Grand Junction · PERA retirees · The subsidy math
Should I Leave PERACare for a $0 Advantage Plan in 2027?
The question arrives every October with the mailers, and this year it arrives with a new carrier: PERACare's UnitedHealthcare members are being moved to Humana for 2027, and a Humana MA #1 enrollee with full service credit will pay $255 a month while Mesa County has 8 individual Advantage plans at $0. Here is what the $115 subsidy actually buys, when the $0 plan wins, when it does not, and how the door back works if you change your mind.
The bottom line
- The subsidy is worth $1,380 a year, and it only exists inside PERACare. Leave, and the $115 a month stops; PERA says it is "always available" again whenever you re-enroll, but only at a future Open Enrollment.
- One retiree, quiet year: the $0 plan is cheaper by about $3,060 on Humana MA #1, or about $828 on MA #2, minus whatever copays the individual plan charges for the same visits. That is the whole case for leaving.
- One retiree, bad year: the group plan usually wins. Humana MA #1's worst case is $5,060 (premiums plus a $2,000 cap). Only one of Mesa County's $0 plans caps below that; the rest run up to $9,850.
- Couples are different. A spouse doubles the PERACare premium but not the subsidy, so a couple on MA #1 pays $7,500 a year before any care. Two $0 plans pay nothing. That gap is large enough to change the answer.
- Doctors decide the rest. The Humana group PPO pays any Medicare provider at the in-network cost. A $0 individual plan has a network, and St. Mary's, Community Hospital and your specialists have to be checked against its 2027 directory before you sign.
Medicare On Main is not affiliated with Colorado PERA and does not sell PERACare plans. We write about PERACare because a large share of the Mesa County retirees who sit down with us spent a career with School District 51, Mesa County, Colorado Mesa University or the state, and every fall the PERA packet and the individual-market mailers arrive the same week. The July post set up the three doors. The September post covered the move to Humana. Yesterday's post took apart the new Moda Medicare Companion plan. This one is the question that produces the most phone calls: should I just take the $0 plan?
The frame first. Mesa County had 41,709 people on Medicare in June 2026, and 17,134 of them, about 41%, were in a Medicare Advantage plan, per the CMS enrollment file. PERACare's Humana plans are Medicare Advantage plans too. So for a PERA retiree already on PERACare's Advantage side, this is not Advantage versus Original Medicare. It is a group Advantage plan with a premium and a subsidy against an individual Advantage plan with neither. Everything below is that comparison, with PERA's published 2027 numbers on one side and the CMS 2027 landscape file for Mesa County on the other.
What the $115 subsidy actually buys
PERA's 2027 Medicare booklet prices Humana MA #1 at $370 a month for one benefit recipient and MA #2 at $184. The subsidy is $115 at 20 or more years of service credit and drops $5.75 for each year below that. PERA subtracts it from the premium and deducts the balance from your monthly benefit, after tax. So the numbers a full-career retiree actually sees are $255 and $69 a month, $3,060 and $828 a year.
Two things the mailer leaves out. First, the subsidy is not a cash benefit. Page 2 of the booklet: "your health subsidy is always available to you whenever you are enrolled in a PERACare health plan." Not enrolled, no subsidy. The $1,380 a year is real money, but it is only real if you are paying a PERACare premium for it to offset. Second, it is one subsidy per benefit recipient. Add a Medicare-eligible spouse and MA #1 becomes $740, less the same $115, which is $625 a month. Unless the spouse is a PERA retiree in their own right, there is no second subsidy.
On the other side of the table, the CMS 2027 landscape file lists 10 Medicare Advantage plans with drug coverage in Mesa County, 8 of them at a $0 premium, with in-network out-of-pocket caps from $4,900 to $9,850. Every one is listed here. A $0 premium is not "free": you keep paying Part B ($202.90 a month in 2026; the 2027 figure is not yet announced) exactly as you do on PERACare, and you pay the plan's copays and coinsurance up to its cap.
