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Medicare in Colorado

Medicare in Colorado

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.

How Does Medicare Work in Colorado?

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:

  • Medicare Advantage: 4,355,921 beneficiaries
  • Medicare Part D (drug plans): 3,419,162 beneficiaries

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.

What Does Medicare Cover in Colorado?

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.

Who Qualifies for Medicare in Colorado?

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.

How Do I Apply for Medicare in Colorado?

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.

Is Medicare Advantage Available in Colorado?

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 to Learn More About Medicare in Colorado

Contact us for more information about Medicare in Colorado or compare Medicare plans and choose the best plan for your needs.

What you should read next

  The Medicare Annual Enrollment Period (AEP), sometimes called Medicare Open Enrollment or the Medicare Annual Election Period, runs from October 15 to December 7 each year. This is the time period in which Medicare-eligible consumers can make certain changes to their Medicare plans. These plan changes would then become effective on January 1. View Our Medicare Annual Enrollment Period Guide Medicare plan costs and benefits can change annually, so it's wise to review your Medicare coverage each year. Use our Guide to the Medicare Annual Enrollment Period as a resource to review your current Medicare plan on an annual basis, then call our licensed insurance agents to compare Medicare plans during AEP.  Medicare Guide to Annual Enrollment Medicare Guide Understand your Medicare plan options and learn what actions to take and when. Download your guide Call to compare Medicare plans: 1-888-605-1433 (TTY 711). Our licensed insurance agents are available to help 7 days a week. Weekdays: 8am – 11pm ET Saturday: 10am – 7pm ET Sunday: 11am – 6pm ET Overview of Medicare Enrollment PeriodsIt's important to know that the Medicare Annual Enrollment Period is different from other Medicare enrollment periods. Here’s a quick overview of the differences:Initial Enrollment Period (IEP): The 7-month initial enrollment period when you can first sign up for Medicare Parts A, B, C or D. This period spans:3 months before your 65th birthdayThe month of your 65th birthday3 months after your 65th birthdayAnnual Enrollment Period (AEP): An election period that allows you to make changes to your Medicare coverage each year. Open Enrollment Period (OEP): Applies only to those with Medicare Advantage, who can change Medicare Advantage plans or drop them and return to Original MedicareGeneral Enrollment Period (GEP): Open enrollment period to join Medicare Part A and B.Special Enrollment Period (SEP): Occurs if you have eligible life changes that mean you need to change your plan before the next annual enrollment period.Be sure to visit our guide to different enrollment periods to learn more.What’s the Difference Between Medicare AEP and the Medicare General Enrollment Period?The Medicare Annual Enrollment Period is sometimes confused with the Medicare General Enrollment period, which is January 1 to March 31 each year. It’s important to understand the differences between the two enrollment periods.The Medicare General Enrollment Period is for Medicare beneficiaries who didn’t sign up for Medicare Part A) or Part B when they first became eligible and aren’t eligible for a Medicare Part B special enrollment period. The AEP, however, is for beneficiaries who are already enrolled in Medicare and want to change their Medicare coverage.What Changes Can I Make During the Medicare Annual Enrollment Period?The first thing to know is that you cannot use the Medicare Annual Election Period to enroll in Medicare Part A or Part B for the first time.If you’re enrolled in Medicare Part A and Part B and you’d like to change your Medicare coverage, here are some things you can do during the Medicare AEP:Change Medicare Advantage plans.Change Prescription Drug (Part D) plans. Enroll in a Prescription Drug Plan.Cancel your Prescription Drug Plan.Switch from Original Medicare to a Medicare Advantage plan.Switch from a Medicare Advantage plan back to Original Medicare (and add a Part D plan or Medicare Supplement plan if needed). 