you've ever had a managed care insurance plan (HMO, PPO, etc.) through an employer, you already know what to expect.

Medicare Advantage vs. Original Medicare: Is There a Big Difference?

The big differences between Original Medicare coverage and what you get with a Medicare Advantage plan in Colorado are easy to see by pointing out the pros and cons. Neither type of insurance is perfect. They each suit different needs.

Medicare Advantage vs. Medicare: The Pros and Cons

• When you have Original Medicare, you are free to use any Medicare-approved doctor you choose. When you join a Medicare Advantage plan, your choices are limited to the plan's network of Colorado providers.
• If you travel frequently or you are a snowbird and winter or summer in another state, your Original Medicare coverage remains the same. It goes where you go. This is not true with Colorado Medicare Advantage plans, which are only required to cover you if you have a medical emergencyWhen you believe you have an injury or illness that requires immediate medical attention to prevent a disability or death..
• With Original Medicare, there are no limits on your out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments.. However, all Colorado Medicare Advantage plans have an annual maximum out-of-pocket (MOOP) limit. If you reach the MOOP spending limit on your copays and coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. , the plan picks up the tab for the remainder of the year.
• If you want prescription coverage and have Original Medicare, you must purchase a Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plan. However, most Medicare Advantage plans include a Colorado Medicare Part D plan. Just be aware that a stand-alone Part D plan gives you the best opportunity to get your most expensive prescriptions at the lowest cost.
• In the Medicare Advantage program, the government allows plans to set their own copays and coinsurance for each healthcare service offered. This makes comparing plans difficult, at best. However, in the Original Medicare system, deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share. and coinsurance are fixed, making them predictable. Plus, you can get a Medigap plan to help pay these costs.
• There are eligibility requirements with Medicare Advantage plans. For example, you must have both Medicare Part A and Medicare Part B to join, and you cannot have end-stage renal diseaseEnd-Stage Renal Disease (ESRD), also known as kidney failure, is a condition that causes you to need dialysis or a kidney transplant. People with ESRD are eligible for Medicare coverage regardless of age. (ESRD) or one of a handful of other diseases.

Colorado Medigap Coverage vs. Medicare Advantage

Most Colorado seniors just getting their Medicare benefits want to know which type of plan is better. We commonly see these three questions:

• Why are Medicare Advantage plans bad?
• What are the disadvantages of Medicare Advantage plans?
• Is it better to have Medicare Advantage or Medigap?

Let's take a minute or two to compare and contrast, shall we?

Why Colorado Medicare Advantage Plans are Bad

This is a myth. There's nothing wrong with Medicare Advantage plans. Over 42 percent of all Medicare beneficiaries in Colorado choose Medicare Advantage enrollment over traditional Medicare. What you really need to know is that these plans are not for everyone, and for some Colorado seniors they are a disadvantage.

In particular, if you have one or more chronic conditions, Original Medicare could be a better option because you have the ability to choose your doctors. MedicareWireMedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. believes that Medicare Advantage is the best option for healthy people, people with Medicare Advantage retiree benefits, and for people who qualify for both Medicare and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States..

Conversely, Original Medicare and a Medicare supplement work best for people with chronic health conditions (based on overall cost), as well as those who can afford a higher monthly premiumA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. , even when they are well.

You can check out supplemental Medicare insurance in Colorado on our Colorado Medicare supplements page.

What are the Disadvantages of Colorado Medicare Advantage Plans?

The disadvantage of Medicare Advantage plans is the strength of Colorado Medigap plans. You see, when you take doctor choice out of the equation, the big difference between Medicare Advantage and Medigap is when you pay for services. It's that same no matter what type of Medicare Advantage plan you're evaluating (e.g., HMO, PPO, PFFS, Cost, or HSA).

With Medicare Advantage, you pay a little each month (with some plans, you pay nothing). This is the monthly premium. But you also pay copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. when you use most medical services, and they add up fast. It does not matter if you have a Health Maintenance Organization (HMO) plan or a Preferred Provider Plan (PPO). The majority of your costs are due when you use health services.

However, with Original Medicare and a Medigap plan for supplemental coverage, you pay for most of your costs in advance with a higher premium. You control your costs by choosing a plan that pays the deductible(s) you want to be covered. This makes your health care costs predictable, and for most people on a fixed budget, that's very comforting.

Which is Best in Colorado, Medicare Advantage or Medicare Supplement Insurance?

• If you can afford Medigap Plan FMedicare Supplement Plan F is the most comprehensive Medicare supplement plan available. This plan covers all Original Medicare deductibles, coinsurance, and copayments, leaving you with no out-of-pocket costs on all Medicare-approved services., G, or N, keep Original Medicare and add one of these top 3 Medicare supplements. These plans help you manage your out-of-pocket costs the best, giving you peace of mind.
• If you are a healthy senior and have good health in your family heritage, Medigap Plan NMedicare Supplemental Plan N is one of the ten standardized Medigap plans. Although it is one of the newest plans available, Medicare Plan N is quickly becoming a favorite with Baby Boomers aging into their... will let you save money by sharing some costs when you see your doctor. The plan benefits are excellent, and you pay just a little to see your doctor (up to $25 per visit).
• If you are a healthy senior but you cannot afford a Medigap Plan F, G, or N, Medicare Advantage is good. Both Original Medicare and Medicare Advantage cover preventive care at no additional cost to keep you healthy
• If you are turning age 65, have one or more chronic health conditions that require frequent doctor visits, and do not qualify for both Medicare and Medicaid (dual eligible), the most Medigap coverage you can afford is the best option.
• If you qualify for both Medicare and Medicaid, Medicare Advantage is your best option regardless of your health condition.
• If you have special needs (i.e., a full-time nursing home resident, diabetes, etc.) and an appropriate Medicare Advantage Special Needs Plan (SNP) is available, this is your best option.
• With both Medigap and Medicare Advantage, you must continue to pay your Medicare Part B premiumThe Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above... (it typically comes straight out of your Social Security income, unless you're not yet taking it).
• With Medicare supplement insuranceMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage., there are no service area restrictions. With Medicare Advantage, you must receive care within the plan's provider network unless you need emergency care.
• Medicare Advantage plans have an enrollment period. You get an individual enrollment period when you're first eligible. After that, there's an annual enrollment periodThe Annual Enrollment Period is when Medicare beneficiaries can join, drop or change Medicare Advantage and Medicare Part D prescription drug plans. AEP begins on 15 October and ends on 7 December. to switch plans or go back to Original Medicare. Medigap plans do not have the same restrictions, but you can be turned down if you leave a Medigap plan and later want to come back. Medicare Advantage plans cannot generally turn you down as a Medicare supplement insurance company can.

References

medicare.gov

• Medicare.gov: the official U.S. government site for Medicare | Medicare http://www.medicare.gov/
• Find a Medicare plan https://www.medicare.gov/plan-compare/

ssa.gov

• Medicare Benefits | SSA https://www.ssa.gov/medicare/
• Extra HelpSocial Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium... with Medicare Prescription Drug Plan Costs | SSA https://www.ssa.gov/medicare/prescriptionhelp/
• Medicare Benefits | SSA https://www.ssa.gov/benefits/medicare/

cms.gov

• Five-Star Quality Rating System | CMS https://www.cms.gov/medicare/provider-enrollment-and-certification/certificat...
• https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS10106.pdf
• Medicare Open Enrollment | CMS https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-h...

This Medicare Advantage state information page was last updated on June 29, 2022.