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Medicare Options in Colorado

Colorado residents are getting increasingly worried about the rising healthcare costs. Nearly 57% of adults in Colorado reported delaying a recommended healthcare treatment because of affordability burdens in a survey assessing healthcare reforms.

Besides costs, a host of other barriers led to this delay, such as difficulty in getting an appointment, lack of transportation, absence of childcare, and so on. Of the many types of countless medical expenses, the ones frequently associated with the affordability barrier were dental bills, doctor bills, and prescription drug bills.

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However, there are a plethora of affordable healthcare insurance coverage plans available for those most vulnerable, including differently-abled persons and those above the age of 65 in Colorado. You can enroll in the employer’s plan or sign up for Medicaid and Medicare if you qualify.

There are also government-funded and private options available for those who don’t qualify, but there are also options for using the Health Insurance Marketplace for the Affordable Care Act. However, according to the laws in Colorado, if you purchase these plans from the exchange, it usually means you wouldn’t qualify for premium tax credits and other income-based savings.

With healthcare expenses rising every year, you must find an insurance plan that doesn’t cost you a fortune but also fulfills all your needs. Find out more about different Medicare plans in Colorado and learn why you need the services of a licensed Medicare insurance agent.

What You Need to Know About Healthcare Insurance in Colorado

A little over half of the residents rely on healthcare insurance provided by an employer, whereas about 3% receive military healthcare benefits, another 8% of Colorado residents own non-group health insurance plans, and nearly 9% of them are still uninsured.

Estimates show that previously, 36% of Colorado Medicare beneficiaries were enrolled in Medicare Advantage plans. However, the percentage of Medicare patients enrolled in Medicare Advantage plans had risen to 44% by the fall of 2021.

Medicare is a government-run health insurance program covering a wide range of medical expenses. The US Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) oversees the program’s administration (HHS).

In most cases, Medicare coverage is automatically activated when an individual reaches the age of 65. In addition, a person is eligible for Medicare if they have received disability benefits for at least 24 months.


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Original Medicare

This is the traditional Medicare that is regulated by federal law. Parts A and B belong within the Original Medicare category. Part A deals with health care services in a hospital. This covers hospital inpatient treatment, hospice care, certain specialized nursing facilities, and some home healthcare.

Part B covers medical insurance. This plan covers everything from outpatient care to in-home care and durable medical equipment. It also includes certain preventive care, such as vaccines and screenings, to maintain your health and prevent illnesses from getting worse.

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Medigap Options in Colorado

Medigap plan is Medicare supplement insurance offered by private insurance carriers for covering cost-sharing requirements for the Original Medicare Part A and Part B. Although Medicare pays for a significant chunk of the healthcare expenses, you’re still responsible for some costs, typically in the form of copays, deductibles, and coinsurance. Medigap plans not only to help pay for these costs but also offer opportunities to add coverage for excess charges or health emergencies during foreign travel.

Over 230,000 Colorado residents signed up for Medicare supplements like Medigap in 2020. Although Plan G and Plan F were the most popular plan types, given their comprehensive coverages, Plan F is no longer available for those who qualify for Medicare as per the changes in laws applicable from January 2020. Moreover, differently-abled Medicare beneficiaries under the age of 65 can still get Medigap in Colorado, but the plans come with much higher premiums.

What Medigap Plan Costs in Colorado

Colorado residents should expect to pay anywhere from $76 to $380 monthly for Medigap plans A, N, and G in Colorado if they sign up during the enrollment period. However, premiums vary depending on the insurance company and the rating of the premiums.

Medigap plans are rated in different ways. If it’s not age-rated or community-rated, the premium charged is the same, regardless of age. This means if the premium fluctuates, it will be caused by factors like inflation rather than aging. Your premium can also be entry-age-rated or issue-age related, meaning it will be charged according to the age when you bought the policy. While the premium may rise due to other factors, it won’t increase as you grow older. Some insurance carriers also use attained-age-rated premiums, which means your premiums can increase due to inflation, and your growing age, among factors.