5 Tips to Prepare for the Medicare Annual Enrollment PeriodThere are many Medicare insurance carriers and plan options, but there are several steps you can take to be a savvy shopper and choose the right plan for your unique needs.1. Mark Your CalendarThis may seem like an obvious tip, but it’s worth mentioning: Mark your calendar for October 15 through December 7 if you’d like to make a change to your Medicare plan.You might even set aside a few hours to research and compare Medicare Advantage plans and Prescription Drug plans ahead of October 15. These plans announce their benefits for the next year starting on October 1.Writing down these Medicare AEP dates and to-dos will help you to commit to these priorities.2. Review Your Medicare Annual Notice of ChangeYou’ll receive lots of information over the next month or so prior to and during AEP, so if you’re currently enrolled in a Medicare Advantage or Prescription Drug Plan, the Annual Notice of Change (ANOC) is one piece of mail you’ll want to read.Your Medicare plan will mail your Annual Notice of Change letter to you by September 30. The ANOC letter will inform you of most changes to your Medicare health plan, including coverage and benefits that will take effect on January 1 each year.Each year, your Medicare health plan sets the amounts it will charge you for premiums, deductibles and other services. Medicare doesn’t set these rates - but your insurance company does. With this in mind, the amounts you pay could change each year.While evaluating your current Medicare plan, you may want to ask yourself questions like:Did the plan cover the services I needed?Did I use out-of-network providers?Did I spend more out of pocket than I originally anticipated?Has something changed with my health (new diagnosis, new prescriptions, etc.)?The ANOC will also provide a side-by-side comparison of your current plan and next year’s plan benefits, costs and other changes (if any).Moral of the story: Don’t toss this piece of mail aside. Always review your ANOC to ensure your plan continues to meet your needs on an annual basis. And if you don’t receive your ANOC by September 30, contact your Medicare insurance company.3. Make a List of What’s Important to Your HealthKeeping a list of what’s important to your health is an invaluable way to prepare for the Medicare Annual Enrollment Period.Start by writing down all of your doctors, preferred health care facilities and hospitals, and prescription drugs, if you take any.We also recommend making a list of value-added benefits that may fit your health, lifestyle and budget.For example, you may be someone who likes to keep active and have social interaction. So a fitness program like SilverSneakers, which gives you access to a network of gyms and other programs, might be a good fit for you. A Medicare Advantage plan may provide these types of fitness or wellness programs.Another thing to consider is whether or not you have an elective surgery planned for 2023. If so, you’ll want to check your hospital-specific benefits under your current Medicare Advantage plan.4. Check Your Plan’s Drug FormularyYour Medicare plan’s drug formulary will not be included in your Annual Notice of Change, so be sure you call your insurance carrier to see if your prescription drugs will be covered for the 2023 plan year.If your prescription drugs aren’t covered, it’s wise to use the Medicare Annual Enrollment Period to find a plan that does cover them.5. Talk To Your DoctorAnother “Medicare must-do” is to make sure all of your doctors and healthcare facilities will remain in network with your current Medicare plan. If they aren’t, you may want to take advantage of the Medicare Annual Enrollment Period.So be sure to ask your doctor if he or she plans on changing health plan affiliations over the next year.What Changes Can I Make During the Medicare Annual Enrollment Period?The first thing to know is that you cannot use the Medicare Annual Election Period to enroll in Medicare Part A or Part B for the first time.But if you’re enrolled in Medicare Part A and Part B and you’d like to change your Medicare coverage, here are some things you can do during the Medicare Annual Election Period:Change from Original Medicare to a Medicare Advantage plan.Change from one Medicare Advantage plan to another.Disenroll from your Medicare Advantage plan and go back to Original Medicare.Change from one prescription drug plan (Medicare Part D) to another.Enroll in a prescription drug plan.Cancel your prescription drug coverage.What Are The Benefits of a Medicare Advantage Plan?Understanding your Medicare plan options - starting with a Medicare Advantage plan - is a smart first step to take because you can switch, enroll into or disenroll from Medicare Advantage plans during AEP.Medicare Advantage plans, otherwise known as “Medicare Part C” or “MA Plans,” bundle Original Medicare (Parts A and B) services into one plan. These plans are offered by private insurance companies. And while