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Figuring out how Medicare works can be a bit of a challenge. Here’s everything about Medicare Colorado you’ll need to know if you live in the Centennial State.
The Best Medicare in Colorado:
- Best Overall in Colorado: Kaiser Permanente
- Most Affordable in Colorado: Aetna
- Best for Extras: Bright Health
- Best for SNPs: Anthem Blue Cross and Blue Shield
- Best for No Deductible: Mutual of Omaha
What is Medicare?
Medicare is a federal health insurance plan. It’s a bit different from regular health insurance. It has several parts, each of which provides a different type of coverage.
Original Medicare is comprised of Parts A and B. People refer to these 2 parts as Original Medicare for 2 reasons. They are the oldest parts of Medicare and most people have these both. Here’s what they cover:
Part A: Part A is hospital insurance. It covers inpatient hospital care, skilled nursing care in a facility and hospice care. Home health care may also be covered under this benefit.
Part B: Part B is medical insurance. It covers your day-to-day medical needs such as doctor’s visits. It covers a wide range of screenings and preventive services. It also covers durable medical equipment like CPAP machines and outpatient care. Home health care may be covered under Part B as well.
Medicare introduced Part D of Medicare in 2006.
Other Medicare Plans
Parts A and B of Medicare leave some gaps. This means that you need to pay deductibles and copays if you just have Original Medicare. You can buy plans to help with these gaps.
Part C: Medicare Advantage plans are Part C of Medicare. Medicare Advantage plans are optional — Medicare regulates these plans. Private insurance companies offer these plans. They bundle Medicare Parts A and B and often include Part C as well. If you purchase a Part C plan, your health care provider will bill your Advantage plan for your health care instead of Medicare. These plans often have lower out-of-pocket costs than Original Medicare. They also may offer additional benefits like a fitness membership or transportation assistance to appointments.
Medigap plans: Medicare supplemental insurance, or Medigap, works in coordination with Medicare Parts A and B. Medicare regulates Medigap plans. These plans also help with Medicare’s out-of-pocket costs. Your providers bill these plans after they bill Medicare. Medicare supplements don’t include prescription coverage. If you need that coverage, you will need to buy a standalone Part D plan.
You can buy either a Part C plan or a Medicare supplement. You can’t own both types of plans.
Legalities of Medicare in Colorado
The Department of Health and Human Services regulates Medicare. Social Security handles enrolling people into Medicare. The Colorado Division of Insurance oversees the insurance companies that sell Medicare Advantage and Medicare supplement plans. If you have an issue with Medicare, you would contact Medicare directly. Have an issue with a Medicare Advantage or supplement plan? Contact the insurance company. Can’t reach a resolution with your insurance company? The next step is to contact the Colorado Division of Insurance.
Many people get Medicare Parts A and B when they turn 65. Part A is free for people who have worked and paid Medicare taxes for 40 quarters or more. Part B includes a premium for everyone.
You can enroll by contacting Social Security when you turn 65. People who receive Social Security disability benefits for 24 months are also eligible for Medicare. People who are on kidney dialysis or who have had a kidney transplant can also receive Medicare benefits, even if they are under age 65.
Types of Medicare Advantage Plans
One of the ways that Medicare Advantage plans keep costs down is through a provider network. Insurance companies work with providers and establish prices. Medicare Advantage plans offer different types of plans and networks, including:
HMOs: An HMO is a health maintenance organization. You seek care within your plan’s network. Coverage may be limited or you may have to pay the costs out of pocket if you go out of network. You also need to get a referral to see a specialist.
PPO: A PPO is a preferred provider network. Your plan would prefer you to stay in-network, but you can see out-of-network providers too. You may pay more for going out of the network. You don’t need a referral to see a specialist.
SNP: An SNP is a special needs plan. These plans are designed for people with specific health needs or who have dual eligibility (Medicare and Medicaid). These plans may also be an HMO or PPO.
Medicare supplement plans don’t have networks like Medicare Advantage plans. You can typically go to any provider who accepts Medicare.