How to Tell if You Need Medigap to Bridge the Gap in your Medicare Plan in Colorado?

You should consider getting supplemental insurance in the form of a Medigap plan if you rely on Original Medicare for your healthcare coverage. Since there’s no cap on what you might pay out-of-pocket for copays, deductibles, and coinsurances in Parts A and B, it could lead to unpredictable and high costs. It’s also a good idea to get enrolled in Medigap if you’re looking for freedom of choice when it comes to healthcare providers, as it allows you to see any Medicare provider throughout the United States. However, if you want Medicare Advantage plans with low or zero monthly premiums, it’s not a good idea.

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You shouldn’t enroll in Medigap just because the policy you want isn’t available, the premiums are too high, or because you missed the enrollment period. If you enroll in Medigap, you’ll need to purchase an additional Part D plan for prescription medications.

However, if you want emergency care coverage for foreign traveling or can afford the monthly premiums, you should consider it. Those who have Medicaid or other creditable coverage and don’t need Medicare Part B, for now, don’t need supplemental insurance as most of their out-of-pocket Medicare expenses are paid for. When you’ll enroll in Part B, the six-month period for Medigap enrollment will automatically start.

Medicare Advantage vs. Medigap Plans in Colorado

Since Medigap plans are designed to supplement the Original Medicare plans, they’re standardized across the United States. Colorado residents are required to pay a nominal fee. Conversely, Medicare Advantage plans provide an alternative way of receiving the benefits offered by Medicare. Insurers offering these plans must include all the services available in the Original Medicare while also frequently adding things like vision, dental, hearing, and prescription medication coverage.

Medigap covers things like deductibles, copayments, coinsurance, and also foreign travel emergency expenses, and excess Part B costs in some plans. Meanwhile, Medicare Advantage covers all Original Medicare services, like the hospital, medical, and prescription drug insurance in Parts A, B, and D. However, additional services can be added to include vision, auditory, and dental care.

Medigap covers Original Medicare, whereas Medicare Advantage replaces Original Medicare. Moreover, Medigap works in tandem with Part D prescription medication coverage, whereas the latter restricts purchasing of a standalone prescription drug coverage policy. Moreover, its network of providers is selected by insurance companies.

Medigap is recommended for those who frequently access the Part A and Part B benefits, like to select the healthcare providers, but want the out-of-pocket costs covered. With Medicare Advantage, it works best for those looking to get their healthcare and medication costs covered through a single plan. It also requires following the network restrictions and rules set in the plan but often comes with extra benefits.


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Medigap Plan Options in Colorado

Although all standard Medigap plans are offered in Colorado, it’s Plans G and F that are the most preferred as they offer the most adequate coverage and are available in high-deductible versions. Here are a few highlights from some of the Colorado Medigap plans.

Plan F—While it’s one of the most comprehensive plans as it covers the deductibles for Part B, it was only available for Colorado residents who qualified for Medicare till December 2019.

Plan G—This plan is for newer beneficiaries looking for comprehensive coverage. It allows Colorado residents to visit any Medicare provider, even the ones charging more than the amount approved by Medicare, as it pays for the excess charges for Part B.

Plan K—It comes with an out-of-pocket limit. So, if you’ve reached the limit, your plan will pay the entire amount for those who pay their Part B deductibles.

Plan L—This is similar to Plan K, but the monthly premiums are higher than Plan M, plus it comes with relatively lower out-of-pocket limits.

Plan M—It’s not suitable for those requiring inpatient care in hospitals as it only pays 50% of the deductibles in Part A.

Plan N—This plan has recently garnered a lot of popularity for offering a lower premium. However, Colorado residents are charged a copay for emergency room visits and doctors.

Medicare Advantage Plans in Colorado

Though Colorado Medicare Supplement plans offer the most extensive coverage, beneficiaries can also go for Medicare Advantage plans in Colorado. They’re offered by private organizations that contract with Medicare. The best copays are only available if you agree to use the plan’s network of physicians and hospitals.

