As of age 65, the vast majority of US citizens are eligible to enroll in the national Medicare program. For those who may not know, Medicare is a government sponsored healthcare program designed to help retired citizens manage their healthcare needs during their golden years. The basics of Traditional or Original Medicare are referred to as Part A and Part B. The intended goal is for Original Medicare to cover the majority of your health care costs – but sometimes, it doesn’t cover everything.
Coverage and Benefits
Also, based on your employment history, there may be additional premiums or fees associated with Part A of Medicare. Part B automatically costs a monthly premium (you can find out exact costs by contacting your local Social Security Office). Part A is free for anyone with a minimum of 10 years in their employment history. If you have less than that, a monthly premium will likely be required.
Once you qualify for Medicare benefits, Part A coverage is both guaranteed and mandatory; Part B coverage, on the other hand, is not necessarily mandatory (but is guaranteed, if you want it). Part A coverage is mostly concerned with hospital stays, emergencies, and end-of-life care. Part B covers almost everything else – annual doctor visits, outpatient services, and preventative care.
Next, there’s Medicare Part C. Also known as Medicare Advantage, this is actually a very specific type of private insurance that is not offered by the government. If you choose a Part C plan, that means you’ll be paying for a policy that has identical benefits to Parts A and B of government Medicare. You cannot elect to opt out of either of those benefits. With Medicare Part D, prescription drug coverage, you must also accept and pay for Medicare Part B. You cannot get Part D prescription drug coverage if you are only paying for Medicare part A benefits.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
Popular Medicare Plans in Colorado
There are well over half a million people in Colorado (667,277 to be exact) who are currently enjoying Medicare benefits and coverage. Medicare Part C, which is a very popular Medicare alternative of sorts, has a 36% enrollment rate (around 240,219 enrollees). Another 15% of Traditional Medicare beneficiaries (104,238 people) are supplementing Parts A and B with a Medigap policy, which we will explore in greater detail below. The other 49% of retired individuals in Colorado likely have some form of supplemental coverage through an employer benefit program, or are taking a risk by relying on Medicare alone for their health care needs.
To determine your eligibility for a Medicare supplement policy, you must first be enrolled in Medicare Parts A & B. For questions regarding eligibility, enrollment dates, and all other Medicare questions, click here.
Is Purchasing Additional Medicare Coverage Absolutely Necessary?
The answer to that question is different for every individual, and depends largely on your own personal circumstances. But for many individuals, supplemental coverage can be essential for mitigating huge medical bills. In the table below are examples of some of the “gaps” in Original Medicare that you would be expected to pay 100% out-of-pocket for a hospital visit or outpatient care.
|Medicare Part A Costs||Medicare Part B Costs|
If you are closer to age 65 and feel as though you are in relatively good health, you may not think you need to compare Medicare plans in Colorado. Unfortunately, unexpected health complications go up with age, when retirement incomes usually dwindle. But there are affordable ways to protect yourself, even on a fixed income. We’ll explore some of those options now.
Colorado residents have seen many quality of life improvements over the last few years – unfortunately, the cost of healthcare isn’t one of them. For retirees, these rising costs can be extremely problematic down the road. The longer you live, the more of an inverse relationship there will be between your health care costs and what you can afford to pay. That’s why many seniors choose to invest in a Medicare Supplement Plan.
The two most popular Medicare supplement insurance options are either Medicare Advantage, or a Medigap Medicare supplement insurance plan. Both are offered by private companies. Beyond that, the two plans couldn’t be more different. It’s important to know why these two programs are distinct from one another and how much money it could save – or cost – you in the long run.
If you think that you don’t need a Medicare Supplement Plan, you may want to think twice about that issue. Although Medicare Parts A & B do cover a lot, they won’t cover everything. And what they don’t cover can get extremely expensive if you aren’t careful. That’s why Medicare supplement plans exist. For a small extra fee each month, you can protect yourself from these expensive coverage gaps and give yourself peace of mind that your health care will continue to be affordable for the foreseeable future.