Side by side: PERACare's Humana plans and a $0 Mesa County plan
The left column is from the 2027 booklet and Humana's 2027 group plan guide. The right column is what the CMS file shows for Mesa County's individual plans; copays and extras are not in the file, so for those we tell you what to read rather than make a number up.
| Line | PERACare Humana Medicare Advantage PPO (2027) | Individual Mesa County Advantage plan (2027) |
|---|---|---|
| Monthly premium, one retiree, 20+ years of service | Humana MA #1 $255 ($370 less the $115 subsidy); MA #2 $69 | $0 on 8 of Mesa County's 10 plans; $18.40 and $20.00 on the other two |
| Monthly premium with a Medicare-eligible spouse | MA #1 $625; MA #2 $253 (one subsidy per benefit recipient) | $0 each on a $0 plan; each spouse enrolls separately |
| Yearly in-network out-of-pocket cap, medical | MA #1 $2,000; MA #2 $3,500 | $4,900 to $9,850 depending on the plan |
| Everyday copays | MA #1: $0 for primary care, specialists, labs, imaging, outpatient surgery, therapy; hospital $300 per admission (max $900 a year). MA #2: $5 / $40 / $200 surgery / $200 a day for hospital days 1–10 | Set by each plan; not in the CMS file. Read the Summary of Benefits for the plan you are pricing |
| Which doctors | Any Medicare provider who accepts the plan, in or out of Humana's network, at the same cost; no referrals | HMO (3 plans) and HMO-POS (1): the plan's network. PPO (6): network plus out-of-network at a higher cost. Check each 2027 directory |
| Prescription drugs | Humana Part D plan built in: MA #1 no deductible, MA #2 $300; $2,400 cap; $15 / $45 / $60 retail | Built in: deductibles $300 to $700, every plan with a no-deductible tier; the same $2,400 cap |
| Prior authorization | Yes: Humana's guide lists inpatient admissions, home health, therapy, advanced imaging, SNF, some drugs | Yes, on every Advantage plan; the list varies by plan |
| Extras | SilverSneakers, Go365 rewards, post-discharge meals, rides and in-home help, routine chiropractic copays | Varies: dental, vision, hearing, OTC cards, fitness; read each plan's 2027 Summary of Benefits |
| If it gets discontinued | PERA re-contracts yearly; a change comes with a PERACare Open Enrollment to pick another PERACare plan | Non-renewal letter by early October; AEP, a special enrollment period to the end of February, and a 63-day Medigap guaranteed-issue window |
| Getting back | Rejoin at a future PERACare Open Enrollment, subsidy intact; mid-year only after an involuntary loss of coverage | Switch individual plans each AEP, or once more January 1 to March 31 |
Sources: PERACare 2027 Medicare booklet, pp. 2–3, 5, 7–8, 16–17; Humana 2027 Group Medicare plan guide; CMS CY2027 landscape file, Colorado, Mesa County, MA-PD. Medicare On Main does not offer every plan available in your area.
The structure of the trade is in the first and third rows. PERACare charges you up front and caps you low. The individual plan charges you nothing up front and caps you high. Humana MA #1 goes further than most group plans: $0 for primary care, specialists, labs, imaging, outpatient surgery and therapy, a $300 per-admission hospital copay capped at $900 a year, and a $2,000 ceiling on everything. The booklet also says the plan pays "any Medicare provider at the in-network cost," which is the feature a PERA retiree who sees a specialist in Denver, or winters in Arizona, is really paying for.
The math, four households
Medical costs only. Drugs are deliberately left out, because for 2027 every plan in both columns has the same federal $2,400 out-of-pocket cap; the differences are the deductible (none on MA #1, $300 on MA #2, $300 to $700 on the Mesa County plans) and the formulary, which you check drug by drug. Full service credit assumed.
| Household and year | PERACare Humana MA #1 | PERACare Humana MA #2 | $0 individual plan |
|---|---|---|---|
| Quiet year: a few office visits, labs, one MRI | $3,060 premiums + $0 copays = $3,060 | $828 premiums + roughly $100–$300 in copays | $0 premiums + the plan's copays (often a few hundred dollars for the same visits) |
| Rough year: a hospital stay, rehab, follow-up imaging | $3,060 + up to $2,000 = $5,060 at most | $828 + up to $3,500 = $4,328 at most | $0 + up to the plan's cap, $4,900 to $9,850 |
| Married couple, both on the retiree's PERACare plan, quiet year | $7,500 premiums (one subsidy) + $0 copays | $3,036 premiums (one subsidy) + copays | $0 premiums + two sets of copays |
| Married couple, both hospitalized in the same year | $7,500 + up to $4,000 = $11,500 at most | $3,036 + up to $7,000 = $10,036 at most | $0 + up to two caps, $9,800 to $19,700 |
Arithmetic from the 2027 booklet premiums, subsidy and out-of-pocket maximums, and the CMS CY2027 MOOP range for Mesa County. Individual-plan copays are plan-specific and not stated; "up to the cap" is the only number the public file supports.
