Medicaid is a health insurance program for people who do not make a lot of money. The federal government and the state government work together to pay for it. In this state, the program has a special name. It is called Health First Colorado.
If you get Health First Colorado, the state pays your medical bills. You can go to the doctor when you are sick. You can get medicine from the pharmacy. You can go to the hospital if you are hurt. For most people who qualify, this health insurance is completely free. You do not have to pay a monthly bill, which is called a premium.
This guide will explain everything you need to know about Health First Colorado. We will look at who can get it, how the state counts your money, what medical care is covered, and exactly how you can apply for it today. We will also talk about what to do if you make too much money to get Medicaid. You can also visit the federal website at medicaid.gov to learn more about how the whole country runs the program, but you should always check the Health First Colorado state agency website by name to see your local rules.
Not everyone can get this free health insurance. The state has rules about who qualifies. The rules look at your age, your health, and most importantly, how much money you bring home.
You might be able to get Health First Colorado if you fall into one of these groups and meet the income rules.
Before you can know if you make the right amount of money, you have to know how to count your household. Your household size is not always just the people who live in your house.
The state uses tax rules to count your family. Your household size usually includes you, your spouse if you are married, and any children who you claim as dependents on your tax return.
If you are a single person who files taxes alone and has no children, your household size is one. If you are married and have two young children, and you all file taxes together, your household size is four.
If you are pregnant, the state counts you as two people. If you are pregnant with twins, you count as three people. This helps you get a larger household size, which means you are allowed to make more money and still qualify for the insurance.
Sometimes, people live together but do not count in the same household. For example, if you live with a roommate and you both buy your own food and file your own taxes, you do not count your roommate’s income. You are a household of one, and your roommate is a household of one.
To decide if you make too much money, Health First Colorado uses something called the Federal Poverty Level. This is often written as FPL.
The Federal Poverty Level is a number the government sets every year. It is the minimum amount of money a family needs to buy basic things like food and shelter. The larger your family is, the higher the poverty level number is.
Colorado allows you to make more than the base poverty level. The state uses a percentage of the FPL to set its rules.
| Group | Income Limit Rule | What You Get | Notes |
|---|---|---|---|
| Adults (Ages 19-64) | Up to 133% of the FPL | Full Health First Colorado coverage | Single adults and parents use this rule. |
| Children (Ages 0-18) | Up to 142% of the FPL | Full Health First Colorado coverage | Kids can qualify even if parents do not. |
| Pregnant Women | Up to 195% of the FPL | Full coverage during pregnancy and 12 months after | The unborn baby counts in the family size. |
| Kids on CHP+ | Up to 260% of the FPL | Child Health Plan Plus | A low-cost plan for kids who are over the Medicaid limit. |
When the state asks how much money you make, they do not just mean your paycheck. They want to know your total income before taxes are taken out. This is called your gross income.
The state uses a special math formula called Modified Adjusted Gross Income. This sounds complicated, but it just means they add up certain types of money and ignore others.
Things that do count as income:
Things that do not count as income:
It is very important to tell the truth about your money when you apply. If your income goes up or down later, you have to tell the state about the change.
If you are approved for Health First Colorado, you will get a card in the mail. This card is your proof of insurance. But what does the insurance actually pay for?
The short answer is that it covers almost everything you need to stay healthy or get better when you are sick. Below is a detailed list of what is covered.
You can go to a primary care doctor for regular check-ups. A check-up is when you go to the doctor to make sure you are healthy, even if you are not sick. You can also go to the doctor when you have a cold, the flu, or pain.
If you need a special doctor, called a specialist, Health First Colorado pays for that too. For example, if you have a bad heart, you can see a heart doctor. If you have a rash that will not go away, you can see a skin doctor.
If you get very sick or hurt and need to go to the emergency room, the insurance will pay for it. If the doctor says you need to stay in a hospital bed overnight, or for many days, Health First Colorado pays for the room, the doctors in the hospital, and the treatments they give you.
It also covers ambulance rides. If you have a true emergency, like a heart attack or a terrible car crash, and you need to ride in an ambulance to the hospital, the state will pay for the ride.
Health First Colorado pays for your prescription medicine. When your doctor tells you that you need medicine, they write a prescription. You take this to a pharmacy that works with the state.
The state has a giant list of medicines they agree to pay for. This list is called a formulary. Most common medicines, like antibiotics for an infection or insulin for diabetes, are on this list. If your doctor wants you to take a medicine that is not on the list, the doctor has to call the state and ask for special permission.
Many health insurance plans do not pay for teeth, but Health First Colorado does.
