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.
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.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
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.
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.
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:
|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|
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.
|Cost||Plan Name||Coverage Type||Premium||Deductible||Rating|
|$0||Kaiser Permanente Senior Advantage Core (HMO)||Health and Drug||$0.00||$0|
|$588||Kaiser Permanente Senior Advantage Silver (HMO)||Health and Drug||$49.00||$0|
|$1188||Kaiser Permanente Senior Advantage Plus Choice (HMO-POS)||Health and Drug||$99.00||$0|
|Cost||Plan Name||Coverage Type||Premium||Deductible||Rating|
|$1044||Aetna Medicare Select Plan (PPO)||Health and Drug||$87.00||$0|
|$0||HumanaChoice H5868-011 (PPO)||Health Only||$0.00||$0|
|$588||HumanaChoice H5868-012 (PPO)||Health and Drug||$49.00||$200|
Cost is a major determining factor when it comes to health care, but this is also the hardest factor to determine because of how much it depends on the specific details of your unique situation. Luckily, there are some more concrete differences between these two forms of supplemental coverage that are easier to determine. Take note of the handy table below:
|Questions||Medicare Advantage||Medicare Supplement|
|How are the plans funded?||Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.||Your monthly premium takes care of the majority of your expenses.|
|Do I continue paying for Part B?||Yes||Yes|
|What does it cost me?||Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.||While each plan does require a monthly premium, many of them are affordably priced.|
|What does the plan cover?||Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.||All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.|
|Can I budget my health care expenses?||It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.||Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.|
|Can my plan be cancelled?||Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.||No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.|
|Are pre-approvals or pre-certifications required?||Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.||No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.|
|Can I use any doctor or hospital?||Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.||Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.|
|Can drug, vision, or dental coverage be included in the policy?||Yes.||No. These forms of coverage must be purchased separately.|
|Who is this plan type generally best suited for?||If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.||If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.|
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.
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