The Basics
Many people with disabilities worry that if they start to work and earn more money, they’ll lose their Health First Colorado (Medicaid) coverage. The Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In) means that you don’t have to be afraid.
With the Medicaid Adult Buy-In (sometimes called WAwD for short), if you have a disability and work, you can earn more and keep your Health First Colorado (Medicaid) coverage. The Medicaid Adult Buy-In pays for almost all the same services that standard Health First Colorado (Medicaid) covers, including visits to the doctor, hospital stays, medical equipment, home care services, and mental health services. You may have to pay a small monthly premium of $200 or less.
To qualify for the Medicaid Adult Buy-In, you must be a U.S. citizen or qualifying noncitizen, at least 16 years old, have a disability, be working, and have $5,468 or less in monthly countable income. (That means you could actually earn as much as $11,020 per month!)
This article will help you understand:
- If the Medicaid Adult Buy-In is right for you
- What services it covers
- How much you will have to pay, and
- How to sign up.
Note: The Health First Colorado (Medicaid) Buy-In Program for Children with Disabilities (or the "Children's Buy-In" for short) is a different program for people who are 18 years old or younger. Learn about it in DB101's Benefits for Young People article.
- You can earn a lot of money and still qualify for the Medicaid Adult Buy-In.
- If your disability does not qualify you for the Medicaid Adult Buy-In, you may be able to qualify for Health First Colorado (Medicaid) through other rules that have no disability requirement.
- You may have to pay a monthly premium that is based on how much income you have.
- You can get it and Medicare at the same time, if you qualify. If you have both, the Medicaid Adult Buy-In will help pay your Part B premium.
If you need to contact someone about the Medicaid Adult Buy-In:
- Talk to a Medicaid Adult Buy-In expert at 1-800-711-6994.
- Get help with Health First Colorado (Medicaid) by calling 1-800-221-3943.
- Contact your county human services department.
Learn more
Is It Right for You?
Almost everyone should be able to get health coverage, so you just need to see which option is right for you and your family. This page helps you see if the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In) might be a good choice for you.
If you don’t qualify for the Medicaid Adult Buy-In, you may still qualify for Health First Colorado (Medicaid) based on other rules or for other programs, like Medicare and private health insurance.
Depending on your situation, other ways for you to get health coverage could include:
- Employer-sponsored coverage, if your employer offers it
- Individual plans on Connect for Health Colorado, which the government may help you pay for.
Read more about them in DB101’s article about How Health Benefits Work.
Medicaid Adult Buy-In Basic Eligibility Requirements
To qualify for the Medicaid Adult Buy-In (sometimes called WAwD for short), 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.
Note: If get Supplemental Security Income (SSI) or qualify for SSI’s 1619(b) provision, you automatically get Health First Colorado (Medicaid) coverage, do not need to apply for the Medicaid Adult Buy-In, and do not need to worry about the rules discussed on this page.
Note: The Health First Colorado (Medicaid) Buy-In Program for Children with Disabilities (or the "Children's Buy-In" for short) is a different program for people who are 18 years old or younger. Learn about it in DB101's Benefits for Young People article.
Tim has a brain injury. He’s had Health First Colorado (Medicaid) for years and needs the services it pays for. He wants to start working again and has a great job offer, but the job is part-time and doesn't offer health insurance.
Tim should consider the Medicaid Adult Buy-In. It pays for the same services that standard Health First Colorado (Medicaid) covers. With the Medicaid Adult Buy-In, Tim could take the job, earn some money, and be able to get his medical needs taken care of, while paying just a small monthly premium.
Disability Determination
To qualify for the Medicaid Adult Buy-In, you must have a disability that meets Social Security’s definition of disability. 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.
Under these rules, 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.
Citizenship and Noncitizen Requirements
You must be a U.S. citizen or meet specific noncitizen requirements to be eligible for the Medicaid Adult Buy-In:
- 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, including the Medicaid Adult Buy-In.
- Most immigrants who have been lawfully present for less than five years do not qualify for the Medicaid Adult Buy-In. However, they may qualify to get private coverage subsidized by the government through Connect for Health Colorado.
- Undocumented immigrants do not qualify for the Medicaid Adult Buy-In, but they may qualify for Emergency Health First Colorado (Medicaid). To learn more about this, contact your local county human services department.