For children, dental care is very complete. It covers regular cleanings, x-rays, fillings for cavities, and even braces if a dentist says they are completely necessary for the child’s health (not just to make their smile look nice).
For adults, there is a yearly limit on dental care. The state gives adults a set amount of money to use on their teeth each year. This covers cleanings, exams, x-rays, fillings, and pulling bad teeth. Sometimes, it can help pay for dentures or root canals. Once you use up your yearly limit, you have to pay for your own dental work until the next year starts.
Children get very good vision coverage. Health First Colorado pays for their eye exams. If a child needs glasses to see the blackboard at school, the state will pay for the glasses.
For adults, the rules are stricter. The insurance will pay for a doctor to check your eyes for diseases, like glaucoma or damage from diabetes. However, Health First Colorado usually does not pay for glasses or contact lenses for adults, unless you just had surgery on your eyes.
Mental health is treated just like physical health. If you feel very sad, worried, or stressed, you can talk to a therapist or counselor. Health First Colorado pays for these visits.
It also pays for medicine that helps your brain, like pills for depression or anxiety. If a person has a problem with alcohol or drugs, the insurance covers treatment programs to help them stop using those substances and get sober.
If you are pregnant, Health First Colorado is one of the best programs you can have. It pays for all your doctor visits while you are pregnant. These are called prenatal visits.
It pays for the ultrasound pictures to look at the baby. It pays the hospital bill when you give birth. After the baby is born, it pays for your check-ups. The baby is also automatically covered for the first year of their life, so all of their shots and baby check-ups are free.
Health First Colorado only pays for medical care that is necessary to keep you healthy or fix a problem. It will not pay for things you want just to look better.
For example, it will not pay for plastic surgery to change the shape of your nose. It will not pay for medicine that helps you lose weight unless you have a severe medical problem. It will not pay for experimental treatments that have not been proven to work. It also will not pay for you to go to a doctor who refuses to take Medicaid. You must always use a doctor who accepts Health First Colorado.
The best thing about Health First Colorado is the cost. For most people, it costs nothing.
There is no monthly premium. You do not have to mail a check to the state every month just to keep your card working.
There are also no deductibles. A deductible is an amount of money you normally have to pay out of your own pocket before a regular insurance company starts helping you. Health First Colorado does not make you do this. They start paying from the very first day.
Sometimes, you might have to pay a very tiny amount of money when you get medical care. This is called a copay.
A copay is usually just one dollar, two dollars, or three dollars. You might have to pay a two-dollar copay when you pick up a prescription from the pharmacy. You might have to pay a few dollars if you go to a regular doctor visit.
However, many people do not even have to pay these tiny copays. The state says that pregnant women never have to pay a copay. Children under age 19 never have to pay a copay. People who live in a nursing home do not pay copays.
If you are supposed to pay a three-dollar copay for medicine, but you have zero dollars in your pocket, the pharmacy cannot turn you away. By law, they have to give you the medicine anyway.
Sometimes, a family makes a little too much money to get Health First Colorado. But they still do not make enough money to easily buy expensive private insurance.
Colorado has a special program just for this situation. It is called the Child Health Plan Plus, or CHP+.
CHP+ is for children under age 19, and for pregnant women. If your income is too high for regular Medicaid, the state will look to see if you fit into CHP+. The income limit for CHP+ is much higher than the limit for regular Medicaid.
CHP+ covers all the same great things: doctor visits, hospital stays, medicine, dental care, and vision.
The only difference is that CHP+ is not completely free. Families might have to pay a yearly enrollment fee. This fee is usually very small, like $25 or $50 for the whole year, depending on your income. Families on CHP+ also have to pay small copays when they go to the doctor or get medicine, but there is a strict limit on how much they can spend in one year so they do not go broke.
When a person turns 65 years old, they usually get Medicare from the federal government. Medicare is an insurance program for older adults.
Sometimes, Medicare is not enough. Medicare has premiums you have to pay every month, and it does not pay for everything.
If an older adult has a very low income, they can have both Medicare and Health First Colorado at the exact same time. This is called being “dual eligible.”
When you have both, Medicare pays for your doctor bills first. Then, Health First Colorado steps in and pays the leftover bills that Medicare did not cover. Health First Colorado can also pay your monthly Medicare Part B premium so you do not have to pay it yourself.
Health First Colorado is also very important for older adults because it pays for long-term care. If an older person needs to move into a nursing home, or if they need a nurse to come to their house every day to help them bathe and eat, Medicare will not pay for that for very long. Health First Colorado will pay for long-term nursing care for people who are poor and have no money left to pay for it themselves.
Applying for Health First Colorado is completely free. You should never pay someone to help you fill out the application.