Read the rows this way:
- A healthy single retiree is paying $3,060 a year for insurance against a bad year. If the bad year does not come, the $0 plan was cheaper by that amount, less its copays. On MA #2 the price of the insurance is $828, and the quiet-year gap nearly disappears once the individual plan's copays are counted.
- If the bad year comes, MA #1 at $5,060 all-in beats every Mesa County $0 plan but one. The Select Health HMO's $4,900 cap edges it, with a network. The Anthem HMO-POS's $9,850 cap is nearly double. MA #2 at $4,328 beats the $4,900 plans too.
- A couple pays $7,500 a year on MA #1 before anyone gets sick. Two $0 plans pay nothing. Even in the year both are hospitalized, MA #1's $11,500 ceiling only beats the individual pair if their caps total more than that, which they do on most but not all Mesa County plans. For couples, PERACare's case rests on the network and the copays, not the arithmetic.
- Fewer service years tilt the table. At 10 years of service the subsidy is $57.50, MA #1 nets to $312.50 a month, $3,750 a year, and the quiet-year gap grows to match.
PERA booklet in one hand, a $0 mailer in the other?
Bring both to our Grand Junction office, or call. We will put Humana MA #1 and MA #2 at your actual service-credit subsidy next to the Mesa County plans your doctors accept, run your prescriptions through each formulary, and show you the quiet-year and worst-year totals. We do not sell PERACare and have no stake in which door you take. Free, no pressure, nothing to sign.
Book a PERACare comparison →What the money does not measure
Doctors
This is where most "I'll take the $0 plan" decisions should slow down. The PERACare Humana PPO, per the booklet, lets you see "any provider ... who is in the Humana Medicare PPO network or who participates in Medicare and accepts the plan as an out-of-network provider," at the same cost either way. Humana's own guide adds the honest footnote: out-of-network providers "are under no obligation to treat plan members, except in emergency situations." So it is not quite Original Medicare, but it is close. An individual Advantage plan is a network product. Three of Mesa County's ten 2027 plans are HMOs, one is an HMO-POS, and the six PPOs charge more out of network. Whether St. Mary's, Community Hospital, your primary care office and the specialist you drive to Denver for are all in a given plan's 2027 directory is a yes-or-no question with a different answer for each plan. How to check it properly.
Prior authorization
Both columns have it. Humana's group guide lists inpatient admissions, home health, physical and occupational therapy, advanced imaging, skilled nursing and certain drugs as examples. Individual plans publish their own lists. Nobody leaves PERACare to escape prior authorization; it comes along.
Extras
The group plan's extras lean toward recovery: 28 delivered meals, up to 12 rides and up to 44 hours of in-home help after a hospital or nursing-facility discharge, plus SilverSneakers and Go365. Individual plans lean toward the mailer: dental, vision, hearing allowances, over-the-counter cards. Those are plan-year benefits; weigh them at what you would actually use, not the headline.
Prescriptions
The Humana PERACare drug plan shares one formulary across MA #1, MA #2 and the Moda plan. The individual plans each have their own. The deductible row above is where they differ on paper, but the tier your specific drug lands on is where they differ in dollars. Run every prescription through every plan you are considering before the premium math means anything.
How the exit works, and how the door back works
- October 15 to December 7: Medicare's Annual Enrollment Period. Enrolling in an individual Advantage plan in this window starts it January 1, per Medicare.gov. Because Medicare allows one Advantage enrollment at a time, that enrollment ends the PERACare plan; the booklet says Medicare "will notify PERA of the additional enrollment, and your PERACare Medicare coverage will be canceled." Send PERA your own cancellation as well, received by December 15, so the premium stops on December 31 rather than a month late.
- October 19 to November 19: PERACare's Open Enrollment, for moving between PERACare plans, including into the new Moda Medicare Companion plan. Doing nothing as a 2026 UnitedHealthcare member means Humana on January 1.
