Medicare and Health First Colorado: How Dual Coverage Works

If you qualify for both Medicare and Health First Colorado, Colorado's Medicaid program, you are what Medicare calls dual eligible. Medicare pays first for covered care, and Health First Colorado pays second. With full Health First Colorado or most Medicare Savings Programs, the state pays your Part B premium, and you automatically get Extra Help with Part D drug costs. You keep the right to choose how you get your Medicare: Original Medicare with a Part D plan, a standard Medicare Advantage plan, a dual-eligible Special Needs Plan built for people with both (Adams County has 19 for 2027), or, if you need a nursing home level of care, the PACE program.

Who pays for what

Exactly what each Medicare Savings Program pays

There are two levels of help. With full Health First Colorado, you get Medicaid benefits plus help with Medicare costs. With a Medicare Savings Program only, the state helps with specific Medicare costs, but you do not get Health First Colorado medical benefits. Each of the four programs pays something different (HCPF and Medicare.gov):

Your drug coverage

Medicare, not Health First Colorado, covers most of your prescriptions once you have Medicare. Because full Health First Colorado members qualify for Extra Help automatically, you pay no Part D deductible and low copays: for 2027, CMS caps Extra Help copays at $5.80 for generics and $14.40 for brand-name drugs, and lower for some people with full Medicaid (CMS CY2027 Rate Announcement). If you do not choose a drug plan, Medicare will enroll you in one, but that plan may not cover your specific drugs well, so check it.

For 2027, CMS sets the Colorado low-income premium subsidy amount at $18.36 a month. Two standalone plans have premiums below it, Wellcare Classic ($7.30) and Humana Basic Rx Plan ($11.30), so people with full Extra Help pay $0 in premium for them (CMS CY2027 Landscape file). Wellcare Value Script ($5.30) also costs less than $18.36 but is not on this list because it is an enhanced plan: Extra Help only pays the part of an enhanced plan's premium that covers basic Part D benefits, so only basic plans at or below the $18.36 amount are guaranteed to be $0 with full Extra Help. In other plans, Extra Help pays up to $18.36 of the premium and you pay the rest.

Dual-eligible Special Needs Plans (D-SNPs)

A D-SNP is a Medicare Advantage plan only for people with both Medicare and Medicaid. It typically includes drug coverage and care coordination, and many add benefits such as dental, vision or a monthly allowance for certain items. According to the CY2027 CMS Landscape file, Adams County has 19 D-SNPs for 2027 and Weld County has 16. In Adams County, 11 of the 19 show a $0 monthly premium in the CMS file, and the rest list $2.10 to $18.40 a month before Extra Help is applied, so ask each plan what you would actually pay.

A D-SNP is not right for everyone. Check that your doctors, hospitals and drugs are covered, ask how the plan works with Health First Colorado for services Medicare does not cover, and compare it with Original Medicare plus a Part D plan.

A worked example: choosing between a D-SNP and Original Medicare

Picture a single person in Brighton with full Health First Colorado who has just become eligible for Medicare. Here is how the two main paths compare. This is an illustration, not advice about a specific plan.

• Original Medicare plus a Part D plan: the state pays the $202.90 Part B premium. Medicare pays first at any doctor or hospital that accepts Medicare, and Health First Colorado picks up the remaining cost-sharing when the provider also accepts Health First Colorado. In Wellcare Classic or Humana Basic Rx Plan the drug premium is $0 with full Extra Help, there is no drug deductible, and copays are capped at $5.80 and $14.40 in 2027.
• A D-SNP: the state still pays the Part B premium. One plan card covers medical and drug benefits, often with a care coordinator and extra benefits. In exchange, you use the plan's network, so the first question is whether your doctors and hospital are in it.
• What usually decides it: whether your current doctors are in a D-SNP network, whether you want help coordinating care, and whether the extra benefits are ones you would use. Either way, you can change plans later if your situation changes.

