When it's time to apply for Medicare, many people have questions about the process and what it will pay for. Additionally, whether you qualify for Medicare and when you are eligible can often be confusing. You can eliminate some of the confusion by doing some research ahead of time, though it is sometimes difficult to find the answers to your questions on the government website. To help you understand Medicare and its various parts, we put together this guide to Medicare in Colorado to help you get the answers you need.
Medicare is a federal program that provides health insurance for individuals who are 65 and older. Medicare also benefits younger individuals with disabilities or end-stage renal disease. In Colorado, over seven million people receive some type of Medicare benefits:
If you receive Social Security benefits or compensation from the Railroad Retirement Board, you are automatically enrolled in Medicare Part A and Medicare Part B when you turn 65. If you do not want Part B, you have to opt-out. You also have additional options.
You can sign up for Part C, which is Medicare Advantage, and Part D, which provides prescription drug coverage. Medicare Advantage is offered through private health insurance companies that combine Parts A and B into a bundle. Sometimes, Medicare Advantage plans include prescriptions, dental, and vision coverage.
Additionally, you can opt to sign up for Medicare Supplement Insurance (Medigap). These plans supplement Original Medicare. With Original Medicare, there is no cap on out-of-pocket expenses, and they can run quite high. Medigap policies cover those extra costs. If you have access to Medicaid, it will serve as coverage for the expenses Medicare does not pay, though not everyone can qualify for Medicaid.
There is one catch with Medigap, however. In most cases, as you age, your premium increases. Keep track of your medical expenses throughout the years you are on Medicare. If you find you are not using Medigap enough to warrant the increased premiums, you might drop it and consider a Medicare Advantage plan or another supplemental plan.
If you paid taxes for a certain amount of time while you were working, you could get Medicare Part A premium-free. Part A and Part B range from $259 to $471 per month, depending on how long you paid into the system via taxes.
Part A covers hospital inpatient expenses and has a $1,484 deductible per benefit period. For days one through 60 of each benefit period, you do not pay a coinsurance fee. For days 61 through 90, the coinsurance is $371, and for days 91 and over, the coinsurance is $742 for each lifetime reserve day. You have 60 lifetime reserve days for your entire lifetime. Once you use them, Medicare does not pay anything for your health care.
If you are under 65 years of age, you can get Part A premium-free if you have been on Railroad Retirement Board or Social Security disability for 24 months, or if you have Amyotrophic Lateral Sclerosis (ALS) or End-stage renal disease and can meet Medicare's requirements.
The premium for Part B is based on your income. It starts at $148.50 as of 2021. The deductible and coinsurance for Part B are $203. Once you meet the deductible, you still pay 20 percent of any amount Medicare approves for your doctor services, including outpatient therapy and medical equipment.
You can qualify for Medicare in Colorado if you are a U.S. citizen or a permanent legal resident who has lived in the United States for over five years. You also have to be 65 years or older or permanently disabled and receive disability from the Railroad Retirement Board or Social Security.
Additionally, you can qualify for Medicare at any age if you have end-stage renal disease or Lou Gehrig's disease (ALS).
Even if you qualify for your deceased spouse's Social Security benefits earlier, you cannot receive Medicare until your 65th birthday.
Regardless of your situation, you can – and should – apply for Medicare three months prior to your 65th birthday because it takes some time to process the application. Even if you are still working and have insurance, you will receive Medicare Part A automatically.
Most people are automatically enrolled in Original Medicare. If you are not automatically enrolled for any reason, you can apply from three months prior to your 65th birthday until three months after. If you miss this enrollment period, you can sign up for Medicare between January 1 and March 31.
If you want to apply to Medicare Part D or Medicare Advantage, you should sign up at the same time you sign up for Parts A and B or you will have to wait for the next enrollment period.
You can also apply online through your Social Security account. If you do not have one, you will need to create a mySocialSecurity account. You can also call Social Security at (800) 772-1213.
If you worked for the railroad, you could call the Railroad Retirement Board at (877) 772-5772. TTY users who need to call the Railroad Retirement Board should call (312) 751-4701.
You can choose Medicare Advantage in Colorado; over a third of all people in the country that have Medicare have a Medicare Advantage plan. In 2018, almost 44 percent of those in Colorado that are on Medicare chose a Medicare Advantage plan.
If you want Medicare Advantage, you can go through a private insurer in your service area. All 64 of Colorado's counties have Medicare Advantage plans available as of 2021. Some counties have more plans than others.
You can enroll in Medicare Advantage plans when you first become eligible for Medicare. Additionally, you can enroll during an annual enrollment period if you choose to switch to Medicare Advantage or choose a different plan. Open enrollment for Medicare Advantage is from October 15 through December 7, though coverage does not start until January. 1 of the next year. Finally, if you are already enrolled in a Medicare Advantage plan and want to switch to a different plan, there is a second enrollment period from January 1 through March 31.
Contact us for more information about Medicare in Colorado or compare Medicare plans and choose the best plan for your needs.