- January 1 to March 31: the Medicare Advantage Open Enrollment Period. If the individual plan disappoints, you get one change to another individual plan or back to Original Medicare. You do not get back into PERACare this way.
- Getting back into PERACare: "there is no penalty for leaving PERACare," and you "can reenroll during a future open enrollment and still be eligible for your monthly PERA health care subsidy." Mid-year re-entry exists only for an involuntary loss of coverage with a termination letter; the booklet is specific that choosing not to pay or not to pick a new plan does not count. In practice: leave in December, decide in March that you miss the group PPO, and the earliest return is the next January.
- Part B-only retirees: an individual Advantage plan requires Part A and Part B, same as the Humana group plan. Denver Public Schools benefit-structure retirees without Part A have a different premium table and should not assume the $0 shelf is open to them.
Mesa County's health profile is the reason the worst-year rows matter more than the quiet-year rows for a lot of readers: per CDC PLACES, 26.6% of adults here live with high blood pressure, 29.8% with obesity and 8.1% with diabetes. The bad year is not hypothetical for a 72-year-old with two of those.
Who tends to come out ahead where
- Leaning toward the $0 individual plan: a married couple paying $625 a month for one subsidy; a retiree with fewer than 15 years of service and a small subsidy; anyone whose doctors are all in one strong local network and who does not travel for care.
- Leaning toward staying on PERACare: a single retiree with full service credit who uses a lot of care; anyone seeing specialists outside the Grand Valley; anyone who values a $2,000 ceiling and $0 copays over a $0 premium; anyone who does not want to redo the doctor-and-drug check every fall as individual plans change.
- A third door for some: the Moda Medicare Companion plan, Original Medicare with a Plan G-shaped benefit and no network, at $328 a month after the full subsidy. It is the most expensive line in the booklet and the only one with no network at all; yesterday's post has it benefit by benefit.
What I would do
Write down your service-credit years and look up your actual subsidy, because $115 is the ceiling, not the number. Compute your PERACare net premium for the year. Then take only the Mesa County plans whose 2027 directory lists every doctor you have seen in the last two years, run your prescriptions through each, and compare worst-year totals, not premiums. If you are single with a full subsidy, the group plan's $5,060 ceiling is hard to beat and the $0 plan has to earn its place on network and copays. If you are a couple, do the $7,500-a-year math honestly and decide whether the any-provider PPO is worth it to you. And whichever way you go, remember that the door back into PERACare opens once a year, in the fall, so this is a decision to make with a calendar in front of you, not a mailer.
How we know all this: the Medicare On Main Data Desk frames every article with public data — here, Colorado PERA's 2027 Medicare Coverage booklet (posted October 1, 2026), PERACare Open Enrollment 2027 page and "How Does PERACare Compare to Other Options?" page, read October 2, 2026; Humana's 2027 Group Medicare Advantage Plan Guide from the PERACare microsite; the CMS CY2027 Medicare Advantage and Part D landscape file, filtered to Mesa County, Colorado; the CMS CY2027 Rate Announcement for the Part D parameters; Medicare.gov's enrollment-period and cost pages; the CMS Medicare Monthly Enrollment file; and CDC PLACES 2023 for Mesa County health prevalence. Individual-plan copays and 2027 Star Ratings are not stated because they are not in the public file. Medicare On Main is a licensed independent insurance agency. We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Not connected with or endorsed by the U.S. government or the federal Medicare program. Medicare On Main is not affiliated with Colorado PERA, Humana or Moda Health and does not sell PERACare plans; PERACare figures are reproduced from PERA's published booklet for information, and nothing here is a recommendation of, or a judgment about, any company or plan.
Frequently asked questions
Can I leave PERACare and come back later?
Yes. PERA's 2027 booklet says "there is no penalty for leaving PERACare" and that if you leave for an individual Medicare plan "you can reenroll during a future open enrollment and still be eligible for your monthly PERA health care subsidy." The catch is timing: re-enrollment is normally only at the fall PERACare Open Enrollment for a January 1 start, or within 30 days of an involuntary loss of coverage with a termination letter. Deciding in March that you want PERACare back means waiting until the next January.
Do I lose my PERA subsidy if I leave PERACare?
