Coloradans who are eligible for both Medicare* and Health First Colorado (Colorado’s Medicaid program), but who will no longer qualify for Health First Colorado, may be able to sign up for Medicare or change their current Medicare coverage.
With the end of the official federal COVID-19 Public Health Emergency, people who enrolled in Health First Colorado over the past three years will have their eligibility for the program reevaluated. This means that some of these people will no longer qualify for Health First Colorado coverage. However, for a subset of people who are also eligible for Medicare, this presents an opportunity to enroll in or make changes to Medicare plans, but only for a limited time.
Original Medicare, Medicare Supplement, Medicare Advantage and Medicare Drug Plans
What is Medicare?
Medicare is a federal health insurance program for people age 65 or older, people under age 65 with certain disabilities, and people of all ages with End-Stage Renal Disease (ESRD). To understand your options, it helps to know the different parts of Medicare.
- Original Medicare - Consists of Medicare Part A, which is hospital insurance, and Medicare Part B, which is medical insurance.
- Medicare Supplement Plans (also called Medigap) - Extra insurance you can buy from a private health insurance company to supplement Original Medicare and help pay your share of out-of-pocket costs. You must have Original Medicare – both Part A and Part B – to buy a Medicare Supplement policy. You can’t enroll in a Medicare Advantage plan if you have Original Medicare with a Medicare Supplement plan.
- Medicare Advantage Plans (also called Medicare Part C) - A Medicare Advantage Plan is another way to get your Medicare coverage besides Original Medicare. When you’re getting started with Medicare, you can either enroll in Original Medicare and buy a Medicare Supplement Plan (also called Medigap) or enroll in a Medicare Advantage Plan, but you can’t have both.
- Medicare Drug Plans (also called Medicare Part D) - Medicare prescription drug plans are available to everyone with Medicare.
What does this mean for you?
1.) If you are eligible for Medicare, but didn’t sign up for it when you first became eligible because you remained enrolled in Health First Colorado during the COVID-19 Public Health Emergency, but will now lose that Health First Colorado coverage:
- You can sign up for Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance) or both without paying a late enrollment penalty.
- You have 6 months after your Health First Colorado coverage ends to sign up.
- You can sign up via the Social Security Administration at its Sign Up for Medicare site, or by filling out a CMS-10797 form and mailing or faxing it to your local Social Security office. You can also call Social Security at 800-772-1213. TTY users can call 800-325-0778.
- Remember: Your Medicare coverage will start the month after you sign up, or the date your Health First Colorado coverage ends, whichever you choose.
2.) If you have both Medicare Part A and Medicare Part B (“Original Medicare”), but you did not enroll in a Medicare Supplement Plan (a Medigap plan) during the open enrollment period because you remained enrolled in Health First Colorado during the COVID-19 Public Health Emergency, but will now lose that Health First Colorado coverage:
- Under Colorado law, you have a six-month window to enroll in a Medicare Supplement Plan under “guarantee issue rules” - meaning that coverage is guaranteed and an insurance company cannot deny coverage or charge a higher premium due to health, medical conditions, past claims or pre-existing conditions.
- The guaranteed issue period begins on the date your Health First Colorado coverage terminates, and ends six months after the date your Health First Colