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Medicare in Colorado

October 6, 2016

Once you turn 65, you’re eligible to receive health insurance coverage under Original Medicare (Part A and Part B). Health benefits for Medicare beneficiaries include medical insurance (Part B) and hospital insurance (Part A). In Colorado, you can also enroll in a Medicare plan option under Medicare Advantage (Medicare Part C), or you can remain with Original Medicare and choose to enroll in a standalone Medicare Prescription Drug Plan or a Medicare Supplement plan. 

Original Medicare for Colorado beneficiaries

As a new Medicare beneficiary, it’s important for you to become familiar with the kind of benefits that Original Medicare, Part A and Part B, offers. In brief, Original Medicare consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).

Colorado Medicare beneficiaries receive the following benefits under Medicare Part A:

  • Limited nursing home care
  • Limited home health services
  • Hospital care
  • Skilled nursing facility care
  • Hospice care

In Colorado, as in other states, you can generally enroll in premium-free Medicare Part A. If you’re not eligible for premium-free Medicare Part A (perhaps you haven’t worked and paid taxes for 10 years or longer in the United States), you may have to pay a monthly premium.

Medical insurance is covered under Medicare Part B. In Colorado and the rest of the United States, you must pay the Medicare Part B monthly premium. If your income is higher than a certain amount, you may also have to pay an income-related monthly adjustment fee. As a Part B beneficiary, you may be covered for Medicare-approved services and items including, but not limited to:

  • A second opinion prior to surgery
  • Durable medical equipment
  • Clinical research studies
  • Ambulance services
  • Mental health services (inpatient, outpatient, and partial hospitalization)

To qualify for Original Medicare, in addition to being 65 years of age, you must also be a United States citizen or legal resident, and you must be eligible for Social Security Administration (SSA) or Railroad Retirement Board (RRB) benefits.

If you’re collecting SSA or RRB benefits, the government automatically enrolls you in Medicare when you turn 65 or have received disability benefits for 24 months. If you don’t qualify for automatic enrollment (for example, if you delayed getting SSA benefits), you must enroll in Original Medicare three months before you turn 65 and no later than four months after that date. This is the Medicare Initial Enrollment Period, and it lasts for seven months.

If you don’t enroll in Original Medicare during your seven-month Initial Enrollment Period, you can still sign up for coverage during the General Enrollment Period, which runs from January 1 to March 31 each year in Colorado, as it does in the rest of the United States. However, if you miss your Initial Enrollment Period and end up joining Medicare at a later date, you might have to pay a late enrollment penalty, which translates into higher monthly premiums.

Medicare Advantage plan options in Colorado

At some point in your lifetime, you may decide to enroll in a Medicare Advantage plan. If you come to this decision, you may have some options:

  • You can enroll in a Medicare Advantage plan through a Medicare-approved private insurance company. Colorado Medicare Advantage plans offer an alternative way to receive your Original Medicare benefits, and they’re required to cover at least the same hospitalization and medical benefits as Original Medicare. The exception is hospice care, which is still covered under Part A. Medicare Advantage plans often offer additional benefits as well, like dental, vision, and hearing, depending on the plan and availability.
  • Many Medicare Advantage plans offer prescription drug benefits. Called Medicare Advantage Prescription Drug plans, they combine health and prescription drug coverage into one Medicare plan option. Just remember, when you enroll in a Medicare Advantage plan, you’ll need to continue paying the Medicare Part B premium, along with any premium the plan requires, as well as any coinsurance, copayments, and deductibles.

Medicare Supplement (Medigap) plans in Colorado

Medicare Supplement (Medigap) plans are offered by private insurance companies and can help you pay for out-of-pocket costs for services covered under Original Medicare. Plan benefits are standardized across 10 plan types (labeled letters A through N), and each plan includes different benefits and level of coverage. In 47 states, Medigap plans offer the same standardized benefits for plans of the same letter type.

Medicare Prescription Drug Plans in Colorado

Also, if you decide to remain with Original Medicare, you can choose to enroll in a stand-alone Medicare Part D Prescription Drug Plan. Medicare Prescription Drug plans help Medicare beneficiaries cover out-of-pocket costs for prescription drugs. Costs for each Medicare Prescription Drug Plan may vary, but they generally require payment of a monthly premium, annual deductible, and copayment or coinsurance.

As a Colorado resident, different Medicare plan options may be available depending on the county in which you live. If you’re a resident of Denver in Denver County, you may have different private Medicare plan offerings than a resident of Steamboat Springs in Routt County. Taking the variety of Colorado Medicare plans into consideration, it’s important that you customize your search for plans based on your individual health and prescription drug needs, and on the zip code where you live.

Colorado resources for Medicare beneficiaries

According to Medicare.gov, there are a number of resources designed to help Colorado Medicare beneficiaries with Medicare-related issues and concerns. Here are some of the resources that may be helpful to you:

Learn more about how Medicare plans work in Colorado, including:

 

Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.