Medicare Advantage
Medicare Advantage: what you gain, and what you trade
Figures on this page checked . Medicare and marketplace numbers reset every year — if you are reading this long after that date, call and we will tell you what moved.
It replaces Original Medicare
Also called Part C. A private carrier is paid by Medicare to provide your Part A and Part B benefits, and your care goes through that plan instead. You keep paying your Part B premium; many Advantage plans charge little or no premium on top.
Most bundle Part D drug coverage, and many add dental, vision, hearing, or fitness benefits that Original Medicare does not cover. Those extras are real and they are also the part most heavily advertised, which is a reason to keep them in proportion.
Ask about the network before the premium
An HMO generally requires you to use in-network providers and to go through a primary care physician for referrals. A PPO lets you go out of network at a higher cost. Either way there is a network, and it is specific to your county and to the plan year.
How we do it
We check your actual doctors and your actual prescriptions against the plan before you enroll, not after. A plan that is excellent in Larimer County and wrong for you are not contradictory statements.
Networks change between plan years. So do drug formularies. That is the annual check-in a broker is for.
The cap is the real benefit
Every Medicare Advantage plan is required to limit what you pay out-of-pocket for Part A and Part B services in a year. Original Medicare has no such limit at all.
If you are choosing between an Advantage plan and going without a Medigap policy, this is not close: the cap is the whole argument. The hard comparison is Advantage versus Medigap, because both solve the no-limit problem and they solve it in different currencies — one with a network, one with a premium.
Prescription drugs sit under a separate ceiling of their own, and it is one of the better things to reach Medicare in years: once your out-of-pocket spending on covered drugs hits the annual cap, covered drugs cost you nothing for the rest of the year. That applies whether your drug coverage is bundled into an Advantage plan or bought on its own.
| What it is | 2026 | 2027 |
|---|---|---|
| The most you pay for covered drugsAfter this, covered drugs cost you nothing for the rest of the year. | $2,100 | $2,400 |
| The most a plan may charge as a deductibleMany charge less, and some charge nothing. | $615 | $700 |
Both are federal limits and both are settled. What is not settled until October 1 is what any particular Colorado drug plan charges next year — carriers may not publish 2027 premiums or drug lists before then, so anyone quoting you one today is guessing.
Questions about Medicare Advantage
Can I switch back to Original Medicare later?
Yes — during Annual Enrollment each autumn, or during the Medicare Advantage Open Enrollment Period from January 1 to March 31. Getting back to Original Medicare is the easy half.
The hard half is the Medigap policy you would want alongside it. If you are outside your six-month Medigap window, Colorado carriers can medically underwrite you, and they can decline. People discover this at the moment their health has changed, which is exactly the moment it bites.
A trial right protects a first-time switch back, and it lasts twelve months. If Advantage was the first thing you chose on Medicare, you can leave inside that year and buy any supplement policy from any carrier with no health questions. Diary month ten rather than month twelve — an application takes time.
Your plan being canceled or leaving your county opens a door too, and that one runs six months rather than 63 days. Ask us before you assume either applies, and before you assume either has closed.
What happens if my plan drops my doctor’s network mid-year?
Networks can change during the year, and it happens in Colorado often enough to plan for. The plan has to notify you, and if you are in an active course of treatment you may be entitled to continue with that provider for a period.
It does not automatically open a window to change plans. Tell us as soon as you get the letter — sometimes there is an enrollment period that fits and sometimes the answer is managing it until Annual Enrollment, and knowing which one early changes what you can do.
I spend part of the year in Arizona. Does my plan travel?
Emergency and urgently needed care travels with you anywhere in the country, regardless of network. That part is not in question and no plan can make you get approval first.
Routine care away from home is a different matter and depends on your plan's own rules. The one to know about is the length of the trip: if you are outside your plan's service area for more than six months without having moved, the plan is required to disenroll you. Some plans offer a travel benefit that extends that to twelve months and some do not, and it is not something you can add later.
Four months in Arizona is fine on any plan. Seven months is a question to settle before you book the second season, not after. Tell us how much of the year you are away and we will check the specific plan.
How high can the annual cap be?
Medicare sets a ceiling each year and plans choose where they sit under it, so caps vary a good deal between plans in the same county. A lower cap is not automatically the better plan — a plan that picks a low cap is allowed higher copays on the way to it, so you can pay more per visit for a ceiling you never reach.
On a PPO there is a second number, and it is the one people miss. The figure on the brochure is the in-network cap. A plan that covers out-of-network care has to set a separate combined limit that is half again as large, and that combined figure is your real worst case if you go outside the network.
Read both off the Summary of Benefits, or send it to us and we will.
CMS-required disclaimer
We do not offer every plan available in your area. Currently we represent 7 organizations which offer 45 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.