Is It Right for You?

Health First Colorado (Medicaid) is government-funded health coverage for people in certain situations. You may qualify if you:

• Have low to moderate income, no matter how much you have in resources or whether you have a disability. Income-based Health First Colorado (Medicaid) is explained on this page.
• Get Supplemental Security Income (SSI) benefits or qualify for SSI’s 1619(b) rule, which helps people who used to get SSI. In either case, you automatically get Health First Colorado (Medicaid) coverage and don’t need to worry about the rules discussed here. Learn more in DB101’s SSI article.
• Have low income, low resources, and a disability. Learn more about disability-based Health First Colorado (Medicaid).
• Have a disability and work, even if your income is higher. Learn more about the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In).

Answer the questions on this page to see if you might qualify for income-based Health First Colorado (Medicaid). If so, it’s probably your best health coverage option because it doesn’t usually have a premium, the copayments for services are generally lower than copayments required by private plans, and Health First Colorado (Medicaid) covers more services than most private plans. Also, if you qualify for Health First Colorado (Medicaid), you cannot get government help paying for an individual plan on Connect for Health Colorado.

Do You Meet the Basic Requirements for Income-Based Health First Colorado (Medicaid)?

To qualify for income-based Health First Colorado (Medicaid), you must:

• Be under 65 years old
  • You can be 65 or older if you are the parent or caretaker of a child.
• Not qualify for Medicare
  • You can be on Medicare if you are the parent or caretaker of a child or are pregnant.
• Be a U.S. citizen or meet specific noncitizen requirements

If you are under 65, do not qualify for Medicare, and are either a U.S. citizen or a noncitizen who qualifies, income-based Health First Colorado (Medicaid) might cover you.

Health First Colorado (Medicaid) Rules for Immigrants:

• Undocumented immigrants do not qualify for full Health First Colorado (Medicaid) coverage, but they may qualify for Emergency Health First Colorado (Medicaid).
• Most immigrants who have been lawfully present for less than five years do not qualify for full Health First Colorado (Medicaid) coverage. However, they may qualify for private coverage subsidized by the government.
• Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements qualify for the same programs that U.S. citizens can get.

Is Your Income Low Enough for Income-Based Health First Colorado (Medicaid)?

These are the main income rules for income-based Health First Colorado (Medicaid):

• If your family’s income is at or under 138% of the Federal Poverty Guidelines (FPG) ($21,597 per year for an individual; $44,367 for a family of four), you may qualify.
• If you are 18 or younger and your family’s income is at or under 260% of FPG ($83,590 per year for a family of four), you may qualify for Child Health Plan Plus (CHP+).
• If you are pregnant and your family’s income is at or under 260% of FPG ($83,590 per year for a family of four), you may qualify. The unborn baby is counted as a family member.

Income-based Health First Colorado (Medicaid), sometimes called "Medicaid expansion," is based on your Modified Adjusted Gross Income (MAGI), which includes most earned and unearned income. However, some income is not counted, including Supplemental Security Income (SSI) benefits, growth of the investments in an ABLE account, and some contributions to retirement accounts. Learn more about what types of income affect income-based Health First Colorado (Medicaid) eligibility.

Note: There are no limits to how much money or other resources you can have for income-based Health First Colorado (Medicaid).

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Income limits for your family:
	$15,650
	$5,500
	$15,060
	$5,380
Income-based Health First CO (Medicaid), adults (138% FPG)
Child Health Plan Plus (CHP+) (260% FPG)
Subsidized private plans, reduced fees (250% FPG)
Subsidized private plans (no income limit)	--
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules. Notes: Some types of income do not count against these limits, including SSI benefits. Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). Disability-based Health First Colorado (Medicaid) eligibility is not included here. For private plans with subsidies, your monthly premium amount depends on your income.

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If your income is low enough and you meet all other requirements, you should sign up for Health First Colorado (Medicaid) or Child Health Plan Plus (CHP+).

More Ways to Qualify for Health First Colorado (Medicaid) if You Have a Disability

There are other ways to qualify for Health First Colorado (Medicaid) if you have a disability. You might qualify for disability-based Health First Colorado (Medicaid) if:

• You get Supplemental Security Income (SSI) benefits.
• You make more money at work than income-based Health First Colorado (Medicaid) allows. In that case, you could apply for Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In).
• You also get Medicare. Usually, Health First Colorado (Medicaid) doesn’t cover people getting Medicare, but disability-based Health First Colorado (Medicaid) does. It may even help pay your monthly Medicare premiums.
• You are 65 years old or older.