You can apply at any time of the year. Regular health insurance has an “Open Enrollment” period, which means you can only sign up during certain months in the winter. Medicaid does not do this. If you lose your job in May and have no money, you can apply in May. If you get pregnant in August, you can apply in August.
There are four ways to apply. You can choose the way that is easiest for you.
The fastest way to apply is on a computer or a smartphone. Colorado has a special website for all state help programs. It is called PEAK (Program Eligibility and Application Kit).
When you go to the PEAK website, you can create a free account. You will type in your name, your address, the names of everyone who lives with you, and how much money you make. The computer system is very smart. Sometimes, it can check your answers against your old tax returns and approve you on the exact same day.
If you do not like using computers, you can apply over the telephone. You can call the Health First Colorado customer service center. A real person will answer the phone. They will ask you the questions out loud, and they will type your answers into the computer for you.
You can print a paper application from the internet, or you can ask the state to mail you a blank paper application. You fill it out with a pen. You must answer every question carefully. Then, you put it in an envelope and mail it to your local county office. This is the slowest way to apply because it takes time for the mail to travel and for a worker to read your paper.
Every county in Colorado has a Department of Human Services office. You can walk into this building during normal business hours. You can pick up an application, sit in the waiting room, and fill it out. If you have questions, a worker behind the desk can help you understand what the form means.
When you apply, the state needs to prove that you are telling the truth. You should gather some important papers before you start the application.
You will need:
If the state needs to see these papers, they will ask you to send copies. You can take pictures of the papers with your phone and upload them to the PEAK website, or you can drop the copies off at the county office.
Once you are approved for Health First Colorado, you do not get to keep it forever automatically. The state has to check your income every single year to make sure you are still poor enough to qualify. This yearly check is called redetermination or renewal.
When it is time for your renewal, the state will look at their computer systems. Sometimes, they can see that you are still working at the same low-paying job, and they will just renew your insurance automatically. They will send you a letter that says, “Good news, your insurance is renewed for another year.”
Other times, the computer cannot tell how much money you make. When this happens, the state will mail a big packet of papers to your house.
This packet is your renewal form. You must open it immediately. It will ask you if you have a new job, if your address changed, or if you had a new baby. You must fill out the form, attach your newest pay stubs, and send it back before the deadline printed on the paper.
If you throw the packet in the trash, or if you miss the deadline, the state will turn off your health insurance. You will lose your coverage, even if you are still poor. If this happens, you have a 90-day window to send the paperwork in late and ask them to turn the insurance back on without making you start a brand new application.
You cannot wait until your yearly renewal to tell the state about big changes in your life. You have a legal duty to report changes quickly.
If you get a new job that pays more money, you must tell the state within 10 days. If you move to a new apartment, you must tell the state so they can mail your letters to the right house. If you get married, or if you have a baby, you must report this.
You can report these changes by logging into your PEAK account online, calling the customer service center, or telling your county office.
Health First Colorado is only for people who live in this state. If you pack your bags and move to a different state, like Texas or Florida, you cannot take Health First Colorado with you.
Medicaid does not cross state lines. If you move, you must tell Colorado to close your case. Then, when you arrive in your new state, you have to apply for their version of Medicaid. Every state has different rules and different income limits.
Sometimes, people get a better job, or they get a big raise at work. This is wonderful news for your family, but it means you might start making too much money to keep Health First Colorado.
If you report your new income and the state says you make too much, they will send you a letter. The letter will say that your Health First Colorado is ending on a specific date.
Do not panic. You will not be left without health insurance. Losing Medicaid is called a “Qualifying Life Event.” This gives you a special rule to immediately buy private health insurance on the Affordable Care Act (ACA) marketplace, also known as Connect for Health Colorado.
Because you still probably do not make a huge amount of money, the government will step in to help you pay for the private ACA plan. They will give you tax money, called Advance Premium Tax Credits, to lower the monthly cost of the private insurance. Some people can find private plans for ten dollars a month or less using this tax help.
What happens if you apply for Health First Colorado and you get a letter saying “No”?
The state will always explain why they denied you. Usually, the letter will say your income is too high, or you did not send in the proof of your pay stubs in time.
If you think the state made a mistake—for example, if they thought you made $4,000 a month but you really only make $1,000 a month—you have the right to fight back. This is called an appeal.
The denial letter will have instructions on how to file an appeal. You have a strict time limit to ask for an appeal, usually 30 days or 60 days. You will ask for a Fair Hearing. A judge will look at your papers, listen to your side of the story, and decide if the state made a mistake. If the judge agrees with you, the state has to give you the health insurance.
If you need health insurance and you have a low income, you should not wait.