Income
The Medicaid Adult Buy-In is for people with disabilities who make money at work. You can earn a lot and still qualify: your countable income must be 450% of the Federal Poverty Guidelines (FPG) or less. That's $5,468 per month or less. 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. For example, if you make $4,000 per month at a job and have no other income, that’s only $1,957.50 in countable monthly income.
That means, you could earn as much as $11,020 per month ($132,240 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.
Try this tool to see how much countable income you have:
| Your Monthly Earned Income | $ |
| Your Monthly Unearned Income (not including SSI) | $ |
| Your Monthly Impairment Related Work Expenses (IRWEs) | $ |
 | |
| Your Monthly Countable Income | |
| Your Annual Countable Income | |
| |
| Your Countable Income as a Percent of FPG |
If you are working, paying taxes and have countable monthly income that is below the income limit, you may qualify for the Medicaid Adult Buy-In.
The Medicaid Adult Buy-In and Employer-Sponsored Health Coverage
You can have Medicaid Adult Buy-In coverage and employer-sponsored private coverage at the same time. There are two main advantages to this:
- Employer-sponsored private insurance may cover some benefits that the Medicaid Adult Buy-In doesn’t or vice versa.
- Employer-sponsored coverage may let you choose from more doctors.
The disadvantage is that you would probably have to pay premiums for both programs, and private coverage usually has higher copayments than the Medicaid Adult Buy-In, so it might not be worth the expense.
The Medicaid Adult Buy-In and Medicare
If you are eligible for both the Medicaid Adult Buy-In and Medicare, you can have both at the same time. This can help because the Medicaid Adult Buy-In will help pay for things that Medicare doesn't pay for.
The Medicaid Adult Buy-In will help pay your Part B premium. And, if your income is low enough, you may also qualify for a Medicare Savings Program to help pay other Part B expenses (and your Part A premium, if you have one), and the Part D Low Income Subsidy, to help pay for your prescription drugs.
Contact the Colorado State Health Insurance Assistance Program (SHIP) if you have questions about how your Health First Colorado (Medicaid) and Medicare benefits work together. To learn more, read DB101’s How Health Benefits Work article, which has detailed information on Medicare Savings Programs and the Part D Low Income Subsidy.
Depending on your situation, you might have employer-sponsored coverage, the Medicaid Adult Buy-In, and Medicare all at the same time. This can sound confusing, but it can help you, because one form of coverage may pay for costs that your other coverage won't pay for.
The rules about how your different types of coverage pay for things are very complicated, so it’s important to check with your health coverage plans when you have questions about which plan will pay for what expenses.
Generally speaking, the Medicaid Adult Buy-In will only pay for expenses that it covers and that your other coverage won't pay for.
Note: If you use a health provider that is not covered by the Medicaid Adult Buy-In, the Medicaid Adult Buy-In will not pay any medical expenses. So, if your health care provider doesn’t take the Medicaid Adult Buy-In and your private insurance or Medicare won’t cover everything, the Medicaid Adult Buy-In won’t help pay the rest. Make sure to find providers who accept the Medicaid Adult Buy-In.
The Centers for Medicaid and Medicare Services (CMS) explains How Medicare works with other insurance.
Learn more
What It Covers
If you get coverage from the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In), it will pay for a broad range of medical services. If you’re not sure if a particular service is covered by the Medicaid Adult Buy-In, or if you need prior authorization, ask your doctor or your regional organization.
Here is a list of some of the main services that the Medicaid Adult Buy-In provides:
- Doctor's visits, including primary care doctors, specialists, home health services, and telemedicine
- Vision care
- Dental services
- Emergency room visits and ambulance services
- Transportation to appointments
- Urgent care
- Outpatient hospital services and surgery
- Inpatient medical care or surgical care
- Organ and transplant services
- Maternity and newborn care
- Mental health care
- Substance use services
- Prescription drug coverage
- Durable medical equipment, such as wheelchairs, oxygen, and others
- Physical therapy
- Occupational therapy
- Speech therapy
- Lab tests, including x-rays and blood tests
- Preventive care, including immunizations and cancer screenings
- Family planning services
Coverage for long-term care services, may require a separate application for Home and Community Based Services (HCBS) Waivers. Learn more about waivers in DB101's HCBS Waiver Programs article.