You might qualify for income-based Health First Colorado (Medicaid), even though you have a disability, if:

• Your disability does not meet Social Security’s definition of disability. Disability-based Health First Colorado (Medicaid) is only for people who have disabilities meeting this standard.
• You have more resources than are allowed by disability-based Health First Colorado (Medicaid) and do not work.
• You make enough money that you would have to pay a monthly premium for the Medicaid Adult Buy-In.

Learn more about disability-based Health First Colorado (Medicaid) and the Medicaid Adult Buy-In.

How to Sign Up

You can apply for Health First Colorado (Medicaid), Child Health Plan Plus (CHP+), and other Colorado programs:

• Online on the Colorado PEAK website
• With a paper application (available in English, Spanish, or large print). Fill it out and return it by mail, fax, or in person at your county human services department, or
• By phone at 1-800-221-3943.

Colorado PEAK lists the details you may need to fill out an application.

Staying on Health First Colorado (Medicaid)

Usually, once approved for Health First Colorado (Medicaid), you continue to qualify as long as your situation doesn’t change. If your income, immigration status, residency, or household size changes, let your county human services department know within 10 days of the change. You can do this in person, by phone, or by email. When you report your changes, the county tells you whether you continue to get Health First Colorado (Medicaid) or if you have new health coverage options, like individual coverage with subsidies or the Medicaid Adult Buy-In.

Is It Right for You?

Health First Colorado (Medicaid) is government-funded health coverage for people in certain situations. You may qualify if you:

• Have low to moderate income, no matter how much you have in resources or whether you have a disability. Learn more about income-based Health First Colorado (Medicaid).
• Get Supplemental Security Income (SSI) benefits or qualify for SSI’s 1619(b) rule, which helps people who used to get SSI. In either case, you automatically get Health First Colorado (Medicaid) coverage and don’t need to worry about the rules discussed here. Learn more in DB101’s SSI article.
• Have low income, low resources, and a disability, but don't get SSI. Disability-based Health First Colorado (Medicaid) is explained on this page.
  
• Have a disability and work, even if your income is higher and you have lots of resources. Learn more about the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In).

Answer the questions on this page to see if you might qualify for disability-based Health First Colorado (Medicaid). If you do, it’s probably your best health coverage option because:

• It doesn’t usually have a premium and copayments are low
• It covers more services than most private insurance, and may help you qualify to get Home and Community-Based Services (HCBS) Waivers
• If you qualify for Health First Colorado (Medicaid), you cannot get government help paying for an individual plan on Connect for Health Colorado, and
• If you also have Medicare coverage, it may help pay your Part B premium.

Note: This page talks about disability-based Health First Colorado (Medicaid) rules for adults. If you are 18 or under, learn about the rules for Medicaid, the Children's Buy-In, and Child Health Plan Plus (CHP+) in DB101's Benefits for Young People article.

Do You Get Supplemental Security Income (SSI)?

If you get SSI benefits, or qualify for SSI’s 1619(b) rule, which helps people who used to get SSI, you automatically get Health First Colorado (Medicaid) coverage and don’t need to worry about the other rules discussed here. Learn more in DB101’s SSI article.

If you get SSI or qualify for 1619(b), you have Health First Colorado (Medicaid) coverage!

If not, keep reading this page to see if disability-based Health First Colorado (Medicaid) might be right for you.

If You Don't Get SSI, Do You Have Low Income and Low Resources?

If you don't get SSI, you need to apply for Health First Colorado (Medicaid) separately. If you meet most of SSI's eligibility rules, even though you don't get SSI, you may qualify for disability-based Health First Colorado (Medicaid) if you:

• Have a disability that meets Social Security’s adult definition of disability.
• Have countable income below the SSI program's limit ($967 per month or less for individuals).
  • The way your income is counted for disability-based Health First Colorado (Medicaid) is very similar to SSI’s countable income calculation: most of your unearned income is counted, while less than half of your earned income is counted.
• Have countable resources below the SSI program's limit ($2,000 for individuals).
  • Some resources don’t count towards these limits, like the home you live in, one car, and any money you have in an ABLE account.
• Meet all other Health First Colorado (Medicaid) program rules, such as being a citizen or meeting noncitizen requirements.

If you have a disability, have income and resources below the limits, and meet all other program rules, disability-based Health First Colorado (Medicaid) might be right for you.

