Medicare beneficiaries living in Colorado may be able to receive their Medicare benefits under the Medicare Advantage (Medicare Part C) program as an alternative to receiving their Original Medicare (Part A and Part B) benefits directly through the government.
Medicare Advantage plans are available through private health insurance companies that contract with Medicare to deliver Original Medicare benefits to beneficiaries. Colorado residents enrolled in Medicare Advantage plans, like beneficiaries in other states, are covered through their individual health plans and not directly through Original Medicare. Plan availability and costs depend on where you live and on the Medicare Advantage plan you choose.
How Medicare Advantage works in Colorado
Medicare Advantage plans in Colorado are available through private, Medicare-approved insurance companies, and they cover all hospitalization and medical benefits offered by Original Medicare (except hospice care, which is covered through Medicare Part A). Medicare Advantage plans may offer additional benefits such as prescription drug coverage as well as routine vision, hearing, and dental coverage.
You need to be enrolled in Original Medicare Part A and Part B before you switch to a Medicare Advantage (Part C) plan. To sign up for a Medicare Advantage plan, you need to enroll during one of the following periods:
- The Initial Coverage Election Period is an eligibility period for enrolling in a Medicare Advantage plan
- If you enrolled in Original Medicare (Part A and Part B) during your Medicare Initial Enrollment Period, automatically or otherwise, your Initial Coverage Election Period and your Initial Enrollment Period are the same. The seven-month Initial Enrollment Period runs from three months before the month you qualify for Medicare until three months after that.
- If you don’t sign up for Original Medicare during the Initial Enrollment Period (if you still have health insurance through an employer or union, for example), your Initial Coverage Election Period is the three-month period before your Part B start date. For example, if you enrolled in Part B during the General Enrollment Period (January 1 to March 31), your Part B start date would be July 1, so your Initial Coverage Election Period would be April 1 to June 30.
- The Annual Election Period runs from October 15 to December 7 each year. If you’re already enrolled in a Medicare Advantage plan and want to switch plans, you may want to do so during the Annual Election Period. You can also switch from Original Medicare to Medicare Advantage at this time. When you change Medicare plans during the Annual Election Period in Colorado, your new coverage generally begins on January 1 of the following year.
- Medicare in Colorado has special provisions to help you deal with unexpected happenings, as it does in other U.S. states. If you experience certain events, you may be able to change Medicare plans during Special Enrollment Periods. These special events include (but are not limited to) moving to a new address, losing your current coverage, qualifying for other coverage, or changes in your current plan that affect your health benefits. The dates and types of changes you can make vary according to each health plan.
- If you’re enrolled in a Colorado Medicare Advantage plan and want to switch to a different Medicare Advantage plan, you can do so during the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31 each year. During this period, you can also decide to switch back to Original Medicare, Part A and Part B, and then join a stand-alone prescription drug plan to go alongside your Original Medicare.
Types of Medicare Advantage plans in Colorado
Medicare Advantage beneficiaries in Colorado might have a variety of options when it comes to choosing the type of Medicare Advantage plan that may suit their health needs. Not every type of plan may be available everywhere in Colorado.
- One option is a Health Maintenance Organization (HMO). Under an HMO plan, you’re typically required to visit doctors, health care providers, and hospitals on the health plan’s network list. You may also need an authorization from your primary doctor to get coverage for certain health services. HMO Point-of-Service (HMO-POS) plans, on the other hand, will let you go out of network for certain health services, usually at a higher cost.
- You can opt for a Preferred Provider Organization (PPO)* plan. PPOs let you choose doctors, health care providers, and hospitals outside the plan’s network, but you may end up paying more by exercising this option.
- In some cases you can enroll in a Special Needs Plan (SNP), which is a type of health plan that generally limits enrollment to people with special health needs (such as end-stage renal disease, or ESRD, requiring dialysis) or those living in an institution like a nursing home or people who qualify for both Medicaid and Medicare. These plans offer coverage tailored to suit the needs of those specific beneficiaries.
- You can enroll in a Private Fee-for-Service (PFFS) plan, where the plan itself decides how much it will pay for your doctor, health care provider, and hospital visits, and also determines your share of each expense.
- You can choose a Medical Savings Account (MSA) plan. Colorado’s MSA plans generally combine a high deductible with a savings account that beneficiaries can use to pay for their health-care expenses.
Many Medicare Advantage plans also include prescription drug coverage. These plans, known as Medicare Advantage Prescription Drug plans, combine health and prescription drug coverage (under Medicare Part D) into one insurance plan. Note that if you choose to enroll in a Medicare Advantage plan, you have to stay enrolled in Original Medicare and continue paying your Medicare Part B premiums in order not to lose your health coverage.
Comparing Medicare Advantage plans in Colorado
Each Medicare Advantage plan in Colorado may charge different amounts and may have different rules regarding services, and these rules may change on a yearly basis, so it’s important for you to compare available Medicare Advantage plans. Think about your health and prescription drug needs, and be aware that the plans available to you will depend on your area of residence.
Premiums for a Medicare Advantage plan with the same coverage and benefits can vary between different counties within the state of Colorado. Some Medicare Advantage plans in Colorado may offer premiums as low as $0, but do keep in mind that you must continue paying your Medicare Part B premiums, no matter which Medicare Advantage plan you choose.
Medicare Advantage plans may offer additional benefits beyond what is included in Original Medicare coverage such as routine vision and dental services. You should decide whether or not you want prescription drug coverage with your Medicare Advantage plan through a Medicare Advantage Prescription Drug plan. With all these options, you can see why it can be important to compare plans with the benefits and costs best suited to your specific health needs.
* Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.