How to Sign Up for Medicare in Colorado
Social Security will automatically enroll you in Medicare if you receive Social Security benefits at age 65. You will need to contact Social Security if you aren’t receiving Medicare benefits. Social Security also enrolls people receiving Social Security disability benefits into Medicare after 24 months of benefits. If you have end-stage renal disease, you will need to contact Social Security for enrollment in Medicare.
You must enroll in Medicare during certain periods. Your initial enrollment starts 3 months before the month you turn 65 and lasts for 3 months after that. If you don’t take Part A or Part B of Medicare, you can enroll when you no longer have other coverage. That’s a special enrollment period and it lasts for 8 months after your coverage ends.
If you miss the other windows, you can enroll in Medicare from January 1 through March 31 each year. Your coverage will start on July 1. Keep in mind that if you don’t enroll in Part B during your initial enrollment or your special enrollment, you’ll pay a late enrollment penalty. The penalty is up to 10% for each year you wait and you pay the penalty for as long as you’re enrolled in Medicare.
Average Cost of Medicare Advantage Plans in Colorado
Medicare Advantage plans are a popular choice for many Medicare beneficiaries. Here are the costs associated with some of Colorado’s plans:
|Plan Name||Company||Plan Type||Health Care Deductible||Drug Deductible|
|Kaiser Permanente Senior Advantage Core||Kaiser Permanente||HMO||$0||$225|
|Aetna Medicare Prime 1||Aetna Medicare||PPO||$0||$0|
|Humana Gold Plus H0028-025||Humana||HMO||$0||$95|
|Anthem MediBlue Plus||Anthem Blue Cross and Blue Shield||HMO||$0||$0|
Best Medicare Insurance Providers in Colorado
Ready to compare plans? Here are the 5 best Medicare insurance providers in Colorado.
1. Best Overall: Kaiser Permanente
Kaiser Permanente earned our top spot due to its high marks from Medicare. It’s rated 5 out of 5 stars, which indicates a high level of care and customer satisfaction. All Kaiser plans are HMOs and the company also often has several types of providers in one facility.
You can opt into Kaiser’s advantage plans as well, which offer dental and vision coverage and transportation benefits. You pay an additional premium for these benefits.
2. Most Affordable in Colorado: Aetna
Aetna offers a PPO plan with no annual premium. Aetna’s Medicare Advantage plans also include benefits for dental care, vision care and hearing aids.
Like most PPOs, you can go to out-of-network providers, but you pay significantly more to see those providers. Aetna’s Medicare plans received 4.5 out of 5 stars from Medicare.
3. Best for Extras: Bright Health
Bright Health offers the standard benefits you would expect from a Medicare Advantage plan, including several additional benefits as well — dental, vision and hearing aid benefits. You can receive most of these services with no copay.
Bright Health also offers a credit you can use to pay for over-the-counter items like aspirin. It also includes telehealth, transportation and a fitness center membership.
4. Best for SNPs: Anthem Blue Cross and Blue Shield
Anthem Blue Cross and Blue Shield offers a few special needs plans. Its MediBlue Care On Site plan helps those who need nursing-home level care receive that care at home.
MediBlue Diabetes helps people with diabetes manage their health care needs. MediBlue Dual Advantage is for people with Medicare and Medicaid. All available plans offer benefits like vision, dental and vision care.
5. Best for No Deductible: Mutual of Omaha
Your deductible is the amount you pay out of pocket before your benefits start. Mutual of Omaha’s Medicare Advantage plans have no health care deductible and no prescription deductible. Its plans also have low copays.
Mutual of Omaha also has lots of additional benefits. Its plans include transportation, hearing aid coverage, a health club membership, dental coverage and vision benefits.
Which Plan is Right for You?
Choosing a plan is a big decision. Keep all the costs in mind, including the premium, the deductible and out-of-pocket maximums. Look at each network to see if it includes your preferred providers. If vision, dental or hearing aid coverage are important to you, make sure your plan of choice includes those, too.
Contact Colorado’s State Health Insurance Assistance Program (SHIP) if you need assistance. It can help you choose a plan that meets your needs. You can call SHIP at 1-888-696-7211 or visit a SHIP location in your area.
Frequently Asked Questions
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.