Tip: If you have a disability, but you have higher income or resources, you may qualify for the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In), which has a much higher income limit and no resource limit! Learn more about the Medicaid Adult Buy-In.

Health First Colorado (Medicaid) Rules for Immigrants:

• Undocumented immigrants do not qualify for full Health First Colorado (Medicaid) coverage, but they may qualify for Emergency Health First Colorado (Medicaid).
• Most immigrants who have been lawfully present for less than five years do not qualify for full Health First Colorado (Medicaid) coverage. However, they may qualify for private coverage subsidized by the government.
• Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements qualify for the same programs that U.S. citizens can get.

How to Sign Up

You can apply for the Health First Colorado (Medicaid), the Medicaid Adult Buy-In, and other Colorado programs:

• Online on the Colorado PEAK website
• With a paper application (available in English, Spanish, or large print). Fill it out and return it by mail, fax, or in person at your county human services department, or
• By phone at 1-800-221-3943.

Colorado PEAK lists the details you may need to fill out an application.

Staying on Health First Colorado (Medicaid)

Usually, once approved for Health First Colorado (Medicaid), you continue to qualify as long as your situation doesn’t change. If your income, immigration status, residency, or household size changes, let your county human services department know within 10 days of the change. You can do this in person, by phone, or by email. When you report your changes, the county tells you whether you continue to get Health First Colorado (Medicaid) or if you have new health coverage options, like individual coverage with subsidies or the Medicaid Adult Buy-In.

Is It Right for You?

Health First Colorado (Medicaid) is government-funded health coverage for people in certain situations. You may qualify if you:

• Have low to moderate income, no matter how much you have in resources or whether you have a disability. Learn more about income-based Health First Colorado (Medicaid).
• Get Supplemental Security Income (SSI) benefits or qualify for SSI’s 1619(b) rule, which helps people who used to get SSI. In either case, you automatically get Health First Colorado (Medicaid) coverage and don’t need to worry about the rules discussed here. Learn more in DB101’s SSI article.
• Have low income, low resources, and a disability, but don't get SSI. Learn more about disability-based Health First Colorado (Medicaid).
• Have a disability and work, even if your income is higher and you have lots of resources. The Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In) is explained on this page.

Answer the questions on this page to see if you might qualify for the Medicaid Adult Buy-In (sometimes called the WAwD for short). If so, it’s a good option to consider because it lets you work, earn a lot of money, and still get comprehensive coverage from Health First Colorado (Medicaid). And, if you also have Medicare coverage, the Medicaid Adult Buy-In may help pay your Part B premium.

Note: There is also a Medicaid Children's Buy-In Program for children 18 and younger, which is much different than the Adult Buy-In. Read about the Children's Buy-In in DB101's Benefits for Young People article.

Tip: For more information about the Medicaid Adult Buy-In, see DB101's Medicaid Adult Buy-In article.

Do You Meet the Medicaid Adult Buy-In’s Basic Requirements?

To qualify for the Medicaid Adult Buy-In, you must:

• Live in Colorado
• Be 16 years old or older
• Have a disability
• Be working, and
• Be a U.S. citizen or meet specific noncitizen requirements.

If you live in Colorado, are 16 years old or older, working, have a disability, and are either a U.S. citizen or a non-citizen who qualifies, the Medicaid Adult Buy-In might be an option for you.

Health First Colorado (Medicaid) Rules for Immigrants:

• Undocumented immigrants do not qualify for full Health First Colorado (Medicaid) coverage, but they may qualify for Emergency Health First Colorado (Medicaid).
• Most immigrants who have been lawfully present for less than five years do not qualify for full Health First Colorado (Medicaid) coverage. However, they may qualify for private coverage subsidized by the government.
• Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements qualify for the same programs that U.S. citizens can get.

Do You Have a Disability That Meets Social Security’s Standards?

To qualify for the Medicaid Adult Buy-In, you must have a disability that meets Social Security’s definition of disability. For adults, Social Security says you have a disability if:

• You have a physical or mental impairment or combination of impairments, and
• Your condition has lasted or is expected to last for at least 12 months.

Note: For the Medicaid Adult Buy-In, Social Security’s disability rules related to earned income do not apply.

If you currently get disability benefits, like Social Security Disability Insurance (SSDI), you already meet Social Security’s disability standards. If not, the state will check to see if your disability qualifies for the Medicaid Adult Buy-In.

