Prefer to learn on your own? Keep reading to learn what you need to know about Medicare coverage options and enrollment in Colorado.
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There are 962,000 Medicare beneficiaries in Colorado, making up 17% of Colorado’s total population. 13% of Colorado’s Medicare beneficiaries are dually eligible, meaning they’re on both Medicare and Medicaid
After you enroll in Original Medicare, you have an important decision to make between Medicare Advantage and Original Medicare (with or without additional coverage). 46% of Colorado Medicare beneficiaries are on a Medicare Advantage plan and the other 54% are on Original Medicare (source).
Medicare Advantage (also known as Medicare Part C) provides beneficiaries with an alternative to Original Medicare. Medicare Advantage plans are offered by private insurance companies and many have low or no additional premiums (you’ll continue to pay your Original Medicare premiums). Advantage plans are required to provide at least the same coverage as Original Medicare. Many people choose to enroll in them because they generally provide added benefits, like dental, vision, and hearing. Before you enroll, you should also be aware of drawbacks that come with Medicare Advantage plans, including limited provider networks, preauthorization approval requirements, and higher out-of-pocket costs when compared to Medigap plans that pair with Original Medicare. You can enroll in or switch your Medicare Advantage plan once a year during Medicare’s Open Enrollment Period.
46% of Colorado Medicare beneficiaries choose to enroll in one of the 64 Medicare Advantage plans available statewide. Plan availability varies by zip code, as do the details of every plan, including premiums, deductibles, and provider network. To hear about available Colorado Medicare plans, schedule an appointment with a Colorado Medicare agent(888) 604-0055.
Medicare Supplement (Medigap) plans pair with Original Medicare to help cover the 20% of costs that Original Medicare doesn’t. Medicare Supplement plans generally have higher premiums than Medicare Advantage plans. They don’t provide coverage for additional healthcare services not covered by Part A and Part B, but they do significantly reduce your out-of-pocket costs. They also allow you to see any doctor that accepts Medicare (about 90% of doctors nationwide) and you won’t need to get prior authorization for covered services.
The best time to enroll in a Medicare Supplement plan is when you first enroll in Medicare, during the Medigap Open Enrollment period. During this period, you cannot be denied coverage, regardless of your age or any pre-existing medical conditions. Outside of this time, insurance companies can ask you questions about your health history and you could be denied acceptance into a plan.
Nationwide, Medicare beneficiaries have 10 Medigap plan options, and every plan within a type (e.g., every Plan F) is identical. Plan G is the most comprehensive Medicare Supplement plan. Learn more about the Colorado Medicare Supplement plans here.
Colorado Medicare beneficiaries can get prescription drug coverage through a Medicare Advantage plan that includes Part D coverage or through one of 23 stand-alone Part D plans available in Colorado (exact number varies by zip code). The average monthly premium for a Medicare Part D stand-alone drug plan is $37.13, which is slightly lower than the national average ($39.87).
Medicare Extra Help Program
Medicare’s Extra Help program helps those with limited incomes and resources pay for Medicare Part D premiums and out-of-pocket costs. You qualify for Extra Help automatically if you get:
If you automatically qualify, you’ll receive a letter with important information concerning your Extra Help.
If you don’t automatically qualify for Extra Help, you can learn more about eligibility here. If you need help, you can speak with one of our Colorado Medicare Advisors who can help you with the application process.
Other ways to save on Medicare prescription coverage in Colorado
In addition to Extra Help, there are two programs that help low-income individuals pay for Medicare expenses.
Medicaid is a joint federal and state government program that’s operated by each state. Colorado’s Medicaid program is named Health First Colorado, and you can learn more about the eligibility requirements and application process by visiting their website.
Health First Colorado has a specific program for persons who are elderly, blind, or disabled (EBD). This program provides various benefits, including:
If you’re over 65 and on Medicare, you may also be eligible for one of Colorado’s Medicare Savings Programs (MSPs). MSPs help Medicare beneficiaries with low income and resources pay for some or all of their Medicare premiums. Some programs also help with deductibles and coinsurance. Colorado has four levels of Medicare Savings Programs with varying eligibility requirements and benefits:
Learn more about eligibility here.
Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:
You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.
Medicare eligibility is the same nationwide. You’re eligible for Medicare if you’re a US citizen who meets one of the following criteria:
If you’re ready to enroll in Medicare, but feeling overwhelmed by the number of options, give us a call at (888) 604-0055 or schedule a consultation at your convenience. Our licensed Colorado Medicare Advisors will help you understand your Medicare options and choose from the plans available to you.