How to Compare Medicare Advantage Plans in CO

If you live in Colorado, you know that life in Denver is very different from life in Durango. The same is true for your healthcare options. When it comes to Medicare, your zip code plays a huge role in determining what’s available to you. The plans offered in one county can be completely different from those just one county over. This is especially true for Medicare Advantage plans in CO, which are built around local networks of doctors and hospitals. This guide will walk you through how these plans work specifically for Coloradans, helping you understand your local choices and find a plan that fits your community.

Key Takeaways

Know the core trade-off: Medicare Advantage plans offer an all-in-one alternative to Original Medicare, often with extra perks, but this convenience usually requires you to use a specific network of doctors and hospitals.
Match the plan to your personal needs: Before you start comparing, make a simple list of your doctors, prescriptions, and health priorities. This checklist is the most important tool for finding a plan that truly covers you.
Act at the right time and place: Your plan options depend on your zip code and can only be changed during specific enrollment periods. Use the official Medicare Plan Finder and Colorado’s free SHIP counselors to get accurate, personalized information.

What Are Medicare Advantage Plans in Colorado?

When you become eligible for Medicare, you have a choice. You can go with Original Medicare (Parts A and B), the government-run program, or you can choose a Medicare Advantage Plan. Think of Medicare Advantage, also known as Part C, as an all-in-one alternative offered by private insurance companies. These plans bundle your hospital, medical, and often prescription drug coverage into a single package. It’s a popular choice for many in Colorado, but it’s important to understand how they work before deciding.

How They Differ from Original Medicare

The biggest difference is who manages your coverage. Original Medicare is administered by the federal government. Medicare Advantage Plans are offered by private insurance companies approved by Medicare. To join one, you must first be enrolled in both Medicare Part A and Part B. While these plans are run by private businesses, they must follow strict rules set by Medicare to ensure you get, at a minimum, the same coverage as Original Medicare. This structure gives you more health plan options beyond the standard government program, allowing you to pick a plan from a private insurer that might better fit your needs.

Common Features and Benefits

A major reason people choose Medicare Advantage is the extra coverage. These plans must cover everything that Original Medicare does—like doctor visits and hospital stays—but most go a step further. The majority of plans include prescription drug coverage (Part D), so you don’t have to sign up for a separate drug plan. Beyond that, many offer benefits that Original Medicare doesn’t, such as routine dental cleanings, eye exams, and hearing aids. Some plans even include perks like gym memberships or transportation to medical appointments. Bundling these benefits into a single plan can make managing your healthcare simpler and more predictable.

Plan Types You’ll Find in Colorado

Not all Medicare Advantage Plans are structured the same way. In Colorado, you’ll find several different types, with the most common being Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). With an HMO, you generally need to use doctors and hospitals within the plan’s network and get a referral to see a specialist. A PPO plan offers more flexibility to see providers both in and out of network, though your costs are lower if you stay in-network. Other options include Special Needs Plans (SNPs) for people with specific health conditions. You can compare types of Medicare Advantage Plans to see which structure aligns best with your preferences.

Who Offers Medicare Advantage Plans in Colorado?

When you start looking for a Medicare Advantage plan, you’ll notice that they aren’t offered by the government itself. Instead, these plans (also known as Part C) come from private insurance companies that have been approved by Medicare. In Colorado, you’ll find a variety of carriers, but the specific plans available to you will depend on your zip code. Someone living in Denver will see different options than someone in Grand Junction.

The good news is that this competition between companies means you have choices. The tricky part is that comparing them can feel like a full-time job. You’ll see familiar names like UnitedHealthcare, Aetna, Kaiser Permanente, Anthem, and Humana, each with its own set of plans, costs, and benefits. It’s a lot to sort through, but understanding who the main players are and how to evaluate their offerings is the first step toward finding a plan that truly fits your life.

How We Help You Find the Right Plan

The official starting point for anyone exploring their options is the Medicare Plan Finder tool on the government’s website. By simply entering your zip code, you can see a full list of the Medicare Advantage plans available in your area. While this tool is comprehensive, it can also be overwhelming. It gives you the “what,” but not necessarily the “why” or the “what if.”

