Colorado Hospital and Critical Illness Gap Calculator

How the cash gap of a serious illness is added up

The calculator separates what an illness costs your household from what your health plan pays, then sets cash benefits and savings against the total.

Cash policies are not health insurance. They pay you a fixed amount when a covered event happens, whatever the hospital charged, so the right size depends on your household budget rather than on medical prices.

1. Medical bills: deductibles, copays and coinsurance your plan leaves you, up to its out-of-pocket limit.
2. Lost income: monthly income lost × months of recovery.
3. Extra costs: monthly travel, help at home or childcare × the same months.
4. Benefits: a hospital indemnity daily benefit × days in hospital, plus any critical illness lump sum.
5. Gap: total costs minus benefits minus savings you would use; a surplus shows if benefits and savings exceed costs.

Mistakes when sizing hospital or critical illness cover

• Insuring the hospital bill alone. Lost wages and recovery costs often dwarf the bill your plan leaves.
• Duplicating a Medigap plan. If Medigap already pays the Part A deductible, a policy bought to cover that deductible may simply repeat it.
• Skipping the definitions. Critical illness policies pay for listed conditions under their own definitions, and many have waiting periods.
• Ignoring pre-existing condition limits. Many policies limit or delay benefits for conditions you had before buying.
• Forgetting benefits from work. Paid leave and disability coverage reduce lost income; count them before buying more.
• Assuming an Advantage maximum covers everything. The yearly limit applies to covered in-network services. Out-of-network bills, uncovered care and prescriptions sit outside it.

Colorado benefits that shrink the gap

Colorado’s paid family and medical leave program, FAMLI, can replace part of your wages during leave for your own serious health condition if you are covered by it. Include it before you size a policy.

On Medicare, the 2026 Part A deductible is $1,736 per benefit period (CMS). Adams County’s 2027 Medicare Advantage plans have in-network out-of-pocket maximums from $3,300 to $9,850, the realistic ceiling on covered medical bills (CMS 2027 landscape file).

Supplemental policies sold in Colorado are overseen by the Colorado Division of Insurance, and every policy is subject to underwriting and carrier approval.

Some Colorado employers run a private paid leave plan approved in place of FAMLI, so ask human resources which program covers you and how much of your wage it replaces.

Health First Colorado accepts applications in any month, so a household whose income collapses during a long recovery may qualify for coverage it did not have before (HCPF).

Key terms: Hospital and illness gap

Hospital indemnity

A policy paying a set amount for each day of a covered inpatient stay.

Critical illness

A policy paying a lump sum when you are diagnosed with a listed condition, such as a heart attack or stroke.

Benefit period

In Original Medicare, a stretch that starts at admission and ends after 60 days in a row without inpatient care; each new one brings a new Part A deductible.

Waiting period

Time after a policy starts before some benefits can be paid.

Out-of-pocket maximum

The most your health plan makes you pay for covered care in a year.

Facts that make the gap estimate realistic

• Your health plan’s deductible, coinsurance, hospital copays and out-of-pocket maximum.
• Monthly take-home pay for each earner.
• Sick leave, short-term disability or FAMLI coverage through work.
• Savings you would actually spend, and any supplemental policies you already hold.