Medicare Plan Options
Within the Medicare program, there are options that allow you to customize your health insurance coverage to meet your needs and budget. If you’re generally healthy and aren’t managing a chronic condition, then the Original Medicare plan may cover everything you need. If you want prescription drug coverage or lower cost-sharing responsibilities, then you may add Part D coverage or Medicare Supplement Insurance to your policy. For the most robust coverage, you may want to check out Colorado’s Medicare Advantage program.
Original Medicare is the basic fee-for-service plan offered by the federal government. This plan covers hospital and medical expenses, including inpatient hospital and nursing home stays, outpatient care, medical supplies, and preventative services. To be eligible for this coverage, you must be at least 65 years old or have a qualifying disability or End Stage Renal Disease. In addition to your monthly premium, you generally pay a $1,484 deductible per benefit period for your Part A coverage, and you may have to pay coinsurance depending on how long you’re in the hospital. Your Part B premium has a $203 deductible, and then you generally pay 20% of your health care costs after meeting your deductible.
Medicare Advantage Plans
Medicare Advantage Plans, also called Part C plans, are an alternative option for getting your Part A and Part B coverage. These plans are popular among those managing chronic conditions or who want more robust coverage. They typically include benefits such as prescription drug coverage; vision, dental, and hearing services; and discounts for fitness and wellness programs. Some Medicare Advantage Plans have separate monthly premiums in addition to the standard Part B premium. Depending on your plan, you may have medical or prescription drug deductibles that must be met before your coverage kicks in. You also may have copays for in-office and telehealth visits with doctors and specialists.
Medicare Prescription Drug Coverage Plans
Prescription drug coverage, also called Part D, is an optional coverage that you can add to your Original Medicare policy. While you may be tempted to skip this coverage when you initially sign up for Medicare if you aren’t taking any prescriptions at the time, it’s important to consider your future needs. You can add this coverage later on, but you’ll be subject to late enrollment penalties for as long as you have your policy. There are several Part D plans to choose from, so it’s a good idea to review a plan’s list of covered drugs and tier pricing before signing up.
Medicare Supplement Insurance Plans
Original Medicare covers a large portion of the medical services you receive, but your cost-sharing obligations may add up quickly if you experience an injury or illness and end up spending an extended period of time receiving inpatient services. Medicare Supplement Insurance, or Medigap, are plans sold by private companies that cover some of the out-of-pocket expenses you may incur. Medigap policies cover health care costs such as your Part A copays, coinsurance, and deductibles. Depending on which plan you choose, it may also provide coverage for medical care when you travel outside of the United States.
Medicare in Colorado by the Numbers
|People enrolled in Original Medicare||Average plan cost||Annual state spending per beneficiary||Spending per beneficiary compared to the national average|
|527,909||Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.
Medicare Resources in Colorado
As a Colorado resident, you have access to a variety of agencies and programs that can take the hassle and confusion out of finding health insurance that fits your needs. The following resources are free to use and provide guidance with evaluating your health care needs and staying up-to-date on enrollment periods. They can also help you get the most from your policy by ensuring you understand and know how to use your benefits, recognize and report Medicare scams or abuse, and appeal denied claims or canceled policies.
Colorado Division of Insurance
The Colorado Division of Insurance is the agency that regulates insurance policies throughout the state and enforces laws that protect consumers. The Division administers the State Health Insurance Assistance Program, which provides you with free, unbiased counseling regarding your post-retirement health insurance options. SHIP counselors are volunteers who are trained to answer any questions you have about your Medicare benefits, Medigap and Medicare Advantage Plans, and long-term care insurance. They can also help clarify your medical bills and dispute billing errors.
Contact Information: Website | (888) 696-7213
State Unit on Aging
Colorado’s State Unit on Aging oversees programs that are funded through the Older Americans Act. The unit operates 16 Area Agencies on Aging, each of which serves a designated region of the state. Through your local AAA, you can get in touch with a SHIP counselor who can help you sign up for Medicare or go over your benefits and cost-sharing obligations with you. The unit also provides civil legal services and operates Aging and Disability Resource Centers throughout the state.
Contact Information: Website | (303) 866-5700
Senior Medicare Patrol (SMP) & Medicare Fraud
The statewide SMP program assists you in recognizing, preventing, and reporting Medicare fraud, billing mistakes, and abuse. Through this program, counselors provide free, confidential advice regarding issues such as getting billed for services you didn’t receive, getting charged too much for services your doctor ordered or getting calls from someone trying to sell you a Medicare plan.
Contact Information: Website | (800) 503-5190
Colorado Legal Services
Colorado Legal Services is a statewide program that provides free civil legal aid for older adults. Through this agency, you can get help applying for Medicare or addressing billing errors or canceled policies. The agency can also help you identify other public benefits you qualify for, including Social Security and Medicaid.
Contact Information: Website | (303) 837-1313
Learn More from Our Sources
- Medicare | What’s Medicare? Last accessed April 2021
- HHS | Who Is Eligible for Medicare? Last accessed April 2021
- Medicare | Medicare Costs at a Glance Last accessed April 2021
- Medicare | How Do Medicare Advantage Plans Work? Last accessed April 2021
- Medicare | How to Get Prescription Drug Coverage Last accessed April 2021
- Medicare | 6 Tips for Choosing Medicare Drug Coverage Last accessed April 2021
- Medicare | What’s Medicare Supplement Insurance (Medigap)? Last accessed April 2021
- Medicare | Medigap & Travel Last accessed April 2021