If you already have a disability determination from Social Security or think that your disability meets Social Security’s standards, the Medicaid Adult Buy-In might be an option for you.

Is Your Income Below the Medicaid Adult Buy-In’s Income Limit?

For the Medicaid Adult Buy-In, you must have countable income at or below $5,869 per month. Only your income is counted, not the income of other household members.

The Medicaid Adult Buy-In counts your income the same way as SSI does: almost all of your unearned income is counted, but less than half of your earned income is counted.

That means, you could earn as much as $11,823 per month ($141,870 per year!) and still qualify. And there's no resource limit, so it doesn't matter how much money you have in the bank or in other resources.

If your income is low enough and you meet all other requirements, you should apply for the Medicaid Adult Buy-In.

How to Apply

You can apply for Health First Colorado (Medicaid), the Medicaid Adult Buy-In, and other Colorado programs:

• Online on the Colorado PEAK website
• With a paper application (available in English, Spanish, or large print). Fill it out and return it by mail, fax, or in person at your county human services department, or
• By phone at 1-800-221-3943.

Colorado PEAK lists the details you may need to fill out an application.

Staying on the Medicaid Adult Buy-In

Usually, once approved for Medicaid Adult Buy-In, you continue to qualify as long as your situation doesn’t change. If your income, immigration status, residency, disability status, or household size changes, let your county human services department know within 10 days of the change. You can do this in person, by phone, or by email.

What Options Are Right for You?

When you work, some of the money you earn automatically comes out of your paycheck and helps fund Medicare, a national public health insurance program.

If you or your spouse worked enough time while paying Medicare taxes, you qualify for Medicare:

• When you turn 65
• After you get Social Security Disability Insurance (SSDI) benefits for two years, or
• If you have Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS) or end-stage kidney disease (ESRD).

If you get Childhood Disability Benefits (CDB) benefits for two years based on a parent’s work record, you also qualify for Medicare.

If you qualify for Medicare, you can choose from two options:

• Original Medicare, including Part A, which helps pay for medical care you get while you’re in a hospital; Part B, which helps pay for medical care you get outside of a hospital, like when you go to the doctor’s office; and Part D, which helps pay for prescription drugs. You also have the option of getting a private Medicare supplement policy, which covers some expenses that Parts A and B do not cover.
  • After you get SSDI or CDB for two years, you automatically get Medicare Parts A and B. Otherwise, you may need to sign up, depending on your situation.
• A Medicare Advantage plan, which combines Parts A, B, and D into a single plan run by a private company. There are many different Medicare Advantage plans to choose from.
  • If you want a Medicare Advantage plan, you need to sign up during your initial Medicare enrollment or during the annual open enrollment period between October 15 and December 7 each year.

Most people don’t have to pay a premium for Part A, but they do have to pay monthly premiums for Parts B and D, or for Medicare Advantage plans.

Answer the questions on this page to see if it makes sense for you to get Original Medicare or a Medicare Advantage plan, and also whether you might qualify for programs that can help you pay your monthly premiums, copayments, co-insurance, and deductibles. If you have any questions, contact the free Colorado State Health Insurance Assistance Program (SHIP).

Note: In some cases, a parent or spouse's work record may help you qualify for Medicare, but it is individual coverage, not family coverage. All expenses, like premiums and deductible are for the individual and are not shared by the family.

Do You Qualify to Get Medicare and Other Coverage at the Same Time?

If you qualify to get Medicare at the same time as you get employer-sponsored coverage, Health First Colorado (Medicaid), or the Medicaid Adult Buy-In, having those other benefits may impact your Medicare decisions:

• If you also qualify for Health First Colorado (Medicaid) or the Medicaid Adult Buy-In, they may help pay your Part B premium and pay for some medical expenses that Parts B and D don't pay for.
• If you also qualify for employer-sponsored coverage, you may wish to decline Part B and Part D coverage, so that you don’t have to pay their premiums. However, your private coverage must meet certain standards, or else you may have to pay monthly penalties if you choose to sign up for Parts B and D later.
  • Important: Before you decline Part B, ask your employer-sponsored coverage to see if you would have to pay monthly penalties if you sign up for Part B in the future. Before you decline Part D, ask if your private insurance is considered creditable coverage by Part D. If it isn't, you would have to pay monthly penalties for Part D if you sign up later. If you have any questions about this, contact the free Colorado State Health Insurance Assistance Program (SHIP).

