The Colorado State government administers a comprehensive Medicaid program to help struggling individuals pay for basic health services like hospital visits and dental care. Depending on your monthly income and how many people you live with, you may qualify for Colorado Medicaid benefits.
The Health First Colorado program (aka Colorado Medicaid) protects about 25% of people living in the State, including children. If you have a disability or struggle to keep up with your medical bills, this healthcare plan may be right for you.
Explore the following guide to learn everything you need to know about Health First Colorado — from qualifications to specific procedure options. Once you finish reading, extend your coverage with help from Insurdinary — the number-one insurance comparison service.
Health First Colorado is a type of health insurance program run by the Colorado Department of Health Care Policy and Financing. The purpose of this service is to provide affordable and accessible care when you need it. It facilitates basic healthcare for those who cannot afford private health insurance.
The primary benefits you can enjoy when choosing Health First Colorado coverage include physical healthcare, oral health and hygiene, and mental health services. Within these categories, you can take advantage of services like:
You can enroll for this coverage any time of the year. Unlike many private insurance options, Colorado Medicaid offers low premiums — including free coverage for some services. The State of Colorado funds this coverage from federal subsidies and taxes reserved for public health.
Your Colorado Medicaid card is physical proof of your membership with Health First Colorado. It includes an identification number that your primary care provider can use to verify your membership.
Knowing how to apply for Health First Colorado is the first step to getting the coverage you need. You can register in one of four ways:
You must have Colorado Medicaid-accepted documentation nearby when filling out your application. Driver’s licenses, passports, marriage certificates, pay stubs, and SSN cards are all valid forms of identification.
As an adult, you can qualify for Health First Colorado coverage if:
You may also qualify for these programs if you fall within the maximum Colorado Medicaid income limit. For example, you cannot earn over $22k to qualify if you have two people in your household.
However, Colorado may still allow you to apply if your regular medical expenses cause you to fall below the monthly income limit.
You have four ways to access your insurance card:
The State of Colorado will audit your household once a year to ensure that you still meet the coverage requirements. This process will require you to fill out renewal documents they mail to your house. The State will typically provide these forms two months before your renewal date.
Your benefits will still be active during this assessment period.
If you need to replace a lost or damaged insurance card, contact the Health First Colorado service line and speak to a representative. They may ask you to confirm your information or fill out a short form before sending you a new copy.
Here is a list of what Health First Colorado covers when you become a member:
You won’t need to worry about co-pays at the dentist with Colorado Medicaid. You can access a $1,500 benefit for teeth cleanings and restorations. This benefit cap does not apply to emergency procedures or artificial teeth treatment. For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in Colorado is advisable.
You should expect to pay about $3 for every prescription or refill you need under the Colorado Medicaid plan. You are not subject to these co-pays if you are pregnant or under 18.
The Colorado Department of Health Care Policy & Financing website lets you explore the preferred drug list for covered medication.
You receive extra benefits and services if you are below the age of 20. Additionally, you may qualify for extended health care benefits if you manage a long-term or escalating disability.
You can keep your health insurance benefits if you receive grant money, scholarships, or other forms of academic assistance as a student.
After you turn 65, you can designate Colorado Medicaid as your primary healthcare insurance. Coverages will typically include routine doctor visits and emergencies. You may also qualify for home care, and community assisted living, but these options are not available for all seniors.
Suppose you do not work enough under Social Security to receive hospital insurance (Medicaid A). In that case, you may still qualify for a cost-savings program.
In an effort to provide inclusive access to care, Health First Colorado offers specific subgroups additional benefits. Here is what you can expect:
You do not need to pay an enrollment fee or office visit co-pay if you are an Indigenous American or a Native Alaskan. Speak to a Department of Health Care Policy & Financing representative if you have more questions about coverage for indigenous individuals.
You may qualify for both Veterans Affairs health care insurance and Health First Colorado if you are a current or former member of the United States Armed Forces. Neither insurance plan will cancel out the other. It’s important to note that Health First Colorado may not provide enough coverage in an instance where someone becomes temporarily or permanently disabled. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work, and to help with the cost of medical needs.
Health First Colorado does not provide coverage for the following:
Many Health First Colorado members don’t realize just how many clinical procedures are available under this plan.