That’s where we come in. We help you make sense of the information you find there. Think of us as your personal translator for all the insurance jargon. We’ll sit down with you, look at the plans available in your county, and help you compare the details that matter most—like whether your doctor is in the network or if your prescriptions are covered at a reasonable cost.

A Look at Major Insurance Carriers

In Colorado, you’ll see several major insurance carriers offering Medicare Advantage plans. Companies like UnitedHealthcare, Aetna, Kaiser Permanente, Anthem, and Humana are some of the most common providers across the state. Each one offers a range of plans designed to meet different health needs and budgets.

For example, some analyses point to Aetna and UnitedHealthcare as having some of the best plans in Colorado. UnitedHealthcare often provides a mix of HMO and PPO plans, giving you flexibility in how you see your doctors. Aetna is known for plans that include strong dental, vision, and hearing benefits, as well as Special Needs Plans for people with specific health conditions.

How to Understand Plan Ratings

One of the most helpful tools for comparing plans is the Medicare Star Rating system. The government rates all Medicare Advantage plans on a scale of 1 to 5 stars, with 5 stars being the highest quality. This rating is based on dozens of factors, including how the plan’s members rate the care they receive, customer service quality, and how well the plan helps members stay healthy.

When you’re looking at a list of health plan options, the star rating gives you a quick, at-a-glance way to gauge a plan’s performance. A plan with 4 or 5 stars has a proven track record of satisfying its members. It’s a simple yet powerful way to narrow down your choices and focus on the plans that are consistently delivering for people just like you.

What Do These Plans Actually Cover?

One of the most common questions we get is, “What am I actually paying for?” It’s a great question. Medicare Advantage plans, also known as Part C, are offered by private insurance companies approved by Medicare. The most important thing to know is that by law, they must provide at least the same level of coverage as Original Medicare (Part A for hospital care and Part B for medical care). But many of them go a step further, bundling other types of coverage into one convenient plan. Let’s break down what you can typically expect.

Doctor Visits and Hospital Stays

At a minimum, every Medicare Advantage Plan must cover the services that Original Medicare covers. This means your hospital stays (Part A) and doctor visits (Part B) are included. To enroll in one of these private health plans, you must first be signed up for both Medicare Part A and Part B. Think of a Medicare Advantage Plan as an alternative way to receive your Medicare benefits, often with a few extra benefits rolled in. So, whether you need a routine check-up with your primary care physician or require a hospital stay for a procedure, your Part C plan has you covered.

Prescription Drug Coverage

One of the biggest draws of Medicare Advantage plans is that most of them also include drug coverage (Part D). This is incredibly convenient because it bundles your medical and prescription benefits into a single plan with one monthly premium and one ID card. Instead of signing up for a separate Part D plan, your prescriptions are managed through your Medicare Advantage plan. This integrated approach simplifies your healthcare and can often be more cost-effective. Just be sure to check the plan’s formulary (its list of covered drugs) to ensure your specific medications are included.

Extra Perks: Dental, Vision, and Hearing

This is where Medicare Advantage plans really stand out. Many plans offer benefits not covered by Original Medicare, such as routine dental exams, vision care like glasses or contacts, and hearing aid coverage. Some plans even include benefits like gym memberships (through programs like SilverSneakers), transportation to doctor appointments, and meal delivery after a hospital stay. These extra perks are designed to support your overall health and well-being, filling in some of the critical gaps left by Original Medicare. When comparing plans, it’s worth looking closely at these additional benefits to see how much value they could add for you.

Can You Keep Your Doctor? (HMO vs. PPO)

This is a crucial question. The answer depends on the type of plan you choose. The most common types of Medicare Advantage Plans are HMOs and PPOs. With an HMO (Health Maintenance Organization), you generally must use doctors, specialists, and hospitals within the plan’s network, except in an emergency. A PPO (Preferred Provider Organization) offers more flexibility, allowing you to see out-of-network providers, though you’ll usually pay more for that care. Before enrolling, it is essential to check the plan’s provider directory to confirm that your trusted doctors and preferred hospitals are in-network.