You may have other options as well, such as retirement benefits, Veterans (VA) benefits, or military (TRICARE) benefits. Learn more about how Medicare interacts with other types of coverage.

Can You Get Help Paying for Medicare Parts A and B?

While Medicare offers good coverage, it is not as low-cost as Health First Colorado (Medicaid). Depending on the care you need, you may have to pay large copayments, co-insurance, or deductibles. And, for Part B, you may have to pay a monthly premium (usually $185.00 per month or a bit less, depending on your situation). Medicare premiums and other expenses can add up to a lot of money.

If you also qualify for Health First Colorado (Medicaid) or the Medicaid Adult Buy-In, they may help pay your Part B premium. And, if you have low income and low resources, you may also qualify for a Medicare Savings Program (MSP). Colorado offers four Medicare Savings Programs:

• The Qualified Medicare Beneficiary (QMB) program helps people with countable income that’s 100% of the Federal Poverty Guidelines (FPG) or less ($1,305 per month or less if you live alone). QMB helps pay for your Part B premium, copayments, and deductibles. Note: If you have disability-based or SSI-linked Health First Colorado (Medicaid) coverage, you automatically qualify for QMB.
• The Specified Low-Income Beneficiary (SLMB) program helps people with countable income that’s more than 100% of FPG, but at or below 120% of FPG ($1,565 per month or less if you live alone). SLMB helps pay for the Part B premium, but does not help with anything else.
• The Qualified Individual-1 program, also called QI-1, helps people with countable income that’s more than 120% of FPG, but at or below 135% of FPG ($1,761 per month or less if you live alone). QI-1 helps pay for the Part B premium, but does not help with anything else.

• The Qualified Disabled Working Individual (QDWI) program helps people who have lost their SSDI benefits because they earn more than the Substantial Gainful Activity (SGA) level ($1,620 per month), but have countable income that’s 200% of FPG or less ($2,609 per month or less if you live alone). It lets you stay on Medicare Part A even though you don’t get SSDI anymore and it will pay for the Part A premium that would otherwise apply.

For MSPs, less than half of your earned income is counted. That means you might qualify even if you think your income is over the limits.

The resource limit for QMB, SLMB, and QI-1 is $11,160 if you live alone and $17,470 if you live with someone else. For QDWI, it’s $4,000 if you live alone and $6,000 if you live with another person.

Your Countable Income:

Your Monthly Earned Income	$
Your Monthly Unearned Income (not including SSI)	$
Your Monthly Impairment Related Work Expenses (IRWEs)	$
	$1,305
	$20
	$65
	$967
Your Monthly Countable Income
Your Annual Countable Income
	$15,650
Federal Poverty Guideline
Your Countable Income as a Percent of FPG

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To apply for an MSP, contact your county human services department.

Learn more about MSPs in Colorado or get help from the Customer Contact Center.

Can You Get Help Paying for Medicare Part D?

Part D helps you pay for your medications, but there are some expenses for you, such as the monthly premium, a deductible, copayments, and co-insurance.

If you cannot afford these costs, you may qualify for the Low Income Subsidy (LIS), which is also called “Extra Help.” With it, you don't have to pay a Part D premium or deductible, and there may be lower copayments.

The Low Income Subsidy is for people who also get Health First Colorado (Medicaid) coverage or who are in a Medicare Savings Program. You may also qualify if your countable income is less than $23,475 per year and your resources are less than $17,600 if you are single (the limits are higher for larger households). Not all of your income and resources are counted when you apply for the Low Income Subsidy. You can apply even if you don’t think you qualify.

Apply for the Low Income Subsidy at your local Social Security office.

Note: Before 2024, there used to be a "Partial LIS" that didn't help as much. Now, everybody who qualifies for the LIS gets the full subsidy.

Do You Want a Medicare Supplement Plan That Covers Costs that Original Medicare Doesn't?

If you get Original Medicare with Parts A, B, and D, you can choose to get a private Medicare supplement (sometimes called a Medigap plan) to cover some of the expenses that Medicare Parts A, B, and D don’t cover. For example, a Medicare supplement could cover things like your co-insurance payments for Part B.

You have to pay a monthly premium for a Medicare supplement, in addition to your premiums for Part B and D. The amount you have to pay depends on the plan.

Learn more about Medicare supplements or find one in your area.

Do You Want a Medicare Advantage Plan That Combines Parts A, B, and D?