Original Medicare offers you a number of benefits, it may not cover health and medical services you might need.Medicare Advantage plans are appealing to many people because they’re considered “all-in-one” plans that give you an annual cap on your spending as well as access to extra benefits, which may include: Dental and vision coveragePrescription drug coverageAccess to fitness programsHealth incentive programsRides to medical appointmentsTelemedicine servicesNote: If you have limited income, you might also qualify for extra savings on Medicare costs through these programs.Medicare Savings Programs. These programs help pay for some of your Medicare Part A and Part B out-of-pocket costs, such as copays, deductibles and premiums. Most programs are for Medicare beneficiaries who also qualify for Medicaid. And as mentioned, Medicaid covers the majority of your costs when you join a Medicare Advantage Special Needs Plan. You can check if you qualify through your local Medicaid office.Medicare Extra Help. Extra Help reduces your Medicare prescription drug plan costs. You should contact Social Security to check your eligibility for Extra Help if you have an existing Medicare drug plan or you join one during AEP. Find A Medicare Advantage Plan During AEPTo enroll in an eligible plan during the Medicare Annual Enrollment Period, you can use our comparison tool as a guide to assess your needs and help you choose a Medicare plan. Or, you can give us a call.Our licensed insurance agents are available to help 7 days a week. Call us toll-free at 1-888-605-1433 (TTY 711). Weekdays: 8am – 11pm ET Saturday: 10am – 7pm ET Sunday: 11am – 6pm ET Tip: Be sure to have these 3 items handy before you call us or enroll in a Medicare plan online during AEP:Your Medicare number, which is found on your red, white and blue ID card.Your list of prescription drugs and preferred pharmacy.Your list of preferred doctors and hospitals.We’re here to help you compare your options and find you a Medicare plan that meets your individual needs. 
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For many seniors, having a walk-in tub can be very helpful. When you have limited mobility, getting in or out of a traditional tub can be very difficult. If you have Medicare for your health insurance coverage, you might wonder, “Can a walk-in tub be covered by Medicare?” This guide will help you understand if this type of tub is considered durable medical equipment and eligible for coverage. Let’s get started! Does Medicare cover walk-in tubs? Does Medicare cover the cost of a walk-in tub? Original Medicare covers specific types of durable medical equipment (DME) as long as you get the equipment from a DME provider that accepts assignment from Medicare.  Durable Medical Equipment must meet the following requirements: Can be used repeatedlyIs used only for a medical reasonIs used in the patient’s homeIs expected to last 3 years or longerIs not useful to people who are not sick or injuredUnfortunately, a walk-in tub is not considered DME by Original Medicare. However, if you have a Medicare Advantage plan, you may be able to get coverage for a walk-in tub using that plan if your doctor prescribes it.How much are walk-in tubs for the elderly?Walk-in tubs can be quite expensive. For a basic model, you could pay between $2,000 and $3,000. Wheelchair-accessible tubs are more than twice as expensive, with prices between $5,000 and $10,000. There’s also the cost of installation to consider, which can vary significantly based on where you live, your bathroom layout, and what types of plumbing, tile work, and other changes need to be made.Getting a walk-in tub is a significant investment, which is why so many seniors would like to have help from Medicare in paying for it.How to get Medicare to pay for a walk-in tubWhile you won’t be able to get Original Medicare to pay for a walk-in tub, you might have better luck with a Medicare Advantage plan. These plans can offer additional benefits above and beyond what Original Medicare provides.Before you choose a Medicare Advantage plan, make sure it fits your needs. For example, they often have specific medical provider networks, and you’ll want to ensure that your preferred doctors and specialists are included. You also want to compare monthly premiums, deductibles, and copayments when you are deciding between plans.A walk-in tub can help you significantly if you have mobility issues, but there are other options that are less expensive. For example, you might look to installing grab bars in your bathroom to help you balance. These can cost as little as $75, up to $200 or so.Keep in mind that Original Medicare doesn’t cover these items, but a Medicare Advantage plan might. This could provide savings to you not just in terms of the walk-in shower, if covered by the plan, but with your overall Medicare costs.  Contact us to learn more about Medicare and walk-in tubsIf you have questions about other aspects of your Medicare coverage, we’re here to help. When you’re comparing Medicare plans and trying to choose the right option for your needs, talking to a licensed agent can help put your mind at ease.Contact us today to compare plans or ask questions about your Medicare coverage!