Breaking Down the Costs of a Medicare Advantage Plan

When you start looking at Medicare Advantage plans, the first thing you probably notice is the low monthly premium. While that’s certainly a plus, it’s only one part of your total healthcare spending. To get a true picture of what a plan will cost, you need to look at all the pieces together: the monthly fee, what you pay for services, and your prescription expenses. It can feel like a lot to juggle, but understanding these different costs is the key to finding a plan that truly fits your budget and your health needs. Let’s walk through each one so you know exactly what to look for.

Your Monthly Premium

The monthly premium is the fixed amount you pay to the insurance company to keep your plan active. In Colorado, you’ll find many plans with a $0 premium. This can be a fantastic way to save money, but remember that you must continue to pay your monthly Medicare Part B premium to the government. Think of the Advantage plan premium as an additional cost (or in many cases, no additional cost) on top of your Part B premium. A low premium is great, but it’s important to balance it with the other out-of-pocket costs you might face when you actually need care.

Deductibles, Copays, and Coinsurance

These are the costs you pay when you actually use your health care. Each plan sets its own amounts, so this is where you’ll see big differences.

A deductible is the amount you have to pay for your medical care before your plan starts to pay its share.
A copay is a flat fee you pay for a specific service, like $25 for a specialist visit.
Coinsurance is a percentage of the cost you pay for a service, like 20% of the bill for a hospital stay.

The Colorado Division of Insurance provides a great overview of these health insurance coverage options. A plan with a $0 premium might have higher copays or a larger deductible, so it’s a trade-off you’ll want to consider based on how often you expect to see a doctor.

The Most You’ll Pay in a Year

One of the most important features of a Medicare Advantage plan is the out-of-pocket maximum. This is a yearly limit on what you’ll spend on deductibles, copays, and coinsurance for covered medical services. Once you hit this limit, your plan pays 100% for the rest of the year. This provides a crucial financial safety net that Original Medicare doesn’t offer on its own.

It’s important to know that this maximum generally doesn’t include your prescription drug costs. For drugs, you’ll want to look at the plan’s coverage structure, which includes a phase known as the coverage gap, or “donut hole.” This is a temporary limit on what your plan will cover for drugs, meaning your costs could go up for a period of time.

Watch Out for These Potential Costs

Beyond the standard costs, a few things can lead to unexpected bills if you’re not careful. First, every plan that includes drug coverage has a list of covered medications called a “formulary.” If your doctor prescribes a drug that isn’t on your plan’s list, you could end up paying the full price. Always check the formulary to make sure your essential medications are included.

Another potential cost comes from the plan’s network. If you see a doctor or visit a hospital that is not in your plan’s network, your costs could be significantly higher. Finally, if you choose a plan without drug coverage and don’t have another form of creditable prescription coverage, you could face a permanent late enrollment penalty if you decide to add it later.

How to Compare Your Plan Options in Colorado

Okay, you’ve seen the commercials and gotten the mailers. Now it’s time to actually compare your Medicare Advantage plan options. It can feel like a lot, but you don’t have to sort through it all by yourself. There are some fantastic, straightforward tools and resources available right here in Colorado to help you find a plan that truly fits your life. Let’s walk through a few key steps that will make the process much clearer and help you choose with confidence.

Use the Official Medicare Plan Finder Tool

Your best first step is to head over to the official Medicare Plan Finder tool. This is the government’s own website, so you know the information is unbiased and up-to-date. Simply enter your ZIP code, and it will show you a comprehensive list of the Medicare Advantage plans available in your specific part of Colorado. You can see plans from major carriers like Humana, Aetna, and Kaiser Permanente all in one place. The tool lets you filter the results based on what’s most important to you, making it much easier to narrow down your choices from the start.

