Medicare Advantage Plans in Colorado

A Medicare Advantage plan in Colorado is the same as a Medicare Part C plan. Medicare Advantage plans will bundle your coverage from each part of Medicare into one plan and will often include additional benefits like:

  • Hearing
  • Vision
  • Dental

Most Medicare Advantage plans in Colorado include prescription drug coverage for 2022, known as Medicare Part D. Look for plans marked MAPD, which means they’re Medicare Advantage Prescription Drug plans.

Many articles imply that Medicare Advantage is replacing traditional Medicare, which can be confusing and misleading. It’s a more popular version of Medicare because of its benefits. You’re not losing Medicare coverage but instead using one specific insurance company for all your health care coverage, benefits, claims, and administrative needs. With Original Medicare, the federal government administers your benefits.

You’ll still pay your Medicare Part B premium when you switch to Medicare Advantage. However, using one network of doctors, specialists, and customer support can simplify your process.

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Top rated Medicare Advantage Providers in Colorado

  • Humana: Humana enrolled about 13 percent of MA members in the state.
  • Kaiser: About one in three Medicare Advantage plan members chose Kaiser in Colorado.
  • Rocky Mountain: This small Colorado insurer has offered some health plans with the highest star ratings in the state.

Popular Medicare Advantage Plan Types in Colorado

Private insurers offer several Medicare Advantage plans in Colorado for 2022. Make sure you understand their differences to pick what’s best for your needs. Like us at Policy Guide, a licensed insurance broker can help you select the best Medicare Advantage plan.

Best Network Freedom: Medicare Advantage PPO

Medicare Advantage PPO (preferred provider organization) plans offer lower payments when you use doctors, specialists, and hospitals that are in-network. In addition, you don’t have to select a primary care physician or have referrals to see specialists.

Most PPO plans offer prescription drug coverage. The premiums for these plans can range from $0 to $100 per month, depending on your network.

Best for Lowest Out-of-Pocket: Medicare Advantage HMO Plan

Premiums for Medicare Advantage HMO (health maintenance organization) plans are usually $0 per month. You’ll also pay lower costs for in-network services, but you must select a primary care doctor who refers you to specialists.

You can select specific HMO plans to get prescription drug coverage.

Best for Low Income or Health Conditions: Medicare Advantage D-SNP

Medicare Advantage D-SNP covers Special Needs Plans. Eligible participants must have certain conditions, such as:

  • Autoimmune disorders
  • Cancer
  • Dementia
  • Diabetes
  • End-stage renal disease
  • Lung disorders

People who live in nursing homes, require nursing services at home, or are on dialysis are also eligible. The SNP curates a network of doctors and specialists who can best treat the exact conditions covered by the plan.

Your income can also qualify you for Medicare Advantage D-SNP. If you have both Medicare and Medicaid, they cover the cost of SNP. Otherwise, the price of the plan will vary depending on the company you choose.

All Medicare Advantage D-SNPs cover prescription drugs.

Colorado Enrollment Facts:

Of almost 1 million Colorado residents eligible for Medicare, more than 400,000 people are using Medicare Advantage:

  • 262,700 enrolled in a local HMO 
  • 29,000 enrolled in a local PPO

Of the 63 million people eligible for Medicare in the United States, more than 26 million enrolled in Medicare Advantage.

How much does Medicare Advantage in Colorado cost?

When you enroll in Medicare Advantage in Colorado, you still pay the Medicare Part B premium from your Social Security. Most monthly premiums cost little or nothing.

Besides the premium, costs vary since you’re using independent insurance companies.

Each plan has a different amount for:

  • Deductibles
  • Copays
  • Maximum out-of-pocket costs

That makes it challenging to find the average cost for Medicare Advantage. You can gauge the average, though.

In Colorado, the average MAPD plan is $23, with a prescription deductible of $98. However, expenses can vary from county to county. Some plans might be more expensive in Denver than in your city, so you should check your specific area.

How much do Advantage Plans cost in Colorado?

PPO Plan $0.00 to $23.00

HMO Plan $0.00

When can I enroll in a Medicare Advantage plan?

Many people have a health plan that only allows you to enroll or change a plan once a year. There are some differences to the Medicare Advantage plans depending on your needs.

Initial Enrollment Period

Generally, the initial enrollment period begins when you turn 65. It lasts for seven months, starting three months before you turn 65 and ending three months after the month you turn 65. Once you sign up, you’re restricted to the open enrollment periods to change your plans or switch to traditional Medicare.

Open Enrollment Period – AKA Annual Election Period

The annual enrollment period (AEP) for Medicare Advantage plans opens on October 15th and ends on December 7th. Your choices go into effect on January 1st and apply to the following year.

You can also switch back to traditional Medicare during this time.

Medicare Advantage Open Enrollment Period

If you made a mistake with your choice during AEP, you have a chance to change it during the Medicare Advantage Open Enrollment Period, which runs from January 1st to March 31st.

You can change plans or go back to traditional Medicare during this time. However, you can only make one change in this period.

Special Enrollment Periods – Special Circumstances

If you’re new to Medicare Advantage, you can switch back to the original Medicare anytime during your first year.

Other special circumstances include:

  • Moving
  • Losing other health insurance coverage
  • Gaining additional coinsurance
  • Becoming eligible for a Special Needs Plan
  • Learning that your plan has changed its Medicare contract
  • Being misinformed about the plan you joined

5-Star Special Enrollment Period

The 5-Star Special Enrollment Period is from December 8th to November 30th. If you live in a service area that has more than one 5-Star plan, you can switch at this time. This allows you to switch to a plan with the highest-rated quality.

Special Enrollment Periods If You Get “Extra Help”

If you’re eligible for both Medicare and Medicaid, you can change your Medicare Advantage plan during special periods. You can also change your Medicare prescription coverage if you receive assistance from the federal Extra Help program. These periods are:

  • January to March
  • April to June
  • July to September

You can change your plan once during each of those three periods. Changes take effect on the first day of the following month following the change.

If your eligibility for a State Pharmaceutical Assistance Program (SPAP) changes, you can join Medicare Advantage once during the year.

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Give us a call today, or request a quote online to learn more about plan options.

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