The Medicaid Adult Buy-In covers many types of health care, but it doesn't cover everything. Here are some examples of things it does not pay for:
- Cosmetic surgery
- Autopsy
- Vocational/educational services
- Artificial insemination, including in vitro fertilization
Learn more
What You Pay
If you get coverage through the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In), you may need to pay a monthly premium and copayments for certain services.
Premiums
The monthly premium for the Medicaid Adult Buy-In is based on your countable income. The higher your income is, the higher your premium will be. The maximum premium is $200.
Use this tool to see your countable income and then check the table below to see how much your premium will be.
| Your Monthly Earned Income | $ |
| Your Monthly Unearned Income (not including SSI) | $ |
| Your Monthly Impairment Related Work Expenses (IRWEs) | $ |
| |
| Your Monthly Countable Income | |
| Your Annual Countable Income | |
| |
| Your Countable Income as a Percent of FPG |
|
If Your Countable Monthly Income Is: |
Then Your Monthly Premium Is: |
|---|---|
|
$0.00 - $486 |
0 |
|
$487- $1,616 |
$25 |
|
$1,617 - $2,430 |
$90 |
|
$2,431 - $3,645 |
$130 |
|
$3,646 - $5,468 |
$200 |
To get a better idea of whether you qualify for the Medicaid Adult Buy-In and how much your premium might be, use the Medicaid Adult Buy-In Estimator.
When Can My Premium Change?
If your income changes, your premium may also change. The Medicaid Adult Buy-In will review your eligibility and premium at least every 12 months. Depending on your situation, your premium could go up or down.
If your income, immigration status, residency, disability status, or household size changes, use Colorado PEAK's Report My Changes tool or let your county human services department know within 10 days of the change. You can do this in person, by phone, or by email.
Billing
If you have to pay a monthly premium to get the Medicaid Adult Buy-In, the state will send you a bill every month, which will tell how to pay. You can also pay online using Colorado PEAK, or in person at: 655 Bannock St., 1st Floor, Denver, Colorado, 80204.
If you miss a payment, you have 60 days to pay it, or you could lose your Medicaid Adult Buy-In coverage. Information about this is sent with the monthly bill.
If you have questions about billing, contact your county human services department or talk to a Medicaid Adult Buy-In expert at 1-800-711-6994.
Copayments
Many services covered by Health First Colorado (Medicaid) have no copayments. For some services and prescription drugs, you may have to pay small copayments (usually $10 or less). The Health First Colorado (Medicaid) website explains copayment amounts.
Learn more
How to Sign Up
Application
There are different ways to apply for the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In):
- 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.
Note: Due to COVID-19, there may be limits on in-person services. Contact your agency by phone to ask about this.
No matter how you apply, it is important to know that if you are not eligible for the Medicaid Adult Buy-In, you may be able to get private insurance subsidized by the government.
Note: If you get Supplemental Security Income (SSI) or are on SSI 1619(b), you don’t need to apply for the Medicaid Adult Buy-In, because you’ll get Health First Colorado (Medicaid) coverage automatically and won’t have to pay a premium.
Colorado PEAK is the easiest way to apply for the Medicaid Adult Buy-In. Colorado PEAK also lets you apply for other state benefits, like SNAP (formerly Food Stamps), at the same time.
Connect for Health Colorado is a good option if you don’t think you will qualify for the Medicaid Adult Buy-In, because it will check if you can get private coverage with subsidies.
Staying on the Medicaid Adult Buy-In
Usually, once approved for the 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, use Colorado PEAK's Report My Changes tool or let your county human services department know within 10 days of the change. You can do this in person, by phone, or by email.
If you need help applying for the Medicaid Adult Buy-In, try the following options:
- Talk to a Medicaid Adult Buy-In expert at 1-800-711-6994.
- Get help with Health First Colorado (Medicaid) by calling 1-800-221-3943.
- Contact your county human services department.
- Get more detailed information from the Health First Colorado (Medicaid) Buy-In Programs home page.
Job Loss
To be on the Medicaid Adult Buy-In, you must be employed. If you lose your job and your Medicaid Adult Buy-In coverage, there should be at least one health coverage option for you. You may become eligible for Health First Colorado (Medicaid) without a premium or an individual insurance plan that the government will help you pay for. Read more about these options in DB101’s article on How Health Benefits Work.
Eligibility During Employer-Approved Leave
If you go on an approved leave from work, but are still employed, you may be able to keep your Medicaid Adult Buy-In coverage by reporting the change and submitting proof that you are still employed to your county human services department or Colorado PEAK.
