Medicare Advantage Plans in Colorado

Fact Checked
Published: 2/5/2021

Medicare Advantage Plans offer a few key differences that distinguish them from Parts A and B of the Original Medicare system managed by the federal government. While Part A pays for inpatient care at a hospital and Part B covers services and supplies used to treat or prevent medical conditions, Medicare Advantage Plans come with a few added benefits. They're required to offer the same level of care as Original Medicare, and they may include additional health care items, such as hearing, vision, dental, and fitness.

  • In 2019, there were 49 Medicare Advantage Plans available in Colorado.
  • 36% of the total Medicare population in Colorado is enrolled in Medicare Advantage Plans as of 2018.
  • In 2018, Original Medicare spent an average of $8,765 per beneficiary in Colorado, which is 13% lower than the national average.
  • Available Medicare Advantage Plans range from two to 49 across Colorado’s 64 counties.

Designed to be an all-in-one solution, Medicare Advantage Plans are offered by approved private insurance companies. They include all of the coverage requirements of Original Medicare Part A and Part B, with some advantages. There are several types of Medicare Advantage Plans available, depending on your insurance provider and location. Learn the differences between these plans and how they affect your coverage so you can make the right choice for your medical situation.

Medicare Advantage Plans in Colorado

Types of Medicare Advantage Plans

There are four types of plans available in Colorado’s Medicare Advantage program, HMO, PPO, PFFS, and SNP. They each offer a different level of flexibility in your network of care providers, and they vary in price. They all provide the same coverage as Original Medicare, but their additional benefits come at an increased premium.

Health Maintenance Organizations (HMO)

The key feature of HMO plans is their reduced cost when compared with the other plan options. This can make them a good choice for seniors on a budget, although the lower price also means less flexibility. You must get care from a provider within the plan’s network, and once you’ve chosen a primary care physician, all future services must come from them. If you want to see a specialist, you have to get a referral from your primary care doctor.

Preferred Provider Organizations (PPO)

PPO plans offer a bit more flexibility than HMOs. While they still have a preferred network of care providers, you have the option of choosing doctors or hospitals from outside of the network. This comes at an increased cost but can be a valuable benefit for those seeking care while traveling. Another advantage is that you usually won’t need a referral from your doctor to see a specialist, and many PPOs also offer prescription drug coverage.

Private Fee-For-Service Plans (PFFS)

Choosing a PFFS plan may be the right choice if you want the fewest restrictions to your medical coverage and don’t mind paying a higher deductible, premium, and copay. Unlike HMO and PPO plans, some PFFS plans don’t have networks at all, letting you choose whichever doctor you prefer. However, keep in mind that not all doctors accept PFFS plans, so you should check before making an appointment. PFFS plans are the only ones you can add a Medicare Part D plan to.

Special Needs Plans (SNP)

SNP plans are for people with specific diseases and conditions and include benefits chosen to serve their needs best. These plans do have a network of preferred care providers, although the providers can include specialists who cater to the needs of the specific medical disorder. All SNPs provide coverage for prescription drugs, and you will usually require a referral to see a specialist.

Enrollment & Eligibility for Medicare Advantage Plans in Colorado

If you are looking to enroll in a Colorado Medicare Advantage Plan, you need to be enrolled in Medicare Part A and Part B, and you cannot be enrolled in Medigap. Enrollment is available to seniors aged 65 and older and those who have received social security benefits in the past.

There are three periods when you can enroll:

  • The first is the Initial Coverage Election Period when you first become eligible. This period includes the three months before your 65th birthday, the month of your birthday, and the three months following. If you have a disability, this period will occur three months before or after your 25th month of receiving benefits.
  • The Annual Election Period runs from October 15th to December 7th. During this period, you can switch from Original Medicare to a Medicare Advantage Plan. If you are already enrolled in Medicare Advantage, you can switch between plans during this period.
  • The Open Enrollment Period takes place between January 1st and March 31st. You can switch between Medicare Advantage Plans or go back to Original Medicare during this period.

Medicare provides special enrollment periods for unusual life circumstances, such as losing your job (and health coverage) and moving out of the area your insurance carrier services.

Prescription Drug Coverage

Under Original Medicare, the add-on Medicare Part D covers prescription drugs. With Medicare Advantage, only SNP plans are required to offer drug coverage, although many plans cover drug costs. If drug coverage is one of your priorities, be sure to check the details of your Medicare Advantage Plan before enrolling. You can’t add Part D at a later time if you’re enrolled in an HMO or PPO. Insurance companies include a list of drugs they cover, known as a formulary, so you can check to ensure that your medications are included.

Medicare Advantage Resources in Colorado

When choosing your Medicare Advantage Plan, make sure you get the coverage that best suits your needs. If you’re feeling confused by the multitude of plan options available, getting in touch with trained, unbiased counselors can be a good first step. Colorado is home to several organizations that can help you make an informed decision.

Denver Area Agency on Aging

The Denver Area Agency on Aging provides a comprehensive selection of services for the region’s older adults. It has programs designed to help seniors aged 60 and older maintain their health and independence. The Health Insurance Assistance Program offers information and counseling to guide you through the Medicare enrollment process, and the counselors will help you fully understand the available benefits.

Contact Information: Website | 303-480-6700

Colorado Department of Human Services

The Colorado Department of Human Services is a statewide government organization that supports people and families by connecting them to the resources they need. Its services for older and disabled adults include legal assistance, nutrition support, employment aid, and caregiver support. Counselors provide information and assistance on a range of topics, including Medicare.

Contact Information: Website | 303-866-5288

Colorado State Health Insurance Assistance Program

The Colorado State Health Insurance Assistance Program dispenses information about health insurance options. Unbiased counselors can give you information relating to enrollment and eligibility, coverage, benefits, and finding a doctor. It also provides resources for those with financial needs, and a selection of senior publications is available.

Contact Information: Website | 888-696-7213

Colorado Senior Medicare Patrol

The Colorado Senior Medicare Patrol is tasked with helping Medicare beneficiaries and their families detect, prevent, and report health care fraud. Staff are available via phone or email to answer questions professionally, confidentially, and free of charge. The Colorado SMP can help you stay up-to-date on recent fraud scams.

Contact Information: Website | 303-894-7499

Learn More From Our Sources