With Medicare Advantage (sometimes called “Part C”), you can get all of your Medicare benefits combined into a single plan run by a private company. As long as a company follows Medicare’s rules, it can have more flexibility in the benefits it offers, how it organizes payments, and how much the plan costs. Also, Medicare Advantage plans have an out-of-pocket maximum, unlike Original Medicare.

The amount you pay depends on your plan, but most plans make you pay as much as the Part B premium costs, plus an additional amount for extra benefits and prescription drug coverage. A Medicare Savings Program and the Low Income Subsidy may help you pay for your Medicare Advantage plan.

Use the Medicare Plan Finder to see which Medicare Advantage plans might be best for your needs.

Is It Right for You?

To get private health insurance, a premium must be paid every month. Many employers offer to pay part, or all, of this monthly premium as a job benefit for employees, their children until they turn 26 years old, and their spouses. Employer-sponsored health coverage is the most common type of coverage in the U.S.

Answer the questions on this page to see if you can get employer-sponsored coverage. If you can, you probably should because you probably won’t qualify for subsidized individual coverage.

Can You Get Health First Colorado (Medicaid)?

If you qualify for Health First Colorado (Medicaid), it is usually your best choice, even if you can get health insurance from an employer. That’s because Health First Colorado (Medicaid) usually has no monthly premium and the copayments for services tend to be much lower than private insurance copayments. Also, Health First Colorado (Medicaid) may cover some services that employer-sponsored coverage doesn't pay for.

If you can’t get Health First Colorado (Medicaid), employer-sponsored coverage might be a good option for you.

You may qualify for Health First Colorado (Medicaid) if you are in one of these situations:

• Your family’s income is at or below 138% of the Federal Poverty Guidelines (FPG) ($21,597 per year for an individual; $44,367 for a family of four). The income limits are higher if you are 18 or younger or are pregnant. There are no limits to how much money or other resources you have. Learn more about income-based Health First Colorado (Medicaid).
• You have a disability or are elderly:
  • Health First Colorado (Medicaid) for people with disabilities and seniors may offer additional services, but it has more eligibility requirements, such as having a disability, having low resources, and different income rules. (If you get Supplemental Security Income (SSI) benefits, you qualify automatically.) Learn more about disability-based Health First Colorado (Medicaid).
  • The Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In) lets people with disabilities who make more money or have more resources than the limits for other types of Health First Colorado (Medicaid) get coverage. However, you may have to pay a monthly premium. Learn more about the Medicaid Adult Buy-In.

Does Your Employer, Your Spouse’s Employer, or Your Parent’s Employer Offer Coverage?

Many employers offer health coverage as a job benefit, but they aren't required to. Contact your employer’s Human Resources department to check what benefits are offered.

If an employer offers health coverage as a job benefit for employees, the employer also has to offer the same health coverage to the employees’ children until they turn 26. An employer may also let the employee’s spouse join the plan, but they are not legally required to do so.

If your employer, your parent’s employer, or your spouse’s employer offers health coverage, it might be a good option for you.

Can You Get the Coverage Your Employer Offers?

Employers offer health coverage for employees and their families only if their employees meet certain requirements, such as:

• The employee must work a certain number of hours each week (called the active work requirement).
  • Example: Your wife’s employer only gives health benefits to employees who work 30 or more hours per week.
• The employee must have worked for the employer for a certain amount of time (called the waiting period). A waiting period cannot be longer than 90 days.
  • Example: Your father’s employer offers health coverage to employees who have worked there for at least 90 days.
• You must sign up during open enrollment.
  • Example: After you are hired, you have to sign up for your employer-sponsored coverage during your first month on the job. If you don’t, you have to wait until the next open enrollment period to sign up for coverage.

If your employer, your parent’s employer, or your spouse’s employer offers coverage and you can get that coverage, you probably should.

Getting Medicare and Employer-Sponsored Coverage at the Same Time

If you get Medicare and also have employer-sponsored coverage, you should learn how your benefits work together.

If you get Original Medicare coverage, you can get Medicare Part A, which usually has no monthly premium, and both Parts B and D, which do have monthly premiums.

If you have private coverage that covers the same things Parts B and D cover, you can choose not to get them so that you don't have to pay their premiums. But it's important to make sure you won't have problems later:

• Before you decline Part B, ask your employer-sponsored coverage to see if you would have to pay monthly penalties if you sign up for Part B in the future.
• Before you decline Part D, ask if your private insurance is considered creditable coverage by Part D. If it isn't, you would have to pay monthly penalties for Part D if you sign up later. If you have any questions about this, contact the Colorado State Health Insurance Assistance Program (SHIP).