Let’s talk a little bit more about Medicare Advantage. Unlike Medicare Parts A, B, and/or D, Medicare Part C is purely private insurance. But your insurance provider has made a legal pact with the government to make sure you get the same benefits that they would give you if you were paying for Medicare Parts A & B. In some cases, you might get more benefits for a reasonably affordable price. But this isn’t the case for everyone. Medigap policies are also private plans, but unlike Medicare Advantage, they do not replace Medicare. They merely supplement it.
Choosing Medicare Supplement Coverage
Medicare Supplement Coverage, commonly referred to as “Medigap” policies, give you health care coverage where Medicare Parts A and B do not. The 10 federally approved and regulated plans are included in the chart below, and include plans A, B, C, D, F, G, K, L, M, and N. Up until 2010, plans E, H, I, and J also existed, but the Medicare Modernization Act eliminated them from the available choices. The good thing about the way these Medigap policies are structured is that they are the same in every state, through every insurance provider. The only thing that varies across state lines is the price of the policy.
Below are the benefits that every Colorado resident can expect from their chosen Medigap policy:
Top Medicare Supplement Plans in the Area
|Type||Starting From||Part A Deductible||Part B Deductible||Excess||Nursing||Travel|
|F||$129||$0||$0||100% Covered||100% Covered||100% Covered||Request Info|
|C||$136||$0||$0||Not Covered||100% Covered||100% Covered||Request Info|
|G||$112||$0||$147||100% Covered||100% Covered||100% Covered||Request Info|
|B||$114||$0||$147||Not Covered||Not Covered||Not Covered||Request Info|
|N||$95||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|D||$120||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|A||$60||$1||$147||Not Covered||Not Covered||Not Covered||Request Info|
|L||$74||$304||$147||Not Covered||75% Covered||Not Covered||Request Info|
|K||$48||$608||$147||Not Covered||50% Covered||Not Covered||Request Info|
|M||$121||$608||$147||Not Covered||100% Covered||100% Covered||Request Info|
Choosing Medicare Advantage
Medicare Part C, or Medicare Advantage, is another popular option for supplementing your Medicare. Although, in reality, it is more of a replacement than a supplement. This is because Medicare Advantage effectively replaces your government Medicare, and leaves the responsibility for your health care coverage in the hands of a private company. However, because you are no longer being protected by the government, your private insurer is legally required to offer you “equal or better” coverage.
Additionally, a Medicare Advantage network might be limited in your particular area. Private insurance companies often have limited networks in order to maintain corporate profits and provide relatively cost-effective health care to their beneficiaries. On the other hand, some Medicare Advantage policies draw in new customers by offering additional coverage. Some of these options include dental, vision, or prescription drugs, just to name a few. So if you need additional coverage and aren’t attached to your current network of doctors, you might want to do some research on Medicare Advantage plans in your area.
What is the Difference Between Medicare Advantage and Medicare Supplement in Colorado?
One of the main differences is how the plans work. A Medicare supplement (Medigap) plan does exactly what it says it does: it supplements your Medicare benefits and helps reduce your costs in exchange for a low monthly premium. Unfortunately, Medigap plans can no longer offer to supplement your prescription drug coverage. You will have to purchase Medicare Part D or some other, private plan if you need help with your prescription drug costs.
It doesn’t matter whether you’re in Colorado, Tennessee, Hawaii, or somewhere in between – Medigap policies are standardized in order to be easier to understand and utilize. Plan F benefits will not change if you cross state lines or if you travel across the country. The only thing that changes from one place to another is the monthly premium they ask you to pay based on where you live.
Then there’s Medicare Part C. Unlike a Medigap Supplement Plan, Medicare Part C offers a wide variety of benefits because it is essentially replacing your regular Medicare. It may also offer things like prescription drug coverage, dental, and more. At the very least, though, your Medicare Advantage benefits will be identical to Medicare Parts A & B. Whether you want original Medicare gap coverage, prescriptions, dental, or anything else depends on what the company is willing to offer you and how much you can afford to pay.
