A major change to Medicare coverage is coming to Northwest Colorado next year, leaving many Routt and Moffat County seniors with fewer options — and potentially higher health care costs.

Starting in January 2026, certain Medicare Advantage plans under Rocky Mountain Health will no longer be available in Routt and Moffat counties, according to Medicare State Health Insurance Program Coordinators Jonnah Glassman and Rebekah Greenwood, representing Routt and Moffat counties, respectively. 

That includes plans now owned by UnitedHealthcare, which purchased Rocky Mountain Health’s Medicare business approximately four years ago, Glassman said.  

What’s changing

Medicare, the federal health insurance program for people 65 and older (or those under 65 with certain disabilities), is made up of two main parts, explained Glassman: Part A, which is free and covers inpatient hospital care; and Part B, which covers outpatient care, doctor visits and medical devices.

Together, Parts A and B, known as Original Medicare, cover about 80% of health care costs, said Glassman. The remaining 20% must be paid out-of-pocket unless an enrollee purchases supplemental coverage.

Before Medicare Advantage plans came to Routt County, most people bought Medigap policies, she said, which cover that leftover 20%. 

“These (Medigap) plans tend to be a little bit expensive, and so when Advantage plans came in, it was great because Advantage plans are a zero premium,” said Glassman. “So you still had to pay your Part B premium, but you didn’t have to pay additional costs of a Medigap plan.”

Advantage plans operate as HMOs or PPOs, but those plans rely on local networks of hospitals and doctors, she explained. If insurers lose contracts with local providers, they can decide to not offer plans in certain regions.

Potential financial impact

The loss of Advantage options could leave many local seniors with just Original Medicare coverage, meaning they’d be responsible for the 20% of costs not covered by Parts A and B. There is no cap on that amount.

“That could mean that if you have a $100,000 bill, you could pay 20% of that bill,” said Glassman.

Those affected will qualify for what Glassman referred to as a “golden ticket” — a guaranteed issue right, which is a temporary protection that allows beneficiaries to buy Medigap coverage without medical underwriting. That means insurers can’t deny coverage or charge higher premiums based on preexisting conditions. 

Glassman said that Medigap coverage costs around $50-60 per month. Compounding concerns, she added, is the fact that Medicare Part B premiums are slated to rise from $185 to $205 in 2026. 

“That’s a $20-a-month increase. That already is a lot for somebody living on a tight income,” she said. “Then, if you add $50 to it a month, that’s $75 a month for health insurance. So we are also concerned about our low-income older adults.”

Those making under $1,900 per month may qualify for a safety net program called the Medicare Savings Plan that can assist with Medicare costs, said Glassman and Greenwood.

According to Glassman, only one Advantage plan is still listed for Routt County in 2026 — an Anthem plan with a $9,000 out-of-pocket maximum.

“It works at the Kremmling hospital, not the Yampa hospital (UCHealth Yampa Valley Medical Center), so it is really a disservice for it to be listed for Routt County, because there aren’t any close-by doctors,” she said. “So I don’t want people to go and say, ‘Oh, well, there’s this Anthem plan,’ but A, it’s a really bad plan, and B, there aren’t doctors in the Steamboat area that accept that plan.”

For Moffat County residents, according to Greenwood, there are no other Advantage plans at all — aside from dual Medicare/Medicaid recipients, who will still be able to have a dual UnitedHealthcare plan. 

This leaves many affected Medicare recipients across the valley to weigh whether to remain with Original Medicare or purchase a Medigap plan under their guaranteed issue rights.

Guidance from local experts

The Medicare State Health Insurance Program, the organization Glassman and Greenwood represent, is a federally funded, nonpartisan program that helps Medicare recipients understand their options. Unlike insurance brokers, said Glassman, SHIP representatives do not sell or recommend specific plans.

The national Medicare open enrollment period runs from Oct. 15 through Dec. 7. Glassman cautioned, however, that guaranteed issue rights for those losing plans follow a separate timeline.

According to a letter sent from UnitedHealthcare to affected recipients on Oct. 2, forwarded by Glassman to the newspaper, residents have a limited window to utilize the guaranteed issue right.

“Because your coverage under our plan ends December 31, 2025, you can buy a Medigap policy no later than March 4, 2026,” said the letter. “If you leave our plan before December 31, 2025, you have 63 calendar days from the day your coverage ends to buy a Medigap policy.”

Glassman urged residents to pay close attention to their mail this fall and, even if they have not received a letter, to call the number on the back of their health insurance card to check. 

“We just are concerned that people are going to miss their guaranteed issue right to enroll into a Medigap plan,” said Glassman. “If they do, if they have health issues, then they’re kind of screwed to be honest.”

Routt County residents concerned about their coverage can also schedule one-on-one consultations through Vintage, the local Area Agency on Aging, at YourVintage.org. Moffat County residents can seek assistance by calling 970-819-6401. 

Glassman will also host a public Medicare presentation on Oct. 28 at 6:30 p.m. at the Bud Werner Memorial Library, open to all community members.

To review available plans or confirm whether a current plan is leaving the area, Glassman recommends visiting Medicare.gov and using the Plan Finder tool at MedicarePlanFinder.com. Community members can also reach out to their licensed insurance brokers for advice.

Greenwood also recommends that people learn more about Medigap and compare policies at Medicare.gov/Health-Drug-Plans/Medigap.

“There are many Medigap plan providers with much different prices to provide the same coverage,” said Greenwood. “UnitedHealthcare still sells Medigap plans and may or may not be the best company for you.”

“Plan G has the most comprehensive new coverage available now, and a high-deductible G plan may be the best option for those that need to keep their monthly premium cost as low as possible,” she added. “There are multiple plans, and everyone is different, so check into what is best for you.”

As Routt and Moffat counties prepare for the exit of Medicare Advantage plans, Glassman said her priority is making sure no one is caught off guard.

“We just want people to be informed and understand their benefits and know who to ask questions to,” said Glassman.