Learn more about Medicare.

How to Sign Up

Talk to the employer’s Human Resources department to learn how to sign up. An employer may offer more than one plan and usually there are trade offs between them. For example, one plan may require you to pay a higher monthly premium, while another may require you to pay higher copayments when you visit a doctor.

Sign up for coverage when it is first offered; otherwise, you may have to wait until the annual open enrollment period, which is usually near the end of the year. Certain changes in family or coverage status may trigger a special enrollment period. For example, if you get married or have a child, your new spouse or baby will be able to sign up with your employer-sponsored coverage without waiting until open enrollment.

If You Have to Stop Working Temporarily

In certain situations, you may be able to leave your job for a while, but keep getting your employer-sponsored coverage until you return to work.

If you work for any government agency or for a private employer with 50 or more employees, the Family and Medical Leave Act (FMLA) lets you take up to 12 weeks of unpaid leave per year for certain family and medical reasons, such as the birth of a child or to care for a sick family member. During this leave, your employer must continue to offer the same health coverage at the same cost as you would get while working. Learn more about the FMLA.

If you serve in the uniformed services, the Uniformed Services Employment and Reemployment Rights Act (USERRA) protects your job and health coverage for up to 24 months while you are serving. Learn more about USERRA.

COBRA and Colorado Continuation Coverage

COBRA and Colorado Continuation Coverage let most employees and family members keep getting the same health plan they got through an employer after losing employer-sponsored coverage.

COBRA

COBRA is a federal law that says that companies with 20 or more employees have to let ex-employees keep getting the same health coverage they had as employees. How long you can get coverage through COBRA depends on your situation. No matter what though, you have to pay the entire premium for COBRA, including any amount that your employer paid in the past. Your plan could be a lot more expensive than you realize.

COBRA used to be important because it was so hard for individuals, especially people with disabilities, to get an individual insurance plan. Now, Connect for Health Colorado makes that much easier and often much cheaper. That said, there are times when COBRA might make sense, like if you’ve already paid the full deductible or out-of-pocket maximum for the year with your employer-sponsored coverage.

The bottom line: Do not sign up for COBRA without comparing it with your other options.

Learn more about COBRA.

Colorado Continuation Coverage

While COBRA only applies to companies with 20 or more employees, Colorado Continuation Coverage is for employees of smaller companies. The rules for Colorado Continuation coverage are similar to COBRA, but there are some differences. The best way to find out if you qualify for Colorado Continuation coverage is to ask the employer or benefits administrator.

Is It Right for You?

With individual coverage, an individual or family pays a monthly premium and the plan agrees to pay some of the costs of approved medical services when needed, including preventive care, lab tests, surgery, or prescription drugs. If you have low to moderate income, the government may help you pay for your monthly premium and get a plan with lower copayments.

Answer the questions on this page to see if it might make sense for you to get individual health coverage. If it does, sign up using Connect for Health Colorado, the easiest place to comparison shop for an individual plan and the only place where you might be able to get help from the government to pay for your private insurance.

Do You Have Any Better Options?

If you can get Health First Colorado (Medicaid), Medicare, or employer-sponsored coverage, you don’t qualify for government help to pay for an individual plan. That means they are usually a better choice than getting an individual plan, because they cost less.

Can You Get Health First Colorado (Medicaid)?

Health First Colorado (Medicaid) is a government health program for people with low income. It’s a great program that usually has no monthly premium and copayments for services that are usually much lower than copayments required by individual plans. Also, Health First Colorado (Medicaid) may cover some services that an individual plan doesn't cover.

If you can’t get Health First Colorado (Medicaid), individual coverage might be a good option for you.

You may qualify for Health First Colorado (Medicaid) if you are in one of these situations:

• Your family’s income is at or below 138% of the Federal Poverty Guidelines (FPG) ($21,597 per year for an individual; $44,367 for a family of four). The income limits are higher if you are 18 or younger or are pregnant. There are no limits to how much money or other resources you have. Learn more about income-based Health First Colorado (Medicaid).
• You have a disability or are elderly:
  • Health First Colorado (Medicaid) for people with disabilities and seniors may offer additional services, but has more eligibility requirements, such as having a disability, having low resources, and different income rules. (If you get Supplemental Security Income (SSI) benefits, you qualify automatically.) Learn more about disability-based Health First Colorado (Medicaid).
  • The Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In) lets people with disabilities who make more money than the income limits for other types of Health First Colorado (Medicaid) get coverage. However, you may have to pay a monthly premium. Learn more about the Medicaid Adult Buy-In.

