MEDICARE Start Quote Request Please enable JavaScript in your browser to complete this form.QualificationsAre you resident of the State of Colorado *YesNoWhat are you looking for? (Check all that apply)Plan with no premium ($0 per month)Vision IncludedDental IncludedHearing Aid IncludedTransportation to medical appointments IncludedGym Membership includedOver-the-counter items includedAcupuncture IncludedTelehealth IncludedGift card Rewards for making healthy choices$0 cost generic drugs includedDo you have or are you planing to get Medicare Part A AND Medicare Part B in the near future? *YesNoYou must have BOTH Part A AND Part BAre you NEW to Medicare? - Are you in your 7-months IEP (Initial Election Period)? (3 months before the month of your birthday, the month of your birthday or no more than 3 months after the month of your birthday) *YesNoAre you enrolling during AEP (Annual Enrollment Period) from October 15 until December 7? (Everyone can enroll during this period) *YesNoAre you enrolling during OEP (Open Enrollment Period) from January 1 until March 31? (You must have an active Medicare Advantage Plan and can only make one change during this period.) *YesNoThen, you must have a Special Election to be able to enroll at this time. Click all that apply *I recently lost or will terminate employer health insurance (including union or COBRA).I recently moved or will be moving to Colorado from another State.I have Medicaid and/or LIS (Can only use once per quarter)I gained, lost or change Medicaid status in the last 3 months.I dropped a Medicare Supplement plan and I am on a 12 months Medicare Advantage Trial Right.I elected a Medicare Advantage when I first got Medicare but now I want a Stand-Alone (and possibly a Medicare Supplement) before the end of my 12 months trial period.I will like to enroll in a 5 star planI was auto enrolled by Medicare or State and want to change within the first 3 months.I was affected by FEMA-declared emergency/disaster area.I was recently released from incarceration.I recently obtain lawful status in the United States of America.I involuntarily lost creditable Prescription Drug coverage as good as Medicare.I am moving, residing in or moving out of a Long Term Care facility.I have made a permanent move, notified of a move or were disenrolled due to out-of-service-area.I gained, lost or had a change in LIS/Extra Help status within the last 3 months.I recently disenrolled from the Program of All-inclusive Care for the Elderly (PACE).I belong to a State Pharmaceutical Assistance Plan (SPAP) or lost SPAP eligibility.I recently returned to the United States after living permanently outside of the U.S.None of the listed elections apply, however I have special circumstance to be allowed to enroll (Note: app will pend).Do you get help from your State Medicaid office for MEDICAL expenses? Medicaid is a special program from your state that helps people with out-of-pocket expenses if their income is too low. *YesNoI don't knowIs there a particular company or plan that you are mostly interested? *YesNo - I am open to all companiesWhat company or companies are you mostly interested? *AllAetnaAnthem Blue Cross and Blue ShieldBright HealthCignaHumanaUnitedHealthcareOtherWhat "Other" company are interested? *Do you know what type of Medicare Advantage plan you are mostly interested (ex. HMO, PPO, PFFS or SNP)? *YesNo - I don't know what those initials mean..Select what type of Medicare Advantage plan you are mostly interested. *HMO - Most popular, has more benefits and less out-of-pocket, must stay in-network, most plans require referrals, only allows Emergency or Urgent service outside the area you reside.PPO - Second most popular, less benefits, higher co-payment than HMO, can go out of network but it cost more, no referrals to specialists required, most plans allow making appointments for doctors and procedures in all United States (but not all PPO will allow).PFFS - not very popular, very similar to PPO except that when you go out-of-network does not cost more for most servicesSNP - Special Needs Plan is for people with certain health conditions or on MedicaidOtherWhat "Other" plan or plans are you interested *Do you need to see doctors in different areas or states (Travel for extended time)? Do you have more than one place you live for longer than 2 months? *YesNoNote: You might need a plan that allows you to see providers in different areas.What "Other" areas? Enter City, State and Zip Code *How do you feel about Networks? What amount of freedom would you like to have with your providers (Doctors, Hospitals, etc.) *I don't care. I don't mind being constrained to a network of provider because usually I will save money that way.I would like to go to any doctor I want. I don't like being restricted to a network even though I know it will cost me more.How do you feel about the plan requiring referrals to be able to see specialists? *I don't care. I don't mind referrals. A lot of specialists require referrals anyway and my primary doctor also give me referrals when I need one.I would like to keep going to my specialists without needing a referral from my primary care doctor.Do you need a plan that includes Prescription Drug coverage? If you have a plan that covers prescription drugs (for example, from an employer retirement plan or VA), you might consider a plan without Prescription Drug coverage. --Warning-- If you get a plan without prescription drug coverage and you don't have prescription drug insurance that is "Creditable" (as good as Medicare), you will pay a penalty in the future if you decide you need prescription drug coverage then. *Yes, I want to have drug coverage.No, I am a veteran or I am getting "Creditable" Prescription elsewhere.No, I don't