What Are Medicare Advantage Plans in Colorado?

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans include Part A (hospital) and Part B (medical) coverage, and most also include Part D (prescription drug coverage). Many plans offer added benefits like routine dental, vision, hearing, and fitness programs.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first sign up for Original Medicare (Parts A and B). Most people become eligible for Medicare enrollment at age 65, but some qualify earlier due to disability or conditions like ALS or ESRD. Key enrollment periods include:

• Initial Enrollment Period (IEP): Begins 3 months before your 65th birthday month and ends 3 months after.
• General Enrollment Period (GEP): January 1–March 31 annually.
• Special Enrollment Periods (SEPs): Triggered by life events such as moving, losing employer coverage, or qualifying health conditions.

Late enrollment or not qualifying for premium-free coverage may result in penalties.

What Types of Medicare Advantage Plans Are Available in Colorado?

Colorado offers the following MA plan types:

• Health Maintenance Organizations (HMOs): Require in-network care; referrals needed for specialists.
• Preferred Provider Organizations (PPOs): Allow out-of-network care at higher costs; typically no referrals needed.
• Private Fee-for-Service (PFFS) Plans: Any provider who accepts plan terms can be used; some plans have networks.
• Special Needs Plans (SNPs):
  • C-SNPs: For chronic conditions like diabetes, HIV/AIDS, or heart disease.
  • I-SNPs: For individuals in institutions or requiring nursing care.
  • Dual Eligible Special Needs Plans (D-SNPs): For people who qualify for both Medicare and Medicaid, offering extra benefits like drug coverage, dental, and care coordination—often with little to no cost.
• Medical Savings Accounts (MSAs): Combine a high-deductible plan with a medical savings account funded by your insurer.

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans include Part D drug coverage. Exceptions include MSAs and some PFFS plans. If your plan doesn’t include drug coverage, you may:

• Enroll in a separate Part D plan (only allowed for some plans).
• Face a late enrollment penalty if you delay getting prescription coverage without having creditable coverage.

How Do You Choose a Medicare Advantage Plan?

Understand Medicare Advantage costs before choosing a plan with this comprehensive guide.

• Premiums: Many MA plans have $0 premiums; others may charge a monthly fee.
• Deductibles, Coinsurance & Copays: Understand what you’ll pay out of pocket for medical services.
• Out-of-Pocket Maximums: This cap limits how much you’ll spend per year on covered services.
• Extra Benefits: Some plans offer dental, vision, hearing, telehealth, fitness programs, and over-the-counter allowances.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during specific enrollment periods:

• Initial Enrollment: Begins 3 months before your 65th birthday month and ends 3 months after.
• Annual Open Enrollment (Oct 15–Dec 7): Join, switch, or drop an MA plan.
• General Enrollment (Jan 1–Mar 31): For those enrolling in Medicare Part B during this period.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Switch or return to Original Medicare if already in an MA plan.
• Special Enrollment Periods: Triggered by life events such as:
  • Moving outside your plan’s area
  • Losing employer/union coverage
  • Plan termination
  • Qualifying health conditions

What If You Want to Change Your Medicare Advantage Plan?

You can switch plans during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

What Are Medicare Resources in Colorado?

Colorado offers several helpful programs:

• Colorado SHIP Program: Provides free counseling on Medicare coverage.
• Colorado SMP Program: Educates beneficiaries about avoiding healthcare fraud.
• Colorado Division of Insurance: Handles complaints and coverage issues.

For low-income residents, Health First Colorado may assist with medical costs. Visit Colorado Medicaid or call 1-800-221-3943 for details. Learn more about the differences between Medicare and Medicaid.

Understanding Medicare Advantage Star Ratings

The CMS star ratings system is how the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) plans using a 5-star quality scale. These ratings help consumers compare the performance of different plans based on a standardized set of measures.

CMS Star Ratings Overview

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings are updated annually and reflect data collected from Medicare Advantage (Part C) and Medicare Advantage Prescription Drug Plans (Part D).

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, also called Medigap, help cover costs not paid by Original Medicare, such as coinsurance, copays, and deductibles.

• You must be enrolled in Parts A and B.
• The best time to enroll is during the six-month Medigap Open Enrollment Period, which begins when you start Part B.
• After that, insurers may require medical underwriting.
• Medigap doesn’t include drug coverage—you’ll need a separate Part D plan.
• There are 10 standardized plans. The most popular include:
  • Medicare Supplement Plan G: Highest enrollment in 2023
  • Plan N: A fast-growing option
  • Plan F: No longer available to new Medicare enrollees after 2020

Medigap plans offer nationwide coverage, predictable costs, and no referrals.

Next Steps

If a Medicare Advantage plan in Colorado is right for you, compare options in your area. Review premiums, provider networks, extra benefits, and out-of-pocket caps—then be ready to enroll when you’re eligible.