Medicare Advantage Plans in Colorado


Medicare Advantage Plans are a relatively new health plan option that falls under Part C of the Medicare legislation.

Basically, a Medicare Advantage Plan takes over for Medicare and is sold by private insurance companies who must follow Medicare’s guidelines and cover the same items as Original Medicare. Medicare Advantage Plans frequently include prescription drug coverage, all in one package deal.

If you join a Medicare Advantage Plan in Colorado you must continue paying your Medicare Part B premium, but you will get your Medicare-qualified health care through the Medicare Advantage Plan—not through Medicare.

Network: Colorado Medicare Advantage Plans are primarily managed care plans—meaning insurance companies may require referrals and pre-authorize what services are covered. It also means coverage is generally limited to providers in their network. There are two types of networks: a PPO (Preferred Provider Organization) or an HMO (Health Maintenance Organization).

PPOs: In this type of network, you’ll get the best benefits when you go to a network provider. If you go to a non-network provider, you’ll still be covered, but will incur higher out-of-pocket expenses. Still, it’s nice to have the option of being able to go out of network.

HMOs: HMO networks are, usually, smaller than PPO networks. Also, in most cases you have to get a referral from your primary doctor to see a specialist. Be aware that there is no coverage if you go to an out of network physician or hospital. An exception to this rule exists if you have a bona fide medical crisis and go to the emergency room. In this instance you would still be covered.
  • Eligibility for Medicare Advantage Plans

Eligibility for Colorado Medicare Advantage Plans:

You must have both Medicare Part A and Part B.

You must pay your monthly Medicare Part B premium to Medicare.

You must not have End-Stage Renal Disease.

You must live in the service area for your Medicare Advantage Plan in Colorado.

Positives of a Medicare Advantage

Lower price tag: Low premiums are the biggest attraction. Premiums in Northern Colorado can range from about $66 per month for a PPO plan to as low as $0 for an HMO plan. Yep, zero as in zip, zilch, nada.

Changes: How long such $0 premium plans will last is a big question mark, but at least in 2017 they are available from several carriers. Most plans automatically include prescription drugs at no additional cost. Some plans include dental and vision, and even free health club memberships.

Negatives of a Medicare Advantage

Out of Pocket Costs: You will incur costs for virtually every single doctor visit and medical procedure, both in and out of the hospital (except for preventive services which are free). Your costs can include deductibles, copayments and coinsurances which will continue until you reach your maximum out of pocket (MOOP) which could be as high as $6700.

Network Restrictions: The biggest drawback is the requirement to see network providers. What if you want to see a highly regarded specialist that is not in the network? In a PPO you would face higher out of pocket costs, while in an HMO you would generally receive nothing from the insurance if you saw an out of network provider (except in the case of a sudden emergency).

Medigap Plan F vs. Medicare Advantage Summary Comparison

Medicare Supplement (aka “Medigap”) PLAN F

Medicare Advantage

Premium

Sample: 65-year old female in Fort Collins will pay anywhere from $127 to $160 per month in 2017.

Anywhere from $0 premium to $96 per month in Fort Collins.

Out of pocket cost to you on Medicare eligible expenses.

Nothing. All Medicare eligible expenses are paid at 100% so you incur no out of pocket costs.

You’ll incur costs for virtually all procedures other than preventive care. In a bad year you could spend up to $6700 in out of pocket costs on some plans, while others may have a slightly lower out of pocket maximum.

Doctor & provider network required?

No. You are free to see any doctor anywhere in the country so long as they participate with Medicare, which virtually all doctors do.

Yes. You must see in-network doctors, otherwise you’ll pay more out of pocket or the service may not be covered at all.

Referrals required for specialist?

-No. Referrals are never required.

In most cases referrals are required, although some plans have slightly reduced this requirement.

When can you enroll on a guaranteed basis?

You have a six-month open enrollment period when you first enroll in Medicare -- during which you can enroll in any Medicare Supplement Plan in Colorado, even if you have health problems. This is a once in a lifetime open enrollment. Miss this and you will need to prove your good health to qualify later.

You have an open enrollment period when you first sign up for Medicare as well as every year from October 15 to December 7th.

Do plan benefits always stay the same?

Yes. Plan benefits will not change once the policy is in force.

No. The plan design can, and usually does, change yearly.

Can a policy ever be cancelled?

No, so long as you continue to pay premiums, the policy can never be cancelled.

Yes, policy is only guaranteed to stay in force until December 31st of each year. If a policy is terminated, you will be given a special enrollment period and may purchase either another Medicare Advantage or a Medicare Supplement without having to answer medical questions.

What happens if you move to another state?

Policy will not change; although premium will be adjusted up or down to reflect the rates in your new state.

Policy will be terminated and you will need to enroll in whatever plans may be available in your new residence area. If you move to a sparsely populated area, you might find there are no plans offered there.

Extra add-on features

Usually none, although a few plans offer free health club memberships.

Most plans include prescription drug coverage. Some may also include limited dental & vision and free health club memberships.

Bottom line of why to buy

a. You want the peace of mind knowing that all of your Medicare eligible expenses will be covered at 100%. Think of it as a “prepaid” medical plan b. You want total freedom to see any Medicare participating doctor.

a. You want the lowest premium possible. b. Think of it as a “pay as you go” medical plan.


Call us today at 970-224-5500 or toll free at 800-553-1444 for a free, no-obligation Colorado Advantage consultation!