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You might remember when the price tag of the EpiPen made headlines in 2016. The cost of this life-saving medication, used to treat severe allergic reactions, went from $93.88 to $608.61 in a seven-year timeframe - a 500% price increase by drug manufacturer Mylan Pharmaceuticals. While the EpiPen story was an extreme case, it's not uncommon for prescription drugs to increase in price and become unaffordable. That's why you want to make sure you're paying the best price for your prescriptions.  Here are 6 tips to save money on prescription drugs & be a savvy shopper. #1. Buy Generic Brands This may be a no-brainer for some, but it's a cost-saving tip worth remembering. Generic drugs can be significantly cheaper than brand-name versions. While everyone benefits from generic drug prices, people over age 65, especially, saved $75 billion in 2016 by choosing generic drugs. It's important to know that you're not compromising the quality of the drug if you choose a generic brand: The FDA says that generic drugs have the same active ingredients and effectiveness of brand-name drugs - a part of the FDA's approval process. So if your doctor prescribes a brand-name drug, ask if there's a generic equivalent. The savings are worth the effort. #2. Join Rewards ProgramsCertain stores or pharmacies may offer coupons or rewards programs. Every rewards program is different, but in general: You can join a store's program (sometimes for free or for a small monthly payment) and earn points based on purchases. You can then use those points towards in-store purchases.You might also receive other perks like free 1 – 2 day shipping for prescriptions, 24/7 pharmacy consultations, or points for reporting wellness activities like walking or running. There are many reward programs to choose from - CVS ExtraCare Pharmacy & Health Rewards, Meijer mPerks, and Rite Aid wellness+ rewards are just three examples.#3. See If Your Drugs Qualify for Home DeliveryYou might save money if you get your prescription drugs shipped directly to your home. In some cases, you can order a 60- to 90-day supply for a better price than buying the drug in person at your local pharmacy. Prescription home delivery also makes sense if you're unable to drive or want the convenience of not having to travel to the pharmacy to pick up medications. Just be sure to check with both your doctor and your insurance company to make sure the home delivery option is available for your specific prescription drug.#4. Get A Prescription Savings CardPrescription savings cards provide discounts or coupons for medications at thousands of retailers nationwide. Many companies such as GoodRx and WellRx now offer them. Some even allow you to use them for pet prescriptions. Prescription savings cards typically show you where a drug is available and what the prices are at certain pharmacies.Simvastatin is a popular drug used to lower cholesterol and reduce the risk of stroke or heart attack. The average retail price of Simvastatin is around $66.39, but it can be as low as $4.00 prescription savings card. Prescription savings cards are suitable for almost everyone. However, it's important to check out the fine print to see what's covered.#5. Apply For Extra HelpYou may qualify to get help paying for your Medicare Prescription Drug Plan monthly premiums, annual deductibles and copayments through the Extra Help program.#6. Know Your Coverage OptionsIf you're enrolled in Original Medicare (Part A & B) and need prescription drug coverage, you have to sign up for a Medicare Prescription Drug Plan (Part D) or a Medicare Advantage (Part C) plan, but you can't have both. Call us today to compare plans and see if you qualify: 1-800-620-4519. This article is for general education purposes and does not replace the advice of a medical professional. Always seek the guidance of your physician or a medical professional for medical advice, diagnosis, and treatment. Outside of the Medicare Annual Enrollment Period, you can only enroll in a Medicare Advantage or Medicare Part D plan if you meet certain criteria.
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