Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Residents of Colorado have the option of signing up for Medicare Advantage when it’s time to enroll in Medicare. Like Original Medicare, which was established in 1965, Medicare Advantage gives enrollees access to the inpatient and outpatient services they need to prevent, diagnose and treat health problems. Although Original Medicare and Medicare Advantage have many features in common, there are also a few significant differences.
One of those differences is the geographic restrictions on Medicare Advantage plans. Because Original Medicare is managed by the Centers for Medicare & Medicaid Services, a federal agency, seniors all over the United States have access to the program. Each Medicare Advantage plan is only available in a certain location, known as the plan’s service area. This means Colorado residents can only sign up for the plans available to them. Another difference between the two types of coverage is that Original Medicare doesn’t have provider networks. If a senior enrolls in Original Medicare, they can get care from any doctor or health care facility in the country. Because Medicare Advantage plans are limited to certain areas, enrollees often have to use in-network doctors and hospitals.
Colorado has more than 468,000 residents enrolled in Medicare Advantage compared with a total Medicare-eligible population of 973,426 individuals, an enrollment rate of 48.1%. This is higher than the national average of 42%. This guide explains how Medicare Advantage works, provides information about some of the most popular plans in Colorado and includes details about the benefits available under Medicare Advantage.
The Top 10 Medicare Advantage Plans in Colorado
Medicare Advantage was established to allow multiple providers to offer Medicare plans to seniors and other Medicare-eligible individuals. As a result, each provider typically offers several plans to meet the varying needs of seniors throughout Colorado. Information about the 10 most popular plans is available in the table below. The enrollment column shows the total number of enrollees covered by each provider. This total was calculated based on the number of individuals enrolled in all the plans offered by an individual insurer. The monthly cost range displays the price for each provider’s least expensive and most expensive plans. Medicare.gov has the most up-to-date data on Medicare Advantage enrollment in Colorado, but the data in this table is current as of April 2022.
HMO, PPO, PFFS
Anthem Blue Cross and Blue Shield
Denver Health Medical Plan, Inc.
Blue Cross Blue Shield of Michigan
Clear Spring Health
How Medicare Advantage Plans Work in Colorado
The graphic below provides details about the four most common types of Medicare Advantage Plans in Colorado. Some plans only cover care delivered by in-network providers, while other plans cover out-of-network care. Depending on the terms of the plan, an enrollee may also be required to choose a primary care doctor or ask for a referral to seek care from a medical specialist.
What Medicare Advantage Plans Cover in Colorado
With exceptions for hospice care, clinical trials and new benefits that are introduced via legislation, Medicare Advantage must cover the same medically necessary services as Original Medicare. This means enrollees have access to all other services covered under Medicare Part A and Part B. Most Medicare Advantage plans also include prescription coverage, eliminating the need for enrollees to purchase a Part D drug supplement. Many providers even offer extra benefits, such as coverage for hearing aids or over-the-counter medications.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Colorado
Medicare Advantage isn’t available to every resident of Colorado. To enroll, an individual must have Medicare Part A and Part B, choose a Medicare Advantage plan that’s available in their service area and meet other eligibility requirements. Enrollees must be at least 65 or have amyotrophic lateral sclerosis, end-stage renal failure or a disability that qualifies them for 24 consecutive Social Security or Railroad Retirement Board disability payments. To qualify for Medicare, an applicant must also be a U.S. citizen or lawful permanent resident.
Medicare doesn’t offer year-round enrollment, so it’s important for seniors to understand when they can sign up for the first time, switch Medicare Advantage Plans or switch from Medicare Advantage back to Original Medicare. The list below provides details on Medicare’s enrollment periods.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Colorado
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
Colorado Division of Insurance SHIP Assistance Program
The Colorado Division of Insurance participates in the nationwide network of state health insurance assistance programs that provide free counseling to help seniors navigate the complexities of Medicare coverage. The goal of the program is to serve as an advocate and help seniors make the right choices based on their needs. Any state resident who qualifies for Medicare coverage is eligible to receive SHIP counseling. The Division of Insurance website features a convenient link to apply for benefits, along with information about supplemental insurance, Medicare basics and how to report insurance fraud.
Located in Denver, the Colorado Gerontology Society is a nonprofit organization that provides free counseling to Colorado residents on any issue related to Medicare and Medicaid. Counselors can answer questions about coverage options, eligibility and how to apply. The organization’s website also provides a list of community resources for seniors and a calendar of upcoming events.
Centura Senior Links is one of the largest health care networks in Colorado, with more than 21,000 professionals, 17 hospitals and over 100 practices. The network provides counselors who can help seniors understand and apply for Medicare and other health benefit programs. Assistance is available in person for those living in Denver, and by phone for seniors located elsewhere in the state.
For more information about Centura Links and how counselors can help with Medicare and other insurance questions, contact the organization directly at 1-866-550-2752.
Colorado Foundation for Medical Care
The Colorado Foundation for Medical Care is the state health care quality improvement organization. It works hand in hand with Medicare and Medicaid to help improve the quality of health care for seniors and other state residents. The foundation also has a hotline available to seniors who have questions or need help signing up for Medicare.
The Colorado Fund for People with Disabilities (CFPD) helps individuals get the health care they need to maintain their quality of life. Counselors are available to answer questions concerning Medicare, and representative payees are available to make sure insurance bills are paid accurately and on time.
The Pikes Peak Area Agency on Aging provides free information and counseling on Medicare and insurance fraud to seniors who live in El Paso, Park and Teller counties. The agency also offers insurance counseling and access to educational resources by phone in the surrounding counties of Custer, Fremont and Las Animas. The trained staff periodically holds educational classes and gives presentations in the Pikes Peak region to help seniors better understand their Medicare options.
To speak to a counselor or learn when the next presentation is scheduled in your area, contact the agency at 719-471-2096.
Boulder County Area Agency on Aging
The Boulder County Area Agency on Aging serves seniors and adults with disabilities and their families by providing information on elder rights, healthy aging, respite care and Medicare counseling. Seniors may sign up for classes to learn about enrollment, benefits and the costs of Medicare. These classes are held monthly throughout Boulder County.
Contact the Boulder County Area Agency on Aging at 303-441-3570 to learn more about the upcoming class schedule, or for answers to questions about Medicare. You can also email the organization at [email protected]