Since Medicare Advantage (MA) was first introduced, it has grown more popular every year. Today, more than one-third of all Medicare beneficiaries choose to receive their benefits through a Medicare Advantage plan. This page describes Medicare Advantage plans in Colorado and how to compare your options.
What is Medicare Advantage in Colorado?
As in the rest of the country, private insurance companies offer Medicare Advantage plans in Colorado.
Medicare Part C plans (commonly known as Medicare Advantage) must provide the same benefits you get with Original Medicare. This includes Medicare Part A, hospital insurance, and Medicare Part B, medical insurance.
Prescription drug coverage is not included with Original Medicare. You get that by joining a standalone Medicare Part D plan or an Advantage plan that covers prescription medications.
Colorado Medicare Advantage plans with prescription drug coverage
Medicare Advantage Prescription Drug plans (MA-PD) combine your Medicare Parts A, B, and D benefits into one policy. Other benefits you may get with an Advantage plan include:
- Fitness programs
- Routine dental care
- Routine vision care
Benefits vary according to the plan you choose.
Who is eligible for Medicare Advantage in Colorado?
You can sign up for Medicare Advantage as soon as you have Medicare Parts A and B.
If you are an American citizen or permanent legal resident for 5+ years, you become eligible for Medicare once you turn 65. You will only be enrolled in Parts A and B automatically if you began collecting Social Security benefits at least 4 months before your birthday.
You may qualify for Medicare before turning 65 if you collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months. In this case, enrollment in Parts A and B occurs automatically during month 25.
Finally, if you've been diagnosed with amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig's disease) or end-stage renal disease (ESRD), you qualify for Medicare.
When can you sign up for a Medicare Advantage plan in Colorado?
Signing up for a Medicare Advantage plan in Colorado is restricted to specific enrollment periods.
- Initial Enrollment Period: Your IEP begins 3 months before you qualify for Medicare and lasts for 7 months. So, if your 65th birthday or 25th month of collecting disability occurs in July, your IEP starts on April 1 and ends on October 31.
- General Enrollment Period: If you miss your IEP, you may sign up for Medicare Part A and/or Part B from January 1 through March 31. After General Enrollment ends, you have from April 1 until June 30 to join a Medicare Advantage plan.
- Medicare Annual Enrollment Period: AEP lasts from October 15 through December 7 and allows you to make any necessary changes to your Medicare coverage, including joining an MA plan.
- Medicare Advantage Open Enrollment Period: From January 1 through March 31, current Advantage enrollees can either join a new MA plan or return to Original Medicare. You may also enroll in a standalone Part D plan if making that change results in losing your drug coverage.
- Special Enrollment Period: If you experience certain life changes, you may be able to join an Advantage plan. Medicare.gov provides the full list of qualifying circumstances.
Types of Medicare Advantages plans in Colorado
There are four main types of Medicare Advantage plans in Colorado. The most common are health maintenance organizations. HMO plans use a provider network that may include any entity that provides healthcare services, such as doctors, nurses, and hospitals. Out-of-network care is usually not covered by an HMO.
Preferred provider organizations (PPOs) also use provider networks. However, for a higher out-of-pocket, you may visit an out-of-network provider. You also don't need a primary doctor or referrals with a PPO plan.
Private fee-for service (PFFS) plans set price points for covered services, with beneficiaries paying anything over that amount. Most PFFS plans have a provider network but allow members to go out-of-network for a higher cost.
Special needs plans (SNPs) limit enrollment to Medicare beneficiaries who meet certain criteria. These vary by plan, but generally amount to:
- Being eligible for both Medicare and Medicaid
- Having a chronic condition
- Living in a nursing home or similar institution
Most SNPs require members to choose a primary doctor who coordinates care and provides referrals. If you qualify for the SNP, you may join at any time.
How to choose a Medicare Advantage plan in Colorado
Consider these four metrics to ensure you get the best plan for your particular needs:
- Costs may include an annual deductible, monthly premiums, and copays or coinsurance.
- Coverage, including the drug formulary for MA-PD plans
Our Find a Plan tool makes comparing Medicare Advantage plans in Colorado easy. Just enter your location information and estimated coverage start date to review the Medicare plan options in your area.
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