Medicare in Colorado
- Discover how you can get Medicare in Colorado, including what plans you can choose from and who is eligible.
What Colorado Medicare Plans Are Available?
Nearly one million people in Colorado benefit from Medicare plans. Colorado has four main types of Medicare plans:
- Original Medicare, also known as Medicare Parts A and B
- Medicare Advantage, sometimes called Medicare Part C
- Medicare Part D prescription drug coverage
- Medicare Supplement Insurance, often called Medigap
Of the 931,229 Medicare beneficiaries in Colorado, 528,816 have Original Medicare and 402,413 have Medicare Advantage plans. Understanding the types of Medicare plans can help you select the best coverage for your needs.
Original Medicare is administered through the Social Security Administration and provides basic health care to those who qualify. Medicare Part A covers hospitalizations and other inpatient care. Medicare generally covers care in hospitals, hospice centers, inpatient rehabilitation centers and psychiatric hospitals. Home health care is often covered as well as acute care in a nursing facility. However, Part A does not cover long-term care in a nursing home. Costs essential to care in a hospital, such as meals and drugs, are also covered.
Medicare Part B covers ordinary outpatient care, such as annual physicals, as well as care for injuries or illnesses. Coverage generally includes diagnostic services and medications that must be administered at a doctor's office, such as vaccinations and IV drugs. However, it doesn't cover prescription medications from retail pharmacies. Original Medicare only covers services from doctors and hospitals that have agreed to accept Medicare.
Medicare Advantage Plans
Medicare Advantage, also referred to as Medicare Part C, is an alternative to Original Medicare. Beneficiaries can purchase Medicare Advantage plans from private insurance companies. The Social Security Administration authorizes these companies to sell Medicare Part C plans and bill the Social Security Administration for some costs.
These plans work a lot like other private health plans, and beneficiaries may be able to select a plan well-suited to their needs. These plans often provide more thorough health care than Original Medicare, and they may cover things like vision care, dental services and prescription drugs. However, enrollees are responsible for costs like premiums, copays and deductibles.
Prescription Drug Plans and Medigap
Private insurance companies also sell Medicare Part D prescription drug coverage. Part D plans help pay for medicines from retail pharmacies. Enrollees can have one of these plans in addition to Original Medicare or a Medicare Advantage Plan.
Medicare Supplement Insurance is available to help cover gaps in Medicare coverage, which is why many people refer to it as Medigap coverage. Medigap can help cover expenses such as coinsurance and deductibles. Beneficiaries can use this coverage to avoid large or unexpected healthcare costs.
Who Is Eligible for Colorado Medicare?
People over age 65 and younger people with specific disabilities may qualify for Medicare. Medicare usually automatically enrolls anyone who starts getting Social Security benefits four months before their 65th birthday. People who aren't automatically enrolled will need to sign up during an enrollment period.
A person's initial enrollment period (IEP) is the best time to enroll in Medicare if needed. This period is seven months long and includes:
- The three months before the person's 65th birthday
- The month of the 65th birthday
- The three months after the 65th birthday
People can also enroll in Original Medicare during the general enrollment period, which runs from January 1st to March 31st each year. However, there are penalties and other costs associated with enrolling after a person's IEP.
Some people can enroll in a plan or adjust their coverage during a special enrollment period with no penalties. Special enrollment periods may be available to people who:
- Were recently covered by an employer's health insurance plan but are no longer employed
- Are moving outside of their current Medicare Plan's service area
- Lose Medicaid coverage
- Are moving into a long-term care facility
All Medicare beneficiaries can adjust coverage during fall open enrollment. This period is also known as the annual enrollment period (AEP) and runs from October 15th to December 7th each year. During the AEP, enrollees can join or drop a Medicare Advantage or supplemental plan. They can also switch Medicare Advantage plans.
How Do I Enroll in Medicare in Colorado?
Many people in Colorado are automatically enrolled in Medicare. If you're automatically enrolled, you'll get a Medicare card in the mail before your 65th birthday. If you aren't automatically enrolled, you can enroll during your IEP by contacting the Social Security Administration. You can do this through the website, at a local office or by calling 1-800-772-1213.
Contact Information for Colorado Medicare, Medicaid and Insurance Help
You can get more information about Medicare and other benefits in Colorado by visiting HelpAdvisor's Colorado Medicaid page. You can also contact the State Health Insurance Assistance Program (SHIP) for Colorado.
The Colorado Department of Regulatory Agencies also provides information about SHIP counselors, Medicare basics and prescription drug programs. Some resources are available in Colorado for those who need health care assistance through the Old Age Pension and Medical Care Program (OAP). You can also get information on obtaining medications in Colorado through the state's Prescription Drug Discount Resources.