Medigap or Medicare Advantage
Medicare Supplement or Medicare Advantage: choosing in Colorado
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Reviewed by Tina Price, a licensed Colorado advisor, on .
Two ways to pay for the same protection
With a Medicare Supplement (Medigap) policy you keep Original Medicare, and the policy pays most of what Medicare leaves you. You pay a premium every month whether you see a doctor or not, and in return a bad year costs you little more than a good one. Drug coverage is a separate Part D plan.
A Medicare Advantage plan replaces Original Medicare. Many charge a low premium or none on top of Part B, and you pay copays as you use care, up to the plan’s yearly limit. Most include drug coverage. The trade is the network: the plan decides which doctors and hospitals it pays for, and that list is specific to your county and to the year.
You pay the Part B premium either way ($202.90 a month for most people this year). Neither choice removes it.
The question that decides it: can you come back?
Your Medigap Open Enrollment Period runs 6 months from the month you are both 65 and enrolled in Part B. Inside it, a carrier has to sell you any policy it offers, with no health questions. After it, Colorado lets carriers ask about your health, charge more, or say no.
Why this matters more than the price
Joining Medicare Advantage later is easy; a plan can’t turn you down for your health. Getting a Medigap policy later may not be. So the choice at 65 is easier to make in one direction than to undo in the other.
You get one safety net. If Medicare Advantage is the first coverage you choose on Medicare and you leave within 12 months, you can buy any Medigap policy with no health questions. Nothing reminds you that clock is running.
Colorado has no “birthday rule”, the yearly chance some states give to switch Medigap plans without health questions. Advice written for California or Oregon doesn’t apply here. How the Medigap window works.
Five questions that sort most people
None of these has a right answer on its own. Together they usually point one way.
- Are your doctors in a network near you? If a doctor you won’t give up isn’t in any Advantage network in your county, Medigap is the way to keep them. We check this before anything else.
- How much of the year are you away? Medigap goes wherever Medicare is accepted. An Advantage plan covers emergencies anywhere, but routine care away from home depends on the plan, and a plan has to drop you after six months outside its service area unless it offers a travel benefit.
- Would you rather pay steadily or as you go? Medigap costs more each month and little when you use care. Advantage costs less each month and more when you are ill, up to its limit.
- How is your health likely to change? Nobody knows, which is the point of the window above. If you might want Medigap in five years, the cheapest time to get it may be now.
- Do the extras matter to you? Many Advantage plans add some dental, vision or hearing coverage. Medigap doesn’t, though you can buy those separately. Look at what the extras pay for before they decide anything.
Where Colorado changes the answer
Networks are set by county. A plan that suits somebody in Larimer County can leave out the specialist somebody in Weld County sees, and the other way round, so a neighbor’s plan tells you little about yours.
If you moved onto Medicare through disability before 65, Colorado requires carriers to sell you Medigap, which many states don’t. The under-65 rules are their own page.
Moving matters too. In Colorado, moving out of your plan's service area is one of the listed triggers for buying Medigap without health questions, so call before you move rather than after.
When the choice works differently
If you have Medicaid as well as Medicare, or might qualify for help with costs, the choice works differently and there are plans built for it. Start with Medicare and Medicaid together.
If you are still working with coverage through a large employer, you may not need either yet. Turning 65 while working covers that.
Questions about choosing
Can I try Medicare Advantage and switch to Medigap later?
Switching back to Original Medicare is the easy half: you can do it during Annual Enrollment (October 15 through December 7) or between January 1 through March 31.
Buying the Medigap policy to go with it is the hard half. Outside your first window, Colorado carriers can ask about your health and turn you down. The exception is the trial right: if Advantage was your first choice on Medicare and you leave within 12 months, no health questions apply.
Where does Part D fit in?
With Medigap you add a standalone Part D plan for drugs. Most Advantage plans include drug coverage. Either way, the same federal limit on what you pay for covered drugs in a year applies.
Going without drug coverage you could have had can mean a late penalty added for as long as you have Part D, so decide on drugs at the same time as the rest.
Which one costs less?
In a healthy year, Advantage usually does, because the monthly cost is lower. In a year with a hospital stay or regular treatment, Medigap often does, because you pay little beyond the premium.
The fair comparison is a whole year at your own level of care, with your own doctors and prescriptions. Send us those and we will run both.
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 or 1-800-MEDICARE to get information on all of your options.