Medicare in Colorado offers a range of health insurance options for individuals over the age of 65, as well as for younger people with certain disabilities or conditions.
This article provides a comprehensive overview of Medicare in Colorado, focusing on eligibility, coverage options, costs, and the enrollment process.
Medicare Eligibility
Medicare is primarily available to individuals who are 65 years or older.
Additionally, people under 65 can qualify if they have disabilities, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS). More than 91% of Medicare beneficiaries in Colorado qualify due to age, while about 8% are eligible due to disability.
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COLORADO HEALTH INSURANCE
The Basics
Original Medicare (Part A and Part B).
Medicare Part A covers hospital insurance and Part B covers 80% of physicians’ charges, lab fees, durable medical equipment, outpatient costs, and up to three pints of blood.
Together, Medicare Parts A and B comprise Original Medicare.
This traditional form of Medicare provides broad coverage but does not cover all expenses, such as prescription drugs. There are also very large deductibles for Part A, and a $240 deductible for Part B, as of 2024.
After this deductible is met, Medicare covers 80% of the costs for approved Part B services, with you responsible for the remaining 20%.
There is no cap on out-of-pocket costs for these services.
Theoretically, your out of pocket costs if you only have Original Medicare are unlimited.
That’s why nearly everyone needs additional protection against the high cost of medical care, over and above Original Medicare.
In Colorado, you have a full range of options, including Medicare Advantage (Part C), Medicare supplement insurance (Medigap), or the lesser known but excellent non-insurance alternative, the Medi-Share 65+ health sharing plan.
Medicare Advantage Plans
These plans are offered by private insurance companies and include all the benefits of Parts A and B, often with additional services such as dental, vision, and prescription drug coverage.
As of 2024, there are 120 Medicare Advantage plans available in Colorado, an increase from 100 plans in 2023.
Medicare Advantage plans are very affordable on a month-to-month basis, with many plans available with a zero premium.
The disadvantage of Medicare Advantage plans is that if you do need care, out of pocket costs can be very high.
Medicare Advantage plans are also managed care plans. These plans operate through networks of approved physicians and other providers. They typically place restrictions on what doctors you can see for non-emergency care and still fully use your plan’s insurance benefits.
In Colorado, some Medicare Advantage plans have narrow regional networks, limiting hospital availability for plan members.
Medicare Advantage Special Needs Plans
However, Medicare Advantage plans offer Special Needs Plans (SNPs) tailored for individuals with specific chronic conditions or circumstances.
These SNPs are only available through Medicare Advantage and provide specialized care coordination and benefits for those who qualify. It’s important to consider the maximum out-of-pocket (MOOP) limit when evaluating Medicare Advantage plans.
Medicare Advantage Out-of-Pocket Costs
The MOOP is the highest amount you’ll pay for covered services in a year, after which the plan covers 100% of costs. In 2024, the MOOP for Medicare Advantage plans cannot exceed $8,300 for in-network services and $12,450 for in- and out-of-network combined.
Learn More: Medicare Supplement Insurance and Medicare Advantage Plans In Colorado
Medicare Supplement Plans (Medigap)
For those looking to supplement your Original Medicare coverage and fill in the gaps, Medicare Supplement plans, also known as Medigap plans, are an excellent option in Colorado.
These plans are designed to cover the out-of-pocket costs that Medicare Parts A and B don’t cover, such as copayments, coinsurance, and deductibles.
One of the significant advantages of Medigap plans is that they come in standardized designs, making it easier to compare and choose the right plan for your needs. The most popular Medigap plans for new enrollees are Plan G and the High Deductible Plan G.
These Medigap plans are guaranteed renewable and cannot be canceled as long as premiums are paid, even if you have health problems.
The advantage to Medigap plans is that you can manage your out-of-pocket expenses much better: With Plan G your maximum out of pocket exposure for Original Medicare deductibles and copays is limited to just $240 per year.
You can also use your Medigap benefits with any doctor. You aren’t limited to a narrow network of authorized care providers, as you are with Medicare Advantage.
While Medigap plans do come with a monthly premium, it’s important to consider the long-term value and financial protection they offer, and the reduction of your out-of-pocket expenses.
At Colohealth, our licensed agents can help you navigate the various Medigap plan options available in Colorado to find the best fit for your unique needs and budget.
Contact us for a free consultation!
Medi-Share 65+
Medi-Share 65+ is a health sharing program designed specifically for Medicare beneficiaries.
It functions similarly to a Medigap Plan G, providing coverage for Medicare’s deductibles, coinsurance, and copays.
The key difference is that Medi-Share 65+ is not insurance but rather a health sharing ministry. Members share eligible medical costs with one another through monthly shares (similar to premiums). Like Plan G, the maximum out-of-pocket exposure is limited to the Part B deductible ($240 in 2024).
