Medicare in Colorado

Medicare is a federal health insurance program designed to make medical services affordable for adults aged 65+, younger people with disabilities and residents diagnosed with end-stage renal disease. As of late 2021, almost 960,000 Coloradans have enrolled in Medicare, which is around 16.2% of the population. The latest published figures are for 2020, which show 56.2% of beneficiaries are enrolled in Original Medicare and the remainder in a Medicare Advantage plan. This is broadly similar to other states, all of which show consumers are gradually shifting towards the latter option.

Original Medicare has two main parts. Part A covers hospital stays and skilled nursing services and hospice care. Part B covers medical services, such as outpatient care, medical supplies and some doctor services. Part A has no cost for residents (and their spouses) who have paid Medicare taxes for a certain amount of time while working. The standard monthly premium for Part B, as of 2022, is $170.10. Part D is optional and covers prescription medications. Part D can be added to the Original Medicare. 

Medicare Advantage is also known as Part C. As of 2022, the average monthly premium is $14.11, although the Centers for Medicare & Medicaid Services (CMS)-approved private insurance companies that administer the program must offer plans with $0 premiums. The variance comes from policyholders adding other services to their plans, such as gym memberships. Finally, there’s Medigap, which is a private insurance program designed to cover costs not met by Medicare, such as coinsurance, copays and deductibles. Most Medicare Advantage plans have Part D included.

This guide covers Medicare in Colorado in detail, including how plans can be personalized. It also provides a list of organizations that can help residents navigate the profusion of information and choice of plans. 

Options for Medicare Coverage in Colorado

Original Medicare can provide coverage for an array of needs, but it can’t help with every health care possibility. Fortunately, private insurance companies approved by the CMS offer other options for Colorado residents. They can help eligible citizens build personal plans that provide the coverage they need with premiums they can afford. 

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home, skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

CMS-approved private health insurance companies offer an alternative form of coverage called Medicare Advantage (or Part C). With the exception of hospice care, which is always provided by Part A, every Part C plan must offer all the coverage available through Parts A and B. Private insurance companies can also provide coverage unavailable with Original Medicare, such as vision, dental and hearing services. Most plans also include Part D as standard.

Although private insurance companies offer Part C with $0 premiums, Colorado’s average is $14.11 per month due to policyholders taking out additional coverage. As of 2022, there are 94 Medicare Advantage plans available in Colorado, an increase of 14 from the previous year. 

Who Should Consider Medicare Advantage

Medicare Advantage may be a good choice for those who:

• Are generally healthy; therefore, they’re eligible for lower premiums
• Want to control their out-of-pocket expenses
• Are happy for the insurer to manage their care
• Want additional coverage, such as dental care

The Top 10 Medicare Advantage Plans

With close to 100 plans to choose from, Colorado residents may find filtering out the least suitable confusing, time-consuming and tiring. The following top 10 list may help as it’s been compiled from the latest enrollment data available in 2022. As insurance companies offer multiple plans with different prices, the costs are shown as a range, and the enrollment figures show the combined totals for all plans per provider. To get more information, please visit Medicare Advantage Plans in Colorado.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Colorado

Evaluating the various Medicare options available in Colorado can be difficult and finding the latest accurate information can take time, but organizations throughout the state offer plenty of help free of charge. Each has staff trained in all consumer aspects of Medicare, equipping them with skills to help residents find the best plans for their needs and nonstandard coverage solutions, such as prescription drugs and plans covering dental, hearing and vision care. They can also provide local information regarding Medigap and guide residents through the enrollment process.