When it comes to Medicare Advantage, things are a little bit more volatile than they are with Medigap plans. Medicare supplement insurance policies have nearly identical guarantees to those of Medicare. As long as you qualify for Medicare, and as long as you pay your premiums on time, you’ll have it for the rest of your life. Medicare Part C plans work like a normal insurance policy, however – you do have to jump through extra hoops in order to qualify, and they can cancel your coverage at any time if they have a legitimate legal reason to do so.
In truth, there are many more ways in which Medigap and Medicare Advantage are different from one another. In fact, we cover almost all of those differences in the chart below. If you still have questions, read through them first. If there are still any confusion or you feel we haven’t answered a question that is relevant to you, don’t hesitate to contact us. We can help you find a plan and compare rates today.
|Questions||Medicare Advantage||Medicare Supplement|
|How are expenses covered under each plan?||Your health insurance company gives the government an estimate of your costs along with a monthly premium; the government will pay most of that premium, and you will be responsible for the rest||If you choose a comprehensive plan like Plan F, all of your expenses will be covered with one low monthly premium. Less comprehensive plans may leave you paying for coinsurance or additional premiums|
|Will I still have to pay for Part B?||Yes||Yes|
|What will it cost me?||Premiums can either be sky high or surprisingly affordable depending on where you live and the average cost of healthcare in your area. It’s a little bit hard to predict||Each plan comes with an affordable monthly premium – many of which are less than $100 a month|
|What will the plan cover?||Medicare Part C offers the exact same benefits as Parts A & B. Supplementing Original Medicare coverage gaps, prescription drugs, vision, dental, etc. will likely cost extra if you would like to purchase them||Medigap plans start by covering all of the coverage gaps in original Medicare. From there, depending on which plan you choose, it may cover things like co-Insurance, co-pays, and even your part B premiums|
|Is it easy to budget my health care expenses?||The more frequent and unpredictable your health care needs are, the more expensive a Medicare Advantage plan will become||The vast majority of your costs come from the monthly premium, which is very easy to budget for|
|Is my plan guaranteed? Or can it be cancelled?||There are no guarantees with Medicare Part C. Your provider can change your coverage, premium prices, or cancel you as long as their decision is strictly legal||In order to be guaranteed coverage, you must qualify for Medicare and you must pay your premiums on time. As long as your provider stays financially solvent, your coverage is guaranteed|
|Do I have to clear a pre-approval or pre-certification process?||Like most private health insurance policies, you will have to qualify for some sort of pre-approval or pre-certification process before they sell you coverage||The only pre-qualification you need to worry about is qualifying for Medicare. If you can do that, you can qualify for Medigap|
|Am I limited to specific doctors or hospitals?||In certain areas, Medicare Advantage plans are affordable because they’re restrictive that works keep costs down – this means your choices of doctors and hospitals will be limited||Any health care provider in the Medicare network will also accept your Medigap insurance, so your restrictions are very few and far between|
|What type of plan is best for me?||Medicare Part C plans tend to be fairly affordable for younger seniors in good health who live in densely populated areas||Older seniors who have more demanding healthcare needs, live in rural areas, and travel frequently can benefit financially from a Medigap supplement|
Informative Medicare Resources
To help you make the most educated decision possible, we’ve gathered a pool of resources and contact information to help you find answers to your Medicare, Medigap, and Medicare Advantage questions in CO. Reaching out and making contact with your local offices will give you some of the best information you could ask for.
Choose at least one topic area you are interested in: Select All
Help with my Medicare options & issues
Other insurance programs
Complaints about my care or services
General health & health conditions
Claims & billing
Health care facilities & services in your area
Important Medicare-Related Healthcare Terms
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.