Learn more
Example
Melanie’s Story
Melanie is 35 years old and has cerebral palsy. She hasn’t been able to work for the past six months due to her disability and has been living on the $850 in Social Security Disability Insurance (SSDI) benefits she gets every month. Health First Colorado (Medicaid) covers her health care expenses.
She’s been feeling better recently and wants to go back to work, so she talks to some friends and passes her resume around. Soon enough, a former coworker offers her a part-time job at his new start-up company. Unfortunately, the job does not come with health insurance and she’d be earning too much money to keep her Health First Colorado (Medicaid). She really wants to take this job, but cannot risk going without health insurance. Between her prescription drugs, physical therapy, and In-Home Support Services (IHSS), her total medical cost is several thousand dollars per month.
Melanie looks at getting an individual plan on Connect for Health Colorado. After filling out her information, it turns out that she could sign up for a plan that would cost her about $300 a month for the premium. The problem is that the plan has a deductible and also has copayments that are way higher than her Health First Colorado (Medicaid) copayments were. Furthermore, it wouldn’t pay for the IHSS she needs like Health First Colorado (Medicaid) does. She hopes to find another option.
She talks about the problem with her IHSS provider, Samantha, who mentions the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In).
“It’s designed for people like you,” Samantha says. “You can go back to work and earn thousands of dollars per month, while still keeping your health coverage.”
“But what about my savings? Can I keep them?” Melanie asks.
“I think so,” says Samantha, “but you should talk to a benefits planner to find out more.”
Together, Melanie and Samantha find a certified benefits counselor and set up an appointment. They learn that Melanie can have any amount of resources and still qualify for the Medicaid Adult Buy-In.
The benefits counselor tells them, “The Medicaid Adult Buy-In pays for all the same services that your Health First Colorado (Medicaid) coverage has been paying for. You may have to pay a monthly premium, but that wouldn’t be more than $200 each month. You’ll also be responsible for small copayments for some services.”
“Plus,” the benefits counselor tells her, “if your condition gets worse and you have to take some time off work, you won’t necessarily lose your coverage as long as you are an employee.”
“This all sounds great,” says Melanie. “I can go back to work! So what do I do now?”
“Take that job,” says the benefits counselor, “and when you get your first check, call your Health First Colorado (Medicaid) caseworker within 10 days to report your earnings and ask about Medicaid Adult Buy-In coverage.”
Melanie is ecstatic. She’ll be able to go back to work, doing something she really enjoys. And she’ll be able to keep her health coverage for a reasonable monthly cost.
Learn more
Frequently Asked Questions
Where can I get help with understanding the Medicaid Adult Buy-In?
For help with the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In):
- Talk to a Medicaid Adult Buy-In expert at 1-800-711-6994.
- Get help with Health First Colorado (Medicaid) by calling 1-800-221-3943.
- Contact your county human services department.
- Get more detailed information from the Health First Colorado (Medicaid) Buy-In Programs home page.
Where can I sign up for the Medicaid Adult Buy-In?
There are different ways to apply for the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In):
- 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.
Note: If you get Supplemental Security Income (SSI) or used to and now are on SSI 1619(b), you automatically get Health First Colorado (Medicaid) coverage. You do not need to apply for Health First Colorado (Medicaid) and do not have to pay a premium.
Note: Due to COVID-19, there may be limits on in-person services. Contact your agency by phone to ask about this.
What is the difference between Health First Colorado (Medicaid) and the Medicaid Adult Buy-In?
Health First Colorado (Medicaid) is a public health coverage program. There are different ways to qualify for Health First Colorado (Medicaid), depending on things like your age, income, resources, and whether you have a disability. One of those ways to qualify is through the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In).
If you qualify for regular Health First Colorado (Medicaid) coverage:
- You only pay small copayments for medical services.
- You may qualify based on the income-based rules described in DB101’s How Health Benefits Work article or based on disability rules, if you have low income and low resources. You automatically qualify for Health First Colorado (Medicaid) if you get Supplemental Security Income (SSI) or qualify for SSI’s 1619(b) provision.
If you qualify for Medicaid Adult Buy-In coverage:
- You pay small copayments and may pay a monthly premium based on your income.
- You have to be working. At your work, you could earn as much as $11,020 per month ($132,240 per year!) and still qualify.