Get Help from State Counselors (SHIP)

You are not alone in this process. Colorado has a fantastic free resource called the State Health Insurance Assistance Program, or SHIP. Think of them as your personal Medicare guides. SHIP provides free, private, one-on-one counseling to help you with your questions. They aren’t trying to sell you anything; their only goal is to help you understand your options. If you’re feeling stuck or just want to talk through your choices with an expert, you can get personalized guidance by calling them directly at 1-888-696-7213. It’s a great way to get clear, unbiased answers.

Decode the Star Ratings

As you look at different plans, you’ll notice they have star ratings. This system is a simple but powerful way to gauge a plan’s quality. The Centers for Medicare & Medicaid Services (CMS) rates each plan on a scale of 1 to 5 stars, with 5 being the best. These star ratings aren’t arbitrary; they’re based on real feedback and data, including member satisfaction surveys and how well the plan helps people stay healthy. A plan with a high star rating is generally a solid choice, so be sure to factor this into your decision. It’s a quick snapshot of a plan’s overall performance.

Check the Plan’s Doctor and Pharmacy Network

This step is absolutely critical. Before you even think about enrolling, you need to confirm that your trusted doctors, specialists, and preferred hospitals are in the plan’s network. Most insurance company websites have an online directory you can search. The same goes for your prescriptions. Check the plan’s pharmacy network to make sure your local pharmacy is included and, more importantly, look at the plan’s formulary (its list of covered drugs) to ensure your medications are on it. Taking a few minutes to verify your providers and prescriptions can save you from unexpected costs and headaches down the road.

Choose the Right Plan: 4 Key Factors

With so many options, it’s easy to feel stuck. But choosing the right Medicare Advantage plan doesn’t have to be overwhelming. It’s all about matching a plan’s features to your personal needs. By focusing on a few key areas, you can cut through the noise and find a plan that truly works for you. Think of it as a checklist for your peace of mind. Let’s walk through the four most important factors to consider: your health, your doctors, your prescriptions, and the extra perks that might matter to you.

Consider Your Health Needs

First, take a moment to think about your overall health. Are you managing a chronic condition, or do you only see a doctor for annual check-ups? Your answer will guide your decision. While some Medicare Advantage plans can be cheaper than Original Medicare plus a Medicare Supplement plan, they usually require you to use doctors and hospitals within their network. If you anticipate needing specialized care, you’ll want to look closely at plans that offer strong coverage for your specific health needs and give you access to the right specialists. It’s a balance between monthly costs and the freedom to see any provider you choose.

Confirm Your Doctors Are In-Network

If you have a primary care doctor or specialists you love, you probably want to keep seeing them. Before you enroll in any plan, it’s critical to check if they are included in the plan’s network. You should always “make sure your current doctors are part of the plan’s network if you want to keep seeing them.” A plan’s network is simply the list of doctors, hospitals, and clinics it has partnered with. Seeing an out-of-network provider can lead to much higher costs or no coverage at all. You can usually find a plan’s provider directory on its website or call your doctor’s office directly to ask which plans they accept.

Make Sure Your Prescriptions Are Covered

Prescription drug costs can add up quickly, so this step is essential. Every Medicare Advantage plan with drug coverage has its own list of covered medications, called a “formulary.” According to the Colorado Division of Insurance, which outlines drug insurance coverage options, “If your drug isn’t on the list, you pay full price.” Before you start comparing, make a list of all the medications you take, including the dosage. Then, for each plan you consider, you’ll need to check its formulary to confirm your drugs are covered and see how much they’ll cost. This single step can save you from hundreds or even thousands of dollars in unexpected expenses.

Weigh the Value of Extra Benefits

One of the biggest draws of Medicare Advantage plans is the extra perks they offer. These plans cover everything Original Medicare does and often add extra benefits like dental, vision, and hearing coverage. Many also include fitness programs like SilverSneakers, transportation to medical appointments, or allowances for over-the-counter products. While these extras are appealing, it’s important to be realistic. Will you actually use that gym membership? Do you need extensive dental work? Consider the real value these benefits add to your life and weigh them against other factors, like the plan’s network and prescription costs.

When Can You Enroll or Change Plans?

