Medicare in Colorado

Medicare is a federal program that provides health insurance coverage to those aged 65 and over, as well as younger people who have disabilities or permanent kidney failure. In Colorado, about a million people are eligible for this program, accounting for about 17% of the state’s 5.8 million residents. This is 3.14% higher than the number of people eligible for Medicare in 2022, pointing to the state’s aging population.

Original Medicare consists of multiple parts that offer different types of coverage: Part A covers inpatient hospital care, home health care, nursing home care, and hospice; Part B provides medical coverage for doctor visits, preventative care, and certain medical equipment; and Part D pays for prescription drugs, with various plans featuring different drug formularies and cost-sharing obligations. Part A is usually free if the beneficiary or their spouse has paid Medicare taxes for at least 10 years, otherwise, it may cost $278 or $506 per month. Part B typically costs around $164.90 per month, which can vary based on income, and the cost of Part D varies depending on the chosen plan.

In addition to Original Medicare, Colorado residents have access to several Medicare Advantage Plans. Also called Part C, these plans are an alternative way to receive Part A and Part B coverage. They’re offered through and serviced by private health insurance companies that follow Medicare’s rules, meaning they provide all the benefits of Original Medicare to the same demographic. However, many plans have benefits beyond what’s in Original Medicare, including prescription drug coverage and vision and dental insurance. In 2023, 51% of Medicare-eligible Coloradans, or 507,933 people, have a Medicare Advantage Plan. This is high compared to the national norm of 48%, and it’s an increase of 5.11% over the percentage of beneficiaries who had this coverage in 2022.

This guide offers an in-depth look at Medicare options in Colorado, focusing on how individuals can tailor plans to meet their specific needs. Additionally, it includes a directory of organizations that can assist residents in sifting through the wealth of information and selecting the right plan for them.

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)

The Centers for Medicare & Medicaid Services administers Medicare in Colorado and the rest of the state. This health insurance program features two parts, including Part A hospital coverage and Part B medical coverage. Medicare is a fee-for-service plan, meaning beneficiaries pay for services as they receive them. Both parts of Medicare have separate deductibles the insured must pay before their coverage kicks in. For Part A, the deductible is $1,600 per hospital stay, and for Part B, there’s an annual deductible of $226. In addition to the deductible, Medicare has copays and coinsurance that beneficiaries must pay.

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)

Like Original Medicare, Medicare Advantage Plans provide hospital and medical insurance. However, instead of being administered by CMS, they’re administered by private health insurance companies that follow the coverage standards set forth by Medicare. There are four different types of plans available, including HMOs, PPOs, PFFS plans and SNPs. Medicare Advantage Plans are an attractive option for those seeking robust coverage, as most plans have prescription drug coverage included in their benefits, and many include vision and dental insurance. Plans typically also have annual out-of-pocket limits and some don’t have a deductible, which may provide significant savings for some beneficiaries.

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 2023. 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 2023 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.