- There is no resource limit.
- You must have a disability that meets Social Security's disability rules (except for the rules related to work). If you aren't sure if your disability qualifies, you can apply and the state will review your disability.
Who qualifies for the Medicaid Adult Buy-In?
To qualify for the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In), you must:
- Live in Colorado
- Be 16 years old or older
-
Have a disability
- Note: For the Medicaid Adult Buy-In, Social Security’s disability rules related to earned income do not apply.
- Be working, and
- Be a U.S. citizen or meet specific noncitizen requirements.
At work, you can earn a lot and still qualify: your countable income must be 450% of the Federal Poverty Guidelines (FPG) or less. That's $5,468 per month or less. 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 $11,020 per month ($132,240 per year!) and still qualify.
You can use the Medicaid Adult Buy-In Estimator to see if you qualify and what your premium would be. Or, get a quick idea of your countable income by trying this tool:
| Your Monthly Earned Income | $ |
| Your Monthly Unearned Income (not including SSI) | $ |
| Your Monthly Impairment Related Work Expenses (IRWEs) | $ |
| |
| Your Monthly Countable Income | |
| Your Annual Countable Income | |
| |
| Your Countable Income as a Percent of FPG |
Does it matter how I qualify for Health First Colorado (Medicaid)?
In most cases, no. The actual medical coverage you get from Health First Colorado (Medicaid) will be the same, no matter how you qualified. Generally speaking, the big difference is that people with disabilities get extra ways to qualify and if you have a disability and start working, you can earn more while still getting Health First Colorado (Medicaid) coverage.
DB101 has information about different ways to get Health First Colorado (Medicaid):
- DB101's How Health Benefits Work article introduces income-based Health First Colorado (Medicaid), which does not require you to have a disability.
- The How Health Benefits Work article also introduces other ways people with disabilities may qualify for Health First Colorado (Medicaid).
- DB101's Medicaid Adult Buy-In article explains how people with disabilities who work can get Health First Colorado (Medicaid) coverage by paying a premium, even if their income is higher than the usual Health First Colorado (Medicaid) income limits.
- DB101's Supplemental Security Income (SSI) article explains how people with disabilities who get SSI qualify for Health First Colorado (Medicaid) automatically.
Is the Medicaid Adult Buy-In free?
You may have to pay a premium based on income for coverage through the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In). The maximum premium is $200 per month. For an estimate of what your Medicaid Adult Buy-In premium would be, use the Medicaid Adult Buy-In Estimator.
What is “countable income?” Is it just how much I make?
No, it is not the same as how much you make. When public programs look at your income to figure out if you should qualify, they don’t always count all of your income. What they do count is called “countable income.” This benefits you, because it means that you might have more income than the income limit for a program, but still qualify.
When the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In) reviews your income to see if you are eligible, only about half of your earned income (money you get from work you do) is counted. For example, if you make $4,000 per month at a job and have no other income, that’s only $1,957.50 in countable monthly income.
Try this tool to get an idea of how much countable income you have:
| Your Monthly Earned Income | $ |
| Your Monthly Unearned Income (not including SSI) | $ |
| Your Monthly Impairment Related Work Expenses (IRWEs) | $ |
| |
| Your Monthly Countable Income | |
| Your Annual Countable Income | |
| |
| Your Countable Income as a Percent of FPG |
Does the Medicaid Adult Buy-In cover the same services as standard Health First Colorado (Medicaid)?
Yes. The Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In) pays for the same services that standard Health First Colorado (Medicaid) pays for, including doctor visits, medical equipment, and In-Home Support Services (IHSS). For a listing of services covered under Medicaid Adult Buy-In, go to the Health First Colorado (Medicaid) website.
If I have Medicare, should I also get Medicaid Adult Buy-In coverage?
If you are eligible for both the Medicaid Adult Buy-In and Medicare, this can help because the Medicaid Adult Buy-In will help pay for things that Medicare doesn't pay for and will help pay your Part B premium.
With the Medicaid Adult Buy-In, if your income is low enough, you may also qualify for a Medicare Savings Program to help pay other Part B expenses (and your Part A premium, if you have one), and the Part D Low Income Subsidy, to help pay for your prescription drugs.