One of the most important things to understand about Medicare is that you can’t just sign up or switch your plan whenever you want. Medicare has specific enrollment periods, and knowing when they are is key to getting the coverage you need without any gaps or penalties. Think of these as your windows of opportunity to make a choice.

Missing one of these windows could mean waiting a whole year before you can make another change. That’s why it’s so helpful to get these dates on your calendar. Whether you’re just turning 65, already on Medicare but thinking about a switch, or experiencing a major life change, there’s a specific time for you to act. Let’s walk through the main enrollment periods so you know exactly when you can enroll in or change your Colorado Medicare Advantage Plan.

When You First Become Eligible

Your first opportunity to enroll in a Medicare Advantage Plan is during your Initial Enrollment Period. For most people, this is the seven-month window that starts three months before the month you turn 65, includes your birthday month, and ends three months after. For example, if your birthday is in June, your enrollment period runs from March 1 to September 30.

This is your prime time to sign up without facing any late enrollment penalties. You can also qualify for Medicare before 65 if you have a disability. In that case, your Initial Enrollment Period will be based on your 25th month of receiving disability benefits. Understanding your personal timeline is the first step to exploring your health plan options.

The Annual Open Enrollment Window

Every year, there is a set time when anyone with Medicare can review their coverage and make changes for the upcoming year. This is the Annual Open Enrollment Period, and it runs from October 15 to December 7. During this window, you can switch from one Medicare Advantage Plan to another, move from Original Medicare to a Medicare Advantage Plan, or go back to Original Medicare.

This is your chance to make sure your plan still fits your needs. Perhaps your health has changed, your prescriptions are different, or you want a plan with better dental benefits. Any changes you make during this period will take effect on January 1 of the next year, giving you a fresh start with your new coverage.

Qualifying for a Special Enrollment Period

Life doesn’t always stick to a schedule, and Medicare understands that. Certain life events can trigger a Special Enrollment Period (SEP), which allows you to make changes to your coverage outside of the usual enrollment windows. These events are specific and can include things like moving to a new address that isn’t in your current plan’s service area, losing other health coverage (like from an employer), or if your plan changes its contract with Medicare.

An SEP gives you a limited time—usually two months—to choose a new plan. It’s not a free-for-all; you have to have a qualifying reason. This provides a safety net so you’re not left without appropriate Medicare coverage options when unexpected changes happen.

How to Make a Change

When you’re ready to make a change during an enrollment period, you have a few ways to do it. A great starting point is the official Medicare Plan Finder tool on Medicare.gov. If you log in, you can create a personalized list of your prescription drugs, which makes it much easier to compare plans and see your estimated costs for each one.

Once you’ve found a plan you like, you can enroll directly through the Medicare website, on the insurance company’s website, or by calling them. You can also work with a licensed insurance agent who can walk you through the process and submit the application for you. Just remember, when you enroll in a new plan, you’ll be automatically disenrolled from your old one.

Does Your Colorado Zip Code Matter?

When it comes to Medicare Advantage plans, your address is more than just a mailing location—it’s a key factor that shapes your options. The short answer is yes, your Colorado zip code absolutely matters. Insurance companies offer different plans in different parts of the state, meaning the choices available in downtown Denver can be completely different from what you’ll find in Grand Junction or a small mountain town.

This isn’t just about which company offers a plan; it also affects the plan’s cost, the network of doctors and hospitals you can use, and even the extra benefits included. Think of it like local real estate—what you get for your money changes from one neighborhood to the next. Understanding how your location influences your Medicare choices is the first step to finding a plan that truly fits your life and health needs right here in Colorado.

Plan Differences Between Urban and Rural Areas

Insurance companies build their Medicare Advantage plans around local networks of doctors, specialists, and hospitals. Because of this, you’ll often find more plan options in urban areas like Denver, Colorado Springs, and Fort Collins, where healthcare providers are more concentrated. These areas might have a wider variety of HMOs and PPOs from several different carriers.

In more rural parts of Colorado, your choices might be more limited. An insurance company may decide to offer plans only in certain counties, which can result in fewer carriers to choose from. This doesn’t mean you can’t find a great plan; it just means you’ll need to look closely at the networks and benefits of the plans that are available in your specific county to ensure they meet your needs.

