Medicaid is both a federal and state regulated and funded health care program for those in need. You can qualify for Colorado Medicaid (otherwise known as Health First Colorado) based on your household size, and your income/ability to pay for your health care needs. In Colorado, the Medicaid program covers about one out of every eight adults and three out of every ten children. Some people qualify and don’t even know it! Are you missing out on great health care benefits?
To qualify for Health First Colorado, you must be a Colorado resident, U.S. citizen or legal alien, and your income must* fall at or below the following income limits (subject to change each year).
*If your annual earnings are higher than these numbers but you spend enough on your medical expenses to fall below these numbers, you may still qualify for medical assistance. Additionally, older adults who do not qualify based on income may still qualify for the “Old Age Pension Medicaid” or “Old Age Pension Health Care” programs. Fill out the Medicaid application to find out if you qualify.
Colorado Medicaid benefits include (but are not limited to):
One of the biggest benefits to Health First Colorado that not nearly enough people take advantage of is the preventative and wellness benefit. As a Health First Colorado beneficiary, you have access to yearly wellness visits, allergy testing, family planning and gynecology exams, vaccines, colonoscopies, mammograms, and more! Taking advantage of these benefits can prevent you from needing to use your other Colorado Medicaid benefits. Most preventative services do not require any co-payments, but there may be certain limits. For example, adults can only have one physical exam each year. Additionally, services like audiology (hearing aids) are limited; adults can get one set of hearing aids every 3-5 years. Lab and radiology tests will require a $1 co-pay.
For the Family Planning program, There are no co-pays for family planning office visits, counseling, sterilization, and contraceptives. Limits include one exam per year and up to three months worth of contraceptives at one time. Sterilization is only available to those over the age of 21. There are no co-payments for prenatal and postpartum care, child delivery, newborn health care (up to one-year-old), or substance abuse treatment for pregnant women.
CHP+, the kids program, is slightly different. Kids get added benefits like blood work, specialist visits, x-rays, and full dental and vision. Emergency care co-pays can range from $3 to $50, medical visits can be up to $10, inpatient hospital stays can reach up to $50, therapy services can reach up to $10, and prescriptions can range from $0 to $15.
Health First dental coverage includes cleanings, fillings, x-rays, root canals, crowns, partial dentures, periodontal scaling, and root planing. There is an annual limit of $1,000 per year (starting in July, ending the following June), but there are no co-pays.
Adult Medicaid beneficiaries have access to medically necessary eye exams, glasses, and contact lenses if contacts (instead of glasses) are necessary. Adults have a $2 co-pay per visit. Kids (under 19) and pregnant women do not have co-pays. Kids have access to standard glasses, frame replacement and repair, ocular prosthetics, and regular eye exams.
Mental health, substance use disorder, and behavioral health services have no co-pays and no limits, but prior authorization may be needed. Covered services include alcohol and drug assessment, screening and monitoring, counseling and therapy, case management, hospital stays, psychotherapy, medication management, and crisis services.
There are no co-pays or limits for ambulance services and emergency transportation. Prior authorization may be required if you are being transferred to a new hospital. In non-emergency situations, if you have no way to get to your medical appointments, you may be eligible to get a ride from a contracted service.
Health First Colorado includes a comprehensive prescription drug benefit. Most adults will pay $3 per prescription, but pregnant women and children will not have a co-pay. In most cases, you will receive the generic version of whatever prescription you need. To receive the brand-name drug, you will need prior authorization. Generic drugs almost always have the same effect as their brand-name counterparts.
This Colorado Medicaid Formulary (2019), or preferred drug list, is what your doctors and other providers should stick to when prescribing your medication. If they attempt to prescribe you a drug that is not on the list, remind them that you are a Medicaid beneficiary and will either need a different drug or their authorization for coverage of the other drug. You’ll notice that you will not find fertility drugs, cosmetic drugs, weight-loss drugs, or any DESI (Drug Efficacy Study Implementation) drugs on the list. Those items will not be covered by Health First Colorado.
To search for Colorado Medicaid providers, click here. Enter the Health First Colorado service or type of doctor you are looking for (or the doctor’s name, if you know it) and your location. You can even check the box for “New Patients” to make sure the doctor you select is currently accepting new patients.
There are four ways to apply for Health First Colorado. You can apply by phone at 1-800-221-3943, by mail, in-person, or online. Applying online is a good idea because you can always save your application and come back to it later.
To apply by mail or in person, start by downloading the Colorado Medicaid application. If you’re going to apply in person, be sure to bring everything you need with you. To be safe, bring all legal documentation you have - your ID, social security card, proof of residency and citizenship, proof of marital status, proof of income, etc. It’s better to be overprepared than to have to go back home and come back later! Click here to find your nearest application location.
If you qualify for both Medicare and Medicaid in Colorado, we can help you get into a dual-eligible special needs plan (DSNP). A DSNP is a form of Medicare Advantage plan specifically for those who can benefit from both Medicare and Medicaid.
To get started, complete this form or call Medicare Plan Finder directly at 833-438-3676.
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