Still, some exclusions may apply depending on your age, medical condition, etc. Take a closer look at what Colorado Medicaid offers in more detail:
|Visiting the dentist every six months to a year is essential for your oral health. You can use your Colorado Medicaid plan for dental exams and cleanings.
|Root canals and cavity repair
|Root canals and cavity fillings are some of the most expensive dental procedures you can receive. Health First Colorado covers these procedures, including crowns, so you can enjoy a healthy smile year-round.
|You can request a dental X-ray for free under the Health First Colorado plan.
|Many optometrists require you to complete an annual eye exam before you can reorder corrective lenses. Health First Colorado covers these services, only requiring a $2 co-pay if you are not pregnant.
|Colorado Medicaid will cover your glasses and contacts only after eye surgery.
|Health First Colorado offers free coverage for surgeries performed at an ambulatory location. Expect to fill out a permission form before seeking these services.
|Hospital staff may need to administer inpatient surgery to treat one of your medical conditions. These procedures cost thousands of dollars out-of-pocket without insurance. Colorado Medicaid only requires you to pay a $10 fee per day — excluding those under 19 or pregnant individuals who can enjoy a $0 co-pay.
|Coverage for transplant surgery requires you to pay the hospital $10 for every day of treatment. Again, if you are pregnant or younger than 19, co-pays do not apply.
|You do not need to pay a fee to your doctor if they recommend anesthetics for your surgery.
|Chest reconstructive surgery
|You can enjoy free coverage for chest surgery if you seek treatment within five years of a related medical diagnosis.
|Routine health checkups will cost you a $2 co-pay per appointment. However, you may only visit one doctor per day regarding your issue.
|Health First Colorado covers emergency visits to the hospital if doctors confirm that you are experiencing an emergency. However, visits that are not emergencies will cost you $8.
|Ambulances are notoriously expensive hospital services that few low-income families can afford. Colorado Medicaid covers your ride, so you can call for help when needed.
|You can schedule transportation to the hospital ahead of time if you are not experiencing an emergency. Colorado Medicaid covers these expenses and excludes no one.
|A trip to urgent care will cost you $2. However, no fees apply if doctors determine you are experiencing an emergency.
|Non-emergency hospital visits
|Some healthcare services require you to complete treatment at your local hospital. These non-emergency procedures will cost you $4 under the Colorado Medicaid program.
|Health First Colorado provides free coverage for hospice stays. However, this insurance plan does not cover patients who spend more than nine months in the facility. In Colorado, the state's Medicaid program features a burial support initiative that offers a maximum of $1,500 to help cover funeral expenses, granted the overall service expenses do not exceed $2,500 and all other qualifications for Medicaid eligibility are satisfied. It is always wise to ensure that in the event of your passing, your family is secured with comprehensive funeral insurance.
|Blood testing and X-rays
|Lab fees can stack up over time, especially if you manage a long-term medical condition. Fortunately, blood tests and X-rays will only cost you one dollar with Health First Colorado.
|Therapy and Counseling
|Substance abuse monitoring
|All assessments are free to you under Health First Colorado coverage. These services include detoxing and pulse tracking.
|Keeping up with your mental health is essential to living a longer, happier life. You can enjoy zero-dollar co-pays on your visits to the therapist's office. Individual counseling services may also include:
|Health First Colorado covers a wide range of group therapy services, including drug and alcohol counseling, grief counseling, and family counseling.
|Developmental latency or impairment therapy
|You can seek treatment for mental health disorders for you or your child at no cost. These services sometimes require you to inform Health First Colorado before seeking professional help.
|At-home physical therapies
|At-home treatments for musculoskeletal, speech, or occupational conditions cost you nothing under the Colorado Medicaid plan. However, you can only undergo treatment for two months before fees apply.
|Hospital-administered physical therapies
|Inpatient therapies for speaking disorders or physical injuries require $10 co-pays for every day of your treatment.
|You can get a mammogram, pap test, and STD screening without a co-pay. However, Health First Colorado limits most gynecological services to one exam a year. Ask your healthcare provider which options are available if you require additional care.
|As a member of Colorado Medicaid, you can ask your doctor to screen you for cancer at no cost. Like visits to the gynecologist, the insurance policy limits you to one screening a year.
|Your family planning specialist can provide a year’s worth of oral or topical birth control treatments at no cost. Health First Colorado also covers emergency birth control. However, you must get a prescription from an in-network provider and pharmacist. You may qualify to receive IUD birth control treatments from your doctor, which could protect you from unwanted pregnancies for up to a decade. This solution also requires no co-pay.
|You can enjoy zero coverage limits and co-pays during childbirth. Additionally, you can visit a prenatal doctor 13 times a year after reporting your pregnancy.
|Colorado Medicaid covers most allergy shots and treatments. Appointments will cost you about $2 each.
|You can seek clinical foot exams and treatments once every two months with a $2 co-pay. However, chronic injuries or complications may cost more to treat.
According to federal law, Health First Colorado will not issue payments to your healthcare provider until a third-party insurance company pays its share. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.
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