ABOUT THE PROGRAM
What is Medicare and How Does it Work?
Medicare is a federal health insurance program for individuals 65 and older and some people who receive disability benefits. Individuals interested in applying must sign up through the Social Security Administration. As a State Health Insurance Assistance Program (SHIP) designated organization, Benefits in Action can provide you with trusted, unbiased counseling services related to your Medicare options.
Enrollment
Individuals generally have 3 months before and after turning 65 to enroll in Medicare in order to avoid incurring life-long penalties on future benefits. If you are turning 65, call to learn about qualifying coverage and avoiding late enrollment penalties.
Disability Exceptions
Individuals under 65 can be eligible for Medicare if they are currently receiving Social Security Disability Insurance (SSDI) benefits (you should be automatically enrolled into Medicare after receiving these benefits for 24 months).
ALS & ESRD Exceptions
Individuals that have ALS (otherwise known as Lou Gehrig's disease) will get Medicare automatically once they begin receiving Social Security disability benefits. Those with End-Stage Renal Disease (ESRD) can get Medicare regardless of age.
The A's, B's, C's, and D's of Medicare
Part A
Hospital Insurance
Helps cover 80% of the costs for in-patient care (hospital room), skilled nursing facilities, hospice care, and limited home health care.
Part B
Medical Insurance
Helps cover 80% of the costs for doctor and health care provider services, outpatient care, home health care, durable medical equipment (wheelchairs, walkers), preventive services (screenings, vaccines, annual "wellness" visits), ambulance costs, and occupational and physical therapy.
Part C
Medicare Advantage Plan
A private health insurance plan approved by Medicare that provides Parts A & B. Many will include Part D and some may offer extra coverage including vision, hearing, and/or dental. These plans each charge different out-of-pocket costs and have different rules for how members get services.
Part D
Prescription Coverage
Helps cover the cost of prescription drugs including brand-name and generic ones. This is often joined with Original Medicare (Parts A & B) or with a Medicare Advantage Plan. Call to ensure you have qualifying coverage and to avoid costly late enrollment penalties.
Medicare Savings Programs (MSP)
Medicaid programs for individuals on Medicare who are either 65 and older OR have a disability. Helps pay for Medicare premiums, deductibles, and coinsurance (if eligible). There are four types of MSP programs, including the following:
For more information about the MSP programs, visit the Colorado Department of Health Care Policy & Financing's page on Medicare Savings Programs.
WHAT'S NEW WITH MEDICARE
Important Medicare Changes in Colorado
Significant changes went into effect recently. Here's what you need to know:
Part A, B, & D Changes
2026 ushered in cost increases and new service coverage for Medicare members.
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Part A
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The in-patient hospital deductible rose to $1,736.
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Part B
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The standard monthly premium for enrollees rose to $202.90.
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Computed Tomography (CT) colonography screenings are now covered.
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Part D
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Members with Part D now pay up to $2,100 in out-of-pocket costs for the year.
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The maximum Part D deductible increased from $590 to $615.
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Citizenship Eligibility Changes
As of July 4, 2025, eligibility for many lawfully present immigrants was reduced. This means that many non-citizen refugees, asylees, and other non-citizens are no longer eligible and will lose their benefit access by January 2027.
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No longer eligible:
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Refugees
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Asylees
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Temporary Protected Status migrants
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Still eligible for Medicare: U.S. citizens, green card holders, citizens of the Compact of Free Association nations, and certain Cuban and Haitian entrants
Not sure if these changes affect your benefits? Call our office and we'll set up an appointment to review your specific situation with one of our SHIP counselors.
Find more information about Medicare and eligibility at Medicare.gov and the Colorado State Health Insurance Assistance Program for Colorado Medicare counseling.
READY FOR COUNSELING?
How to Navigate Your Medicare Benefits
Our counselors handle the hard part for you. Choose the way that works best for you.
FREE • EXPERT HELP
Consult With a Benefits in Action (SHIP) Counselor
Our trained counselors walk you through available options and are certified by the State Health Insurance Assistance Program (SHIP). We offer a variety of services, including:
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Navigating Enrollment: Guidance on when and how to enroll in Medicare, whether you are turning 65, retiring, or qualifying due to a disability.
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Comparing Plans: Assistance in weighing the pros and cons of Medicare Advantage, Medigap (Medicare Supplement Insurance), and Part D prescription drug plans. During Open Enrollment (October 15 - December 7 of each year), we can help you decide whether you should make any changes to your current plan.
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Financial Assistance: Assistance with determining eligibility and applying for programs that lower Medicare costs, such as Extra Help or Medicare Savings Programs.
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Resolving Issues: Assistance with filing Medicare appeals, investigating billing errors, addressing coverage denials, and reporting fraud.
BE PREPARED
Documents You'll Need for Counseling
Having these on hand will improve our SHIP counselors' ability to assist you.
Medicare Card
A red, white, and blue card with information about your current Medicare health insurance
List of Medications
A list of current prescriptions that you are taking and want to have covered
List of Doctors
A list of preferred and/or current doctors that you want to continue seeing
Current Private Plan
If you are comparing private plan options through Medicare, have information on your current plan
Not sure what to gather? Our office will walk you through it – call us and we'll tell you exactly what you need.
WHAT TO EXPECT
The Medicare Counseling Process
Changing your plan or getting more information about your options can feel daunting or overwhelming, but we are here to help reduce potential stress. Work with a SHIP counselor to ensure you are well-informed about your options before making a decision about your Medicare.
Appointment With a Counselor
Schedule an appointment with our office to meet with a SHIP counselor. The appointment is over the phone, and the counselor will call you from our main number (720-221-8354).
Review Your Options
Use the information from the counseling appointment to determine your next steps. If you were comparing Medicare plans during the call, we can send you information about those plans so that you can contact them directly.
Don't Leave Benefits on the Table
Thousands of Coloradans who may benefit from other options never ask because the process feels too complicated. That's exactly why we're here. Our counselors are friendly and ready to help.
COMMON QUESTIONS
Frequently Asked Questions About Medicare in Colorado
WE CAN HELP WITH MORE
Other Benefits We Help With
Medicare is just one of many programs we can help you navigate. Our navigators assist with a wide range of Colorado assistance programs.
Grant Disclaimers
This website is supported by the Administration for Community Living (ACL) and the U.S. Department of Health and Human Services (HHS) as part of the national SHIP financial assistance award totaling $756,931, the SMP financial assistance award totaling $504,885, and the MIPAA financial award totaling $247,210 with 100% funded by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, ACL/HHS, or the U.S. Government.