What are Medicare Advantage Plans in Colorado?
For Colorado residents, Medicare Advantage (MA) plans are an alternative to Original Medicare. Sometimes called Medicare Part C, MA plans combine Original Medicare Part A (hospital coverage) and Part B (outpatient services) in one plan. They usually include prescription drug coverage (Part D). In addition, these plans typically offer extra benefits that Original Medicare doesn’t cover.
What You Need to Know
Most Medicare Advantage plans offer benefits that Original Medicare doesn’t cover, like prescriptions, dental, vision, and hearing coverage.
Medicare Advantage plans to put a cap on your annual out-of-pocket costs for healthcare.
You can change your Medicare Advantage plan only during certain times of the year.
Types of Medicare Advantage Plans
- Health maintenance organizations (HMOs): HMOs are the most common type of MA plans1. They are network-based, which means you can only access care from participating providers, except for emergency care.2 You usually need a referral from your primary care physician to see a specialist.
- Preferred Provider organizations (PPOs): With PPO plans, you can see providers that are not in the network. However, your costs will be higher when you do so.3 With a PPO plan, you don’t need a referral to see a specialist.
- Special needs plans (SNPs): SNPs are for people with certain healthcare and financial needs4. You may qualify for a SNP if you:
- Have a chronic illness such as cancer, diabetes, or end-stage renal disease (Chronic condition SNP or C-SNP).
- Qualify for both Medicare and Medicaid (Dual eligible SNP or D-SNP)
- Live in an institution like a nursing home or receive home nursing care (Institutional SNP or I-SNP).
- Private fee-for-service (PFFS) plans: With these plans, you can go to any provider that accepts the plan. Some PFFS plans have a network of providers that have agreed to treat the plan’s members.5 If the plan doesn’t have a network, or you want to access a provider outside of it, you must ask the provider if they accept the plan before receiving any service.
- Medical savings account (MSA) plans: MSA plans have two parts: a high-deductible plan and a medical savings account.6 You pay for all your healthcare costs until you meet the annual deductible. The MSA plan deposits money into the medical savings account. You can use these funds to help pay for your healthcare until you meet the deductible.
What Are Prescription Drug Options with Medicare Advantage?
Some PFFS plans and MSA plans don’t cover prescriptions. In these cases, you can join a stand-alone Part D plan.
How Do You Choose Medicare Advantage Plans?
Here are some things to consider when shopping for a MA plan:
- Monthly premiums: The monthly premium is the amount you pay the plan each month. When you sign up for a Medicare Advantage plan, you must also pay the Medicare Part B monthly premium. In 2021, the premium is 148.50.8 Some MA plans will pay all or part of this for you. Find out if your plan’s premium includes the Part B premium, especially if it says it has a zero premium.
- Other out-of-pocket costs: Your share of the costs includes deductibles, coinsurance, and copayments. These costs cannot exceed the maximum set by Medicare.9
- Plan Benefits: Most MA plans provide extra benefits, such as telehealth, fitness, dental, eye exams and glasses, hearing aids, and more.10
When and How to Enroll in Medicare Advantage?
Medicare allows you to join, switch, and leave MA plans only during certain times of the year.
- Initial Enrollment Period: When you first become eligible for the federal Medicare program, you have a seven-month period to sign up. It starts three months before the month you turn 65, includes the month of your 65th birthday and continues three months after that.
- Open Enrollment Period (October 15 – December 7): During this time, you can join, switch, or leave Original Medicare, MA plans and Part D plans.
- Medicare Advantage Open Enrollment Period (January 1 – March 31): You can switch from one MA plan to another or drop your MA plan and return to Original Medicare during this period.
- General Enrollment Period (January 1 – March 31): If you have Part A coverage and you get Part B for the first time during this period, you can also join a MA plan.
- Special Enrollment Period: You can change your MA coverage under certain circumstances, such as:
- Moving out of your plan’s service area
- Losing healthcare coverage, such as Medicaid
- Gaining health insurance under an employer or union
- Losing coverage due to changes in your current plan
- Experiencing a special circumstance such as the diagnosis of a chronic condition that makes you eligible for a C-SNP
Who Has Signed up For Medicare Advantage in Colorado?
In Colorado, 37% of Medicare-eligible individuals signed up for a MA plan in 2021. This is similar to the national average of 38%.
How Much Do Medicare Advantage Plans Cost in Colorado?
In 2021, the average monthly premium for a Colorado MA plan is $15.80.11 Remember, you may also be responsible for the Medicare Part B premium.
What If You Want to Change Your Medicare Advantage Plan?
You can change your MA plan during Open Enrollment and Medicare Advantage Open Enrollment.
What Are Alternatives to Medicare Advantage in Colorado?
For Colorado residents, Medicare Advantage is not your only option:
- Program of All-Inclusive Care for the Elderly (PACE): This is a Medicare and Medicaid program for elderly individuals who wish to remain at home instead of going to a nursing home.12
- Original Medicare: You can stay with Original Medicare (Part A and Part B). If you go this route, you may want to purchase a Medigap policy from a private insurance carrier to help pay for uncovered expenses. Many people also get Part D prescription drug coverage.
- Medicare Cost Plans: These combine Original Medicare and Medicare Advantage.13 If you visit an out-of-network provider, Original Medicare will cover the costs. Insurers can only offer these plans in areas where there is only one MA plan available.14
What Are Medicare Resources in Colorado?
- Colorado State Health Insurance Assistance Program (SHIP): To get free, personalized insurance counseling to help navigate Medicare and Medicare Advantage.
- Colorado Department of Regulatory Agencies: To file a complaint about a MA Plan.
- Health First Colorado: To find out if you qualify for Medicaid.
Medicare Advantage plans are increasing in popularity and offer another health insurance option for Medicare-eligible individuals. For more information about MA and a complete listing of plans in your area visit the Medicare Plan Finder.