When it comes to premiums, Colorado Medicare Advantage plans may be less expensive than Medicare Supplements. However, you will incur copays along the way.

As with many other types of healthcare, you’ll have to foot the bill for certain services, including hospital stays, physical exams, lab work, supplies, etc. Before signing up for a health insurance plan, make sure that your provider is in the network.

There are four types of Medicare Advantage plans in Colorado.

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Health Maintenance Organization (HMO)

Most HMOs mandate that you use only in-network providers for all healthcare services:

  • You’re required to have a PCP (primary care physician), specialist referrals, and prior approvals for certain procedures and prescriptions.
  • Plans typically provide drug coverage. You can’t purchase separate drug coverage.
  • Staying within your network keeps costs low.
  • Require Medicare Part B step therapy.

Preferred Provider Organization (PPO)

Medicare PPO plans have a recommended network of providers, but you can also choose doctors or hospitals outside the network for a higher price.

  • You don’t need to have a PCP or referrals for specialists.
  • Most plans provide drug coverage.
  • Drug coverage cannot be purchased separately.
  • Out-of-network charges and higher premiums.

Private Fee-For-Service (PFFS)

PCPs and specialist referrals aren’t necessary under PFFS programs.

  • You can consult any Medicare-approved doctor or healthcare facility, provided that they agree to the plan’s terms.
  • Drug coverage may be included, or you can purchase a separate drug plan.
  • You’ll pay more if you go with a provider who doesn’t agree with the rules of your insurance plan.

Special Needs Plan (SNP)

SNPs are only available to people with certain medical conditions, and they feature care coordination and benefits that are specifically designed to match their specific needs:

  • You require a PCP and recommendations for specialists.
  • Plans always include prescription coverage.
  • SNPs are open to everyone who meets the eligibility criteria at any point in time.


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Medicare Enrollment in Colorado

Medicare will register Colorado residents automatically if they have received at least four Social Security or Railroad Retirement Board payments before their 65th birthday.

Otherwise, residents can reach out to their local Social Security Office or apply online. We recommend not mailing your application, as that is a much slower process. Enrollment in Medicare is open during the following time frames:

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Initial Enrollment

The initial registration period begins three months before and ends three months after your 65th birthday. This is the time to enroll if you have never had Medicare before. You can also change or update your current Medicare plan if you began receiving it at a younger age.

General Enrollment

For those who missed the initial enrollment time, you get another window that runs from January 1 to March 31. During this period, you can enroll in Original Medicare (Parts A and B), Medicare Advantage (Part C), Medigap, and Part D plans.

Open Enrollment

You get a 3-month window from October 15 to December 7 each year, during which you can make changes to your Part C plan.

Special Enrollment

If you lose your insurance coverage or your eligibility changes due to unforeseen circumstances, you may be eligible for a special enrollment period.


Let Us Help You Find the Best Medicare Plan

Integrity Now Insurance Brokers boasts a team of qualified Medicare Insurance agents that will play an active role in helping you find the right health insurance company and plan. We’ve helped countless clients understand the complexities and jargon that were in the way of them getting themselves suitable Medicare insurance in Colorado.

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We’ve got a network of the top Medicare Insurance providers across the US. Our extensive experience allows us to keep a watchful eye on the factors that hinder top-class healthcare access. We only work with Medicare insurance providers with a proven track record.

Our Medicare Insurance brokers have ample experience working with senior citizens, adults with disabilities, and other individuals that may need help with Medicare and Medigap to take care of their medical expenses. Your best interests are our only concern as independent Medicare insurance agents.

We help you compare quotes and select the Medicare insurance plan that is both within your budget and the best fit for your specific situation.

Give us a call to talk to one of our knowledgeable representatives, waiting to provide you with all the information you need to get started on a plan that helps you live a debt-free and stress-free life while helping you access the best healthcare facilities just like you deserve.


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