How Medicare Advantage works
Medicare Advantage (also called Part C) is an alternative way to get your Medicare benefits. Instead of receiving coverage directly from the federal government (Original Medicare), you enroll in a plan offered by a private insurance company that contracts with Medicare.
These plans must cover at least everything Original Medicare covers (Parts A and B), but most offer additional benefits. You still pay your Part B premium, and some plans charge an additional monthly premium — though many in Colorado have $0 premiums.
Key difference: Unlike Original Medicare, which has no out-of-pocket maximum, all Medicare Advantage plans cap your annual out-of-pocket spending. In 2026, the maximum allowed by Medicare is $8,850 for in-network services — though many plans set lower limits.
Types of Medicare Advantage plans
- HMO (Health Maintenance Organization) — Requires you to use doctors and hospitals within the plan's network except in emergencies. Usually requires a referral to see specialists. Often the lowest premiums.
- PPO (Preferred Provider Organization) — Lets you see any doctor, but you pay less when using in-network providers. No referrals needed for specialists. More flexibility, often higher premiums.
- PFFS (Private Fee-for-Service) — Determines how much it will pay providers and how much you pay when you receive care. You can see any provider who agrees to the plan's terms.
- SNP (Special Needs Plan) — Designed for people with specific diseases, limited income, or who are dual-eligible for Medicare and Medicaid.
- HMO-POS (Point of Service) — An HMO that allows some out-of-network care at higher cost.
Common extra benefits in Colorado
Many Medicare Advantage plans in Colorado include benefits that Original Medicare does not cover:
- Dental care — cleanings, fillings, dentures, and sometimes implants
- Vision care — routine eye exams, glasses, and contacts
- Hearing — hearing exams and hearing aids
- Fitness programs — gym memberships like SilverSneakers
- Over-the-counter allowances — quarterly credits for OTC health products
- Transportation — rides to medical appointments
- Meal delivery — post-hospital or post-surgery meals
- Telehealth — virtual doctor visits
Colorado tip: Plan availability and benefits vary significantly by county. Denver County may have 40+ plan options, while a rural county on the Western Slope may have fewer than 10. Always compare plans for your specific ZIP code.
Pros and cons
Advantages:
- Out-of-pocket maximum protects you from catastrophic costs
- Extra benefits (dental, vision, hearing, fitness) included in many plans
- Many $0 premium options in Colorado metro areas
- Prescription drug coverage usually included
- One card, one plan — simpler to manage
Trade-offs:
- Provider networks limit which doctors and hospitals you can use
- May need referrals to see specialists (HMO plans)
- Coverage may not travel well if you spend time out of state
- Prior authorization may be required for some services
- Plan benefits can change every year at renewal
How to enroll in Medicare Advantage
You can enroll in a Medicare Advantage plan during:
- Initial Enrollment Period (IEP) — The 7-month window around your 65th birthday.
- Annual Election Period (AEP) — October 15 through December 7 each year. Coverage begins January 1.
- Open Enrollment Period (OEP) — January 1 through March 31. If you're already in a Medicare Advantage plan, you can switch to a different plan or return to Original Medicare.
- Special Enrollment Periods (SEP) — Available if you have qualifying life events like moving, losing employer coverage, or qualifying for Medicaid.