Contact the Colorado State Health Insurance Assistance Program (SHIP) if you have questions about how your Health First Colorado (Medicaid) and Medicare benefits work together. To learn more, read DB101’s How Health Benefits Work article, which has detailed information on Medicare Savings Programs and the Part D Low Income Subsidy.
Is the Medicaid Adult Buy-In the same thing as the Children's Buy-In?
The Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In) and the Health First Colorado (Medicaid) Buy-In Program for Children with Disabilities (or the "Children's Buy-In" for short) are different programs.
While both programs help people get Health First Colorado (Medicaid) benefits, they help different groups of people:
- The Medicaid Adult Buy-In is for people who are 16 years old or older who are working and earning money at their jobs.
- The Children's Buy-In is for people who are 18 years old or younger. For this program, the children do not need to be working. Learn about it in DB101's Benefits for Young People article.
You can also learn about both programs on the Health First Colorado Buy-In Programs website.
Learn more
Pitfalls
Not getting health coverage because you think it will be too expensive
In the past, some people found it impossible to find health coverage that was affordable and met their needs. Now, there should be an option for almost everybody, regardless of whether you have a disability. The exact health coverage that will be right for you will depend on things like your family’s income, whether you have access to employer-sponsored coverage, your age, where you live, and if you have a disability.
If you do not have the option of employer-sponsored coverage, you may be able to get government help to pay for an individual plan on Connect for Health Colorado. If you cannot afford private individual coverage, your best options will be public programs, like Health First Colorado (Medicaid) or Medicare, if you qualify.
Note: It is very important to have health coverage, but since 2019, there is no tax penalty if you don't have coverage.
Not enrolling in the Medicaid Adult Buy-In because you have private coverage
The Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In) covers some services that private health care plans do not cover.
If you’re in that situation and your private premium is higher than what your Medicaid Adult Buy-In premium would be, you should enroll in the Medicaid Adult Buy-In. You’ll get more comprehensive coverage at a lower price.
Not enrolling in Medicare
If you are eligible for both the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In) and Medicare, you should enroll in both.
The Medicaid Adult Buy-In will help pay for things that Medicare doesn't pay for and will help pay your Part B premium. And, if your income is low enough, you may also qualify for a Medicare Savings Program to help pay other Part B expenses (and your Part A premium, if you have one), and the Part D Low Income Subsidy, to help pay for your prescription drugs.
Contact the Colorado State Health Insurance Assistance Program (SHIP) if you have questions about how your Health First Colorado (Medicaid) and Medicare benefits work together. To learn more, read DB101’s How Health Benefits Work article, which has detailed information on Medicare Savings Programs and the Part D Low Income Subsidy.
Not going back to work because you fear losing your Health First Colorado (Medicaid) coverage
If you lose one health coverage option, there will be another one you can get. If you lose your Health First Colorado (Medicaid) coverage, you will either become eligible for employer-sponsored coverage or private individual coverage. And, if you can’t afford the individual coverage, the government may help you pay for it.
The bottom line: There is a coverage option for everybody. Do not worry that getting a job will leave you without health coverage.
Learn more
Next Steps
Learn more about the Medicaid Adult Buy-In
To learn more about the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In):
- Visit the Health First Colorado (Medicaid) website.
- See the official Health First Colorado (Medicaid) list of frequently asked questions. It includes questions related to all Health First Colorado (Medicaid) eligibility groups and related programs.
- Get help with Health First Colorado (Medicaid) by calling 1-800-221-3943.
- Visit the Health First Colorado (Medicaid) Buy-In Programs home page.
- Talk to a Medicaid Adult Buy-In expert at 1-800-711-6994.
Apply for the Medicaid Adult Buy-In
There are different ways to apply for the Health First Colorado Buy-In Program For Working Adults With Disabilities (Medicaid Adult Buy-In):
- 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.
Note: Due to COVID-19, there may be limits on in-person services. Contact your agency by phone to ask about this.
Ticket to Work
Social Security’s Ticket to Work Program helps people with disabilities who get Social Security benefits re-enter the workforce and become more independent. The Ticket to Work Program offers free access to employment-related services, such as training, transportation, and vocational rehabilitation. You can call the Ticket to Work Help Line at 1-866-968-7842 or 1-866-833-2967 (TTY).
Get Help with Your Benefits
A trained Benefits Planner can help you understand your benefits programs. Exactly who you need to contact depends on your situation and the benefits you get.
View DB101's full list of experts who can help you understand different benefits.