Medi-Share 65+ offers nationwide access to any Medicare-participating provider, with no network restrictions. It can be a more affordable alternative to Medigap plans for some Medicare beneficiaries in Colorado.
Don’t go it alone when it comes to choosing between Medigap and Medi-Share 65+ plans, as our Personal Benefits Managers at ColoHealth will help you find the right coverage to maximize your Medicare benefits, and their professional consultation is free.
Prescription Drug Coverage (Part D)
This is coverage for prescription medications, available as a stand-alone plan or included in many Medicare Advantage plans.
The maximum deductible for Medicare Part D plans is set at $505 by federal law.
As of 2024, Colorado residents have 21 stand-alone Part D plans to choose from.
| Plan Name | Monthly Premium | Deductible | Initial Coverage Limit | Coverage Gap | Catastrophic Coverage Phase |
|---|---|---|---|---|---|
| AARP MedicareRx Preferred | $99.00 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| Aetna Medicare Rx Choice | $79.00 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| Cigna Secure Rx | $33.20 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| Elixir RxSecure | $22.00 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| Humana Basic Rx Plan | $32.90 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| Humana Premier Rx Plan | $89.00 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| Mutual of Omaha Rx Plus | $89.00 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| SilverScript Choice | $32.80 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| SilverScript Plus | $89.00 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| UnitedHealthcare Pharmacy Direct | $99.00 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| WellCare Patriot Rx | $32.80 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| Aetna Medicare Rx Saver | $32.00 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| Cigna Rx Medicare (PDP) | $22.00 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| Elixir RxPlus | $89.00 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| Humana Walmart Value Rx Plan | $22.80 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| Mutual of Omaha Rx Value | $32.00 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| SilverScript SmartRx | $7.30 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| UnitedHealthcare Pharmacy Direc | $32.00 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| WellCare Medicare Rx Value Plus | $89.00 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| WellCare Wellness Rx | $22.80 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
| Aetna Medicare Rx Walgreens | $79.00 | $505 | $4,660 | 25% for generic/25% for brand | Greater of $4.15 generic/$10.35 brand, or 5% |
This table includes the monthly premium, deductible, initial coverage limit, coverage gap, and catastrophic coverage details for each of the 21 stand-alone Part D plans available in Colorado for 2024 that are offered by various providers.
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Enrollment
Enrollment in Medicare is time-sensitive.
Initial enrollment for Medicare begins three months before turning 65 and ends three months after the 65th birthday month. During this period, applicants cannot be denied a policy based on past or current health conditions. This is also known as the guaranteed enrollment period.
However, if you miss your guaranteed enrollment period, and you don’t have creditable coverage (such as via a workplace plan, if you stay in the workforce past age 65), you may have to pay late enrollment penalties for Part B and/or Part D when you sign up.
Medigap plans also have a limited enrollment period: To enjoy guaranteed enrollment and the best rates, you should enroll in a Medigap plan within six months of enrolling in Medicare Part B.
The Fall Election Period
Colorado residents can also change their Medicare Advantage and Part D plans during the annual enrollment period from October 15 to December 7.
Costs
Costs associated with Medicare in Colorado vary based on the coverage plan and individual circumstances.
For Original Medicare, most people don’t pay a premium for Part A, but there is a premium for Part B, which is approximately $174.70 per month in 2024. Medicare Advantage plans in Colorado had an average monthly premium of $15.84 in 2024. Costs for Part D plans vary, and many beneficiaries may qualify for Extra Help to assist with these expenses.
For those needing assistance, the Colorado State Health Insurance Assistance Program (SHIP) offers free counseling to help navigate Medicare options and enrollment. Additionally, the Colorado Division of Insurance provides resources and advocacy to protect residents from insurance scams and to assist with plan decisions.
With the support of programs like SHIP and the Colorado Division of Insurance, residents can better manage their health insurance needs and ensure they receive the coverage that best suits their circumstances.
Medicare in Colorado offers a variety of plans to meet the healthcare needs of its senior and disabled populations. Understanding the different parts of Medicare, the associated costs, and the enrollment periods can help beneficiaries make informed decisions about their healthcare coverage.
What To Do Now
For additional information or to request a personalized quote, individuals can contact one of our Personal Benefits Manager for a free consultation.
For Further Reading: How to Get the Most Out of Your HSA Account | Should Colorado Impose Caps on Drug Prices? | Cracking Down on Hidden Healthcare Costs: Colorado’s Price Transparency Revolution
Leslie Alford is a Personal Benefits Manager at ColoHealth. Her aim is to help you make smart and informed healthcare coverage decisions that will fit your needs and budget. Read more about Leslie on her Bio page.