have other "Creditable" prescription drug coverage, I don't think I need it and I am aware of the penalty.Do you currently have an active Medicare Advantage Plan? *YesNoI don't knowWith what company do you have your current plan? *Do you want to make sure the new plan covers any particular prescriptions? *YesNoNo, I don't take any prescription drugsEnter all the drugs you would like to make sure the plan covers: Name, dosage (ml) and quantity needed per month or per day (Check the bottle for correct spelling of the name) *Do you prefer any particular pharmacy? *YesNoEnter the name of one or two pharmacies you prefer *How important is for you to stay with your Primary Care Doctor? *Very important. I will not change my primary doctor even if I have to pay more.I prefer to stay but I could consider changing if there is a significant savings on the plan.Not very important. I don't have a primary doctor or I don't mind changing.Who is your Primary Care Doctor? *What is your Primary Care Doctor Zip Code? *Do you have other Specialist doctors (ex. Cardiology, Dermatology, etc.) that you definitely MUST have in the plan network and you will not want to change? *YesNoEnter all the doctors you need to be in network. Make sure to enter First Name, Last Name and Zip Codes (or city where is located). *Are there any particular Hospital or Hospitals you require to be in your plan network? *YesNoIs the University of Colorado Hospital (UCHealth) in Aurora one of those hospital or hospitals? *YesNoList any additional hospitals *List all the hospitals you require to be in network *Name *FirstLastEmail *Optional PhoneZip Code *County *Add any Notes, comments, questions or special request-------------------------------------------------------------Resident State Qualification *Sorry, I cannot give you a quote outside Colorado, you must be a resident of ColoradoMedicare Qualification *You do not qualify because you must have Medicare Part A AND Part BElection Period QualificationYou might not be able to enroll right now if you do not have an election period at this timeYou might have to wait until the Annual Election Period (October 15 to December 7 to sign up for a plan). Everyone qualify during this time!-------------------------------------------------------------After answering all questions with *, place a check mark on each suggestion and click Summit Quote RequestYour Medicare Plan Type *Based on your response, it looks like you will be good with an HMO plan.Your Medicare Plan Type *Based on your response, it looks like you will be good with an HMO plan without prescription drug coverage.Your Medicare Plan Type *Based on your response, it looks like you want a PPO but you can consider an HMO that does not require referrals (like Humana HMO, for example)Your Medicare Plan Type *Based on your response, it looks like you want a PPO.Your Medicare Plan Type *Based on your response, it looks like you want a PPO without prescription drug coverage.Your Medicare Plan Type *Based on your response, it looks like you need a PPO plan.Your Medicare Plan Type *Based on your response, it looks like you need a PPO plan without prescription drug coverage..Your Medicare Plan Type *Based on your response, you might need a PPO. It depends on the areas you reside. If you live in different states for extended time, you need a National PPO. Otherwise, you might be good with a local PPO or a HMO plan.Your Medicare Plan Type *Based on your response, you might need a PPO without drug coverage. It depends on the areas you reside. If you live in different states for extended time, you need a National PPO without drug coverage. Otherwise, you might be good with a local PPO or a HMO plan without drug coverage.Your Medicare Plan Type *Based on your response, you might need a PPO. It depends on the areas you reside. If you live in different states for extended time, you need a National PPO. Otherwise, you might be good with a local PPO or a HMO that doesn't require referrals (like Humana HMO, for example)Your Medicare Plan Type *Based on your response, you might need a PPO without drug coverage. It depends on the areas you reside. If you live in different states for extended time, you need a National PPO without drug coverage. Otherwise, you might be good with a local PPO or a HMO without drug coverage that doesn't require referrals.Your Medicare Plan Type - Additional Notes *There are Special Needs (SNP) plans for people with Medicare and Medicaid (Dual eligible). Depending on your level of Medicaid, you might qualify for a SNP plan. These plans have more benefits than regular plans. Some hospitals and clinics also have CICP. CICP is a state of Colorado program that helps Colorado residents who are not eligible for Medicaid or CHP+. Eligibility is based on family size, income and resources. CICP is not health insurance.Your Medicare Plan Type - Additional Notes *You indicated that you were mostly interested in a HMO plan; however, a PPO might be more appropriate for your needs.Your Medicare Plan Type - Additional Notes *University Hospital (UCHealth) in Aurora is a teaching hospital and there are not very many plans that contract with them. You will be limited on the plan choice.Your Medicare Plan Type - Additional Notes *If you have too many medical bills and you cannot keep up with payments with your current income, you might want to check with your county department of Human Services to see if you can qualify for some help.Prescription Drug Late Enrollment Penalty (LEP) *You indicated that you do not want Prescription drug coverage. Keep in mind that many plans include prescription drug coverage for $0 premium. You do not pay the penalty if you never enroll in a Medicare prescription drug plan.CommentSubmit Request