Can You Get Medicare?

Medicare is a government health program for seniors (65 years old or older) and people with disabilities. To get Medicare coverage, you or a family member must have worked for a certain number of years and met other eligibility rules.

If you get Medicare, you cannot get government help to pay for an individual health plan. You can still buy an individual plan through Connect for Health Colorado, but you have to pay the entire premium yourself. Note: If you get Medicare and want more coverage than it offers, look into Medicare Advantage or Medicare supplement policies. Connect for Health Colorado does not offer these.

If you can’t get Medicare, individual coverage might be a good option for you.

Can You Get Employer-Sponsored Coverage?

Many employers offer private health coverage as a job benefit for employees, their children until they turn 26, and their spouses. If your employer offers you health coverage that would cost you less than 9.02% of your household’s income and that coverage meets a certain benefits level, you won't qualify for government help paying for an individual plan. If you can get employer-sponsored coverage, but sign up for an individual plan anyway, you will have to pay the full premium.

Note: Before 2023, the spouse or children of an employee would not qualify for subsidies on Connect for Health Colorado if the employer offered coverage that was affordable for the employee's policy alone, even if the cost to add the rest of the family wasn't affordable. This was called the "family glitch." This changed starting in 2023. Learn more about affordability rules for family members and how it affects eligibility for tax credits on Connect for Health Colorado.

If you can’t get employer-sponsored coverage, individual coverage might be a good option for you.

When an Individual Plan Is Your Best Option

You should get an individual plan through Connect for Health Colorado if you cannot get health coverage from:

• Your job
• Your spouse’s job
• Your parent’s job
• Health First Colorado (Medicaid), or
• Medicare.

The government may make your individual plan more affordable if you cannot get health coverage from any of the above options:

• You may get a tax subsidy to help pay your monthly premium.
• You may also qualify for a plan with lower expenses, such as smaller copayments, if your family’s income is at or below 250% of the Federal Poverty Guidelines (FPG) ($37,650 for an individual; $78,000 for a family of four).

Note: There is no income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG.) To get subsidies, you still must meet other eligibility rules and the premium amount you pay depends on your income and your plan.

When Connect for Health Colorado looks at your income, they count most of your earned and unearned income. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect whether you get help paying for individual coverage.

Try Connect for Health Colorado's tools for comparing costs and plans.

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Income limits for your family:
	$15,650
	$5,500
	$15,060
	$5,380
Income-based Health First CO (Medicaid), adults (138% FPG)
Child Health Plan Plus (CHP+) (260% FPG)
Subsidized private plans, reduced fees (250% FPG)
Subsidized private plans (no income limit)	--
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules. Notes: Some types of income do not count against these limits, including SSI benefits. Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). Disability-based Health First Colorado (Medicaid) eligibility is not included here. For private plans with subsidies, your monthly premium amount depends on your income.

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How to Sign Up

Connect for Health Colorado is a one-stop shop where you can compare plans and figure out which is right for you. And it is the only place where you can get government help to pay for your individual plan.

Start out by comparing your options so that you can make an informed decision when you are ready. If you find Connect for Health Colorado confusing or think there is a mistake, get help by calling Connect for Health Colorado at 1-855-752-6749 or 1-855-346-3432 (TTY) or get local help.

Open Enrollment

Open enrollment for individual plans has ended for this year. People in certain situations can still sign up for a health plan under special enrollment rules.

Usually, you can only sign up for an insurance plan through Connect for Health Colorado during a specific time called open enrollment:

• To get an individual plan that covers you during 2025, you must sign up between November 1, 2024 and January 15, 2025.
• If you do not sign up during that time, you are not usually allowed to sign up for an individual plan through Connect for Health Colorado until another year has passed.

Special Enrollment

You can sign up for an individual plan through Connect for Health Colorado even though it is not the usual open enrollment period if:

• Your household income is at or below 150% of FPG
• You lose other health coverage you had
• Your income changes and you gain or lose eligibility for government help paying for your coverage
• You become a legal resident of the U.S.
• You move
• There was a mistake in your enrollment, or
• In other life-changing circumstances, such as having a child or getting married.

Note: American Indians do not have these restrictions on enrollment.