Find Plans Available in Your County

So, how do you cut through the noise and see exactly what’s available to you? The best place to start is the official Medicare website. The government’s Medicare Plan Finder tool is designed for this exact purpose. By simply entering your zip code, you can see a detailed list of every Medicare Advantage plan offered in your county.

This tool allows you to compare plans side-by-side, looking at everything from monthly premiums and deductibles to prescription drug costs and provider networks. It’s the most accurate and unbiased way to get a clear picture of your options. Using this resource ensures you’re only spending time considering plans you are actually eligible to enroll in, saving you from potential frustration down the road.

Tap Into Local Health Resources

You don’t have to figure this all out on your own. Colorado offers a fantastic free resource to help you make sense of your Medicare options. The State Health Insurance Assistance Program, or SHIP, provides free, confidential, and unbiased counseling. These trained counselors can answer your specific questions about the plans in your area, help you understand the costs, and walk you through the enrollment process.

This is a state-run program, so their goal is simply to help you understand your choices. You can get personalized help from Colorado’s SHIP counselors by calling them directly at 1-888-696-7213. It’s a great way to get one-on-one support from a local expert who knows the ins and outs of Colorado’s Medicare landscape.

Look for Benefits Unique to Colorado

One of the main draws of Medicare Advantage plans is that they often include extra perks not covered by Original Medicare. These benefits can vary widely from one plan and county to another, making it even more important to see what’s offered in your zip code. Common extras include coverage for dental, vision, and hearing services, which are essential for maintaining overall health.

Beyond that, you might find plans that offer fitness memberships like SilverSneakers, allowances for over-the-counter health products, transportation to medical appointments, or even meal delivery after a hospital stay. When comparing plans, don’t just look at the medical coverage. Consider how these extra benefits could add value and support your lifestyle here in Colorado.

Frequently Asked Questions

If I join a Medicare Advantage plan, do I still have Medicare? Yes, you absolutely do. Think of it this way: you are still in the Medicare program, but you’re choosing to get your benefits from a private insurance company instead of directly from the government. You must remain enrolled in Original Medicare (both Part A and Part B) and continue paying your Part B premium. A Medicare Advantage plan simply becomes your primary coverage, often bundling your hospital, medical, and drug benefits into one package.

I see a lot of $0 premium plans advertised. Is there a catch? That’s a great question. While many plans do have a $0 monthly premium, it doesn’t mean they are completely free. The “catch” is that you’ll still have out-of-pocket costs like deductibles, copays, and coinsurance when you visit a doctor or receive a service. A plan with a $0 premium might have higher copays than a plan with a monthly premium. It’s a trade-off, so you’ll want to look at the total potential costs, not just the monthly fee.

Can I switch back to Original Medicare if I don’t like my Advantage Plan? Yes, you have opportunities to make a change. The main window to do this is during the Annual Open Enrollment Period, which runs from October 15 to December 7 each year. During that time, you can switch from your Medicare Advantage Plan back to Original Medicare and also sign up for a separate Part D prescription drug plan. This gives you a chance every year to make sure your coverage is still the right fit for you.

What happens if I travel? Am I covered outside of Colorado? This really depends on the type of plan you have. If you have an HMO plan, your coverage is generally limited to your plan’s local network, except for emergencies or urgent care. PPO plans offer more flexibility, allowing you to see out-of-network providers, but you’ll likely pay more for that care. If you travel frequently within the U.S., a PPO plan might be a better fit. For international travel, most Medicare Advantage plans do not offer coverage, so you would need to look into a separate travel insurance policy.

My doctor is really important to me. What’s the best way to make sure I can keep seeing them? This is one of the most important steps you can take. Before enrolling in any plan, you must confirm that your doctor is in its network. The most reliable way to do this is to call your doctor’s office directly and ask which Medicare Advantage plans they accept for the upcoming year. You can also use the provider directory on the insurance company’s website, but calling the office is the best way to get the most current information.