Medicare Advantage Plans in Colorado

Medicare Advantage plans are offered through private health insurance companies that have contracts with Medicare. Medicare Advantage plans are required to cover any services that fall under Original Medicare (Parts A and B). Some expand coverage to dental, vision, hearing and more.

In Colorado, there are several Medicare Advantage plans to choose from, depending on where you live. These plans fall under several types, including Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs), and Private Fee-for-Service plans (PFFSs).

Anyone who qualifies for Original Medicare is eligible to switch to a Medicare Advantage plan. All Colorado residents have access to a Medicare Advantage plan in 2024, though the availability of specific plans differs based on ZIP code.

Medicare Advantage plans must cover at least what Parts A and B of Original Medicare cover. Medicare Part A covers services you receive in the hospital or nursing home, also known as inpatient care. Medicare Part B covers outpatient care, including wellness visits, examinations in your doctor’s office and therapy sessions.

While Medicare Parts A and B cover these general areas of care, Medicare prescription drug plans — also known as Part D — are an optional add-on. Some Medicare Advantage plans may include Part D coverage and other services, including:

• Dental care
• Hearing aids
• Medical transportation
• Over-the-counter medications
• Fitness classes

The cost of Medicare Advantage plans in Colorado will vary based on where you live and what coverage you want to have included in your plan. You can find plans in your area by entering your zip code at Medicare.gov, or you can contact GoHealth to help you find the right plan for your needs.

In 2024, the average premium for a Medicare Advantage plan in Colorado is $15.84 per month. Some people qualify for a $0 per month premium.

Your costs also will depend on rules set by your individual plan. Many Medicare Advantage plans require you to receive care within a specific provider network to receive the maximum coverage for your healthcare services.

The federal government sets Medicare Advantage eligibility since Medicare is a federal public health insurance program.

Medicare is available to:

• People who are age 65 and older.
• People with end-stage renal disease (ESRD).
• People with amyotrophic lateral sclerosis (ALS).
• People with disabilities who qualify for Social Security.

In addition to specific eligibility rules, Medicare also has set periods for when you can enroll. You can sign up for Medicare in the three months before or after the month you turn 65, or after you have been receiving Social Security Disability Insurance payments for at least 24 months.

Suppose you are interested in enrolling in a Medicare Advantage plan. In that case, it may be best to consider this option when you first enroll in Medicare. Whether you choose Original Medicare or Medicare Advantage, you have options for Part D coverage when you enroll.

Suppose you wait to sign up for a Part D plan. In that case, a late enrollment penalty may be added to your Medicare premium for the rest of your life. This penalty is based on how long you were eligible for a prescription plan but chose not to enroll.

Some important dates to remember when enrolling in a Medicare Advantage plan include:

• Annual Enrollment Period for all Medicare plans — October 15 to December 7.
• Window to change from one Medicare Advantage plan to another: January 1 to March 31.

In certain circumstances, you may be eligible for a Special Enrollment Period. These circumstances can include but are not limited to a new disability, changes to your eligibility or moving to an area that doesn’t offer your current plan.

Whether or not you include Part D drug coverage in your Medicare Advantage plan is up to you. Most offer options with and without drug coverage. Without a Part D plan bundled with your Medicare Advantage coverage, you should expect to pay the entire cost of your outpatient prescription medications.