You stop receiving it while you are not in a PERACare health plan, because the subsidy is applied to a PERACare premium and nothing else. It is not forfeited for good: PERA says the subsidy "is always available to you whenever you are enrolled in a PERACare health plan." For a retiree with 20 or more years of service the subsidy is $115 a month, $1,380 a year, and that is the number the $0 plan has to beat.
Is PERACare better than a Medicare Advantage plan?
PERACare's Humana plans are Medicare Advantage plans, so the real question is group versus individual. The group plan costs a premium after the subsidy ($255 or $69 a month for one retiree with full service credit) and gives back a low cap ($2,000 or $3,500), $0 or small copays, and any Medicare provider at the same cost. A $0 individual plan in Mesa County has no premium and a cap of $4,900 to $9,850, with a network. Which is "better" depends on how much care you use and whether your doctors are in the individual plan's network. PERA itself acknowledges that its plans may not fit everyone.
How much is the PERA health care subsidy in 2027?
$115 a month at 20 or more years of service credit, falling $5.75 for each year below that: $86.25 at 15 years, $57.50 at 10, $5.75 at one. It applies to the health plan premium only, never to dental or vision, and PERA deducts the remaining premium from your monthly benefit after tax. Denver Public Schools benefit-structure retirees without Part A have a separate, higher chart.
Can I have PERACare and another Medicare Advantage plan at the same time?
No. Medicare allows one Advantage or Part D enrollment at a time, and the booklet is blunt: "If you enroll in a PERACare Medicare plan, do not enroll in any other Medicare plan ... Medicare will notify PERA of the additional enrollment, and your PERACare Medicare coverage will be canceled." Enrolling in an individual plan during October 15 to December 7 is therefore also your exit from PERACare, effective January 1. Tell PERA in writing as well so the premium deduction stops on time.
When can I switch from PERACare to an individual Medicare plan?
For a January 1, 2027 start, enroll in the individual Advantage plan between October 15 and December 7, Medicare's Annual Enrollment Period, and send PERA a cancellation so it is received by the 15th of December. PERACare's own window, October 19 to November 19, is for choosing among PERACare plans. The reverse trip, back into PERACare, runs on PERA's calendar, not Medicare's.
Sources
- Colorado PERA — PERACare 2027 Health Benefits Program, Medicare Coverage (booklet, posted October 1, 2026) — 2027 premiums (MA #1 $370 / $740, MA #2 $184 / $368), the $115 subsidy chart, out-of-pocket maximums $2,000 / $3,500, every copay quoted, the any-Medicare-provider language, the "do not enroll in any other Medicare plan" rule, the no-penalty and re-enrollment rules, the eligibility chart and the 15th-of-the-month cancellation rule.
- Colorado PERA — How Does PERACare Compare to Other Options? — PERA's acknowledgment that its plans may not fit everyone, and its own comparison checklist; October 15 – December 7.
- Colorado PERA — PERACare Open Enrollment 2027 — October 19 – November 19, 2026; January 1 effective date; UnitedHealthcare enrollees move to Humana unless they choose otherwise.
- Humana — PERACare Group Medicare microsite (2027 plan documents and provider search) — 2027 Summary of Benefits, plan guide, provider and pharmacy search.
- Humana — 2027 Humana Group Medicare Advantage Plan Guide, PPO and PDP (PDF) — network and out-of-network language, prior-authorization examples, post-discharge meals / rides / home care, SilverSneakers and Go365, transition fill.
- CMS — CY2027 Medicare Advantage and Part D Landscape file (September 2026 release) — Mesa County's 10 Advantage drug plans, 8 at $0, MOOP $4,900–$9,850, Part D deductibles $300–$700, plan types.
- CMS — CY2027 Rate Announcement (Part D deductible and out-of-pocket threshold) — 2027 Part D deductible maximum $700; out-of-pocket threshold $2,400.
- Medicare.gov — Joining a plan (enrollment periods) — October 15 – December 7 with a January 1 start; Medicare Advantage Open Enrollment January 1 – March 31.
- Medicare.gov — Medicare costs (2026 Part B premium) — Part B premium $202.90 in 2026.
- CMS Medicare Monthly Enrollment (data.cms.gov) — Mesa County, CO, June 2026 — 41,709 beneficiaries, 17,134 in Medicare Advantage.
- CDC PLACES: Local Data for Better Health, County 2023 — Mesa County high blood pressure, obesity and diabetes prevalence.