PACE: an option if you need nursing home level care

The Program of All-Inclusive Care for the Elderly (PACE) is for people who need the level of care a nursing home provides but want to keep living at home. HCPF lists the requirements: you must be 55 or older, meet nursing facility level of care, live in the service area of a PACE organization, and be able to live safely in the community when you join.

A PACE organization provides all Medicare-covered and Health First Colorado covered services, including primary care, prescriptions, adult day services, home care, transportation, hospital and nursing home care, through its own team and network. You must use PACE providers, and you can leave the program at any time. InnovAge, a PACE organization in Colorado, lists centers including Thornton, Aurora and Denver; service areas are set by ZIP code, so ask whether your address is covered.

Home and community services and long-term care

Medicare pays for only short stays in a skilled nursing facility after a qualifying hospital stay: in 2026, days 1 to 20 at $0 and days 21 to 100 at $217 a day, and nothing after day 100. Ongoing long-term care is a Health First Colorado benefit, not a Medicare one.

If you need help to stay at home, Health First Colorado offers home and community-based services waivers. The Elderly, Blind, and Disabled (EBD) waiver serves people 65 and older with a significant functional impairment, and people 18 to 64 who are blind, have a physical disability or are living with HIV, when they need nursing home level care. HCPF lists income below three times the federal SSI limit and countable resources under $2,000 for one person or $3,000 for a couple. Services include adult day services, home modifications, respite and, through Community First Choice, personal care and homemaker help. Waivers can have waitlists, and your local case management agency handles the assessment.

When you can change plans

People with Medicare and Health First Colorado, or with Extra Help, can make certain changes outside the October 15 to December 7 window. Under current Medicare rules this includes a monthly chance to switch to Original Medicare with a standalone drug plan, or into certain plans that coordinate Medicare and Medicaid. The details depend on your situation, so check with 1-800-MEDICARE or with us before you make a change mid-year.

If you lose Health First Colorado

Health First Colorado eligibility is reviewed each year, so watch your mail and keep your address current with your county. If you lose coverage, you get a Special Enrollment Period to change your Medicare plan, and you may still qualify for a Medicare Savings Program or Extra Help on its own.

Colorado also gives you a Medigap protection many states do not: if you had Medicaid when you first became eligible for Medicare and later lose it, the Colorado Division of Insurance says you have a guaranteed issue right to buy a Medicare Supplement without health questions. Use it within the time limit.

How to apply and get help

• Apply for Health First Colorado or a Medicare Savings Program through your county Department of Human Services, or online through Colorado PEAK. Most of Brighton uses Adams County Human Services; the part of Brighton in Weld County uses the Weld County Department of Human Services.
• Health First Colorado Member Contact Center: 1-800-221-3943 (State Relay 711).
• 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) for questions about Medicare plans that work with Medicaid, or our Brighton office, (303) 887-8584, for a free, no-obligation review of your options.
• Make sure your legal name and date of birth match Social Security records, so the state can start paying your Part B premium without delay. If Part B Buy-In has not started within a month of approval, HCPF says to contact your county.

What to ask before you choose

• Am I on full Health First Colorado, or only a Medicare Savings Program, and which one?
• Are my doctors, hospital and pharmacy in this plan's network, and do they accept Health First Colorado?
• What will I actually pay in premium after Extra Help?
• Does the plan offer care coordination, and who is my contact?
• If I may need long-term care, should I ask about PACE or a home and community-based services waiver?

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The bottom line

With Medicare and Health First Colorado together, Medicare pays first for care, the state pays your Part B premium unless your only help is QDWI (which pays the Part A premium), and Extra Help keeps drug costs low. Your main choice is how to receive Medicare: Original Medicare with a Part D plan, a standard Medicare Advantage plan, one of the dual-eligible Special Needs Plans near Brighton, or PACE if you need nursing home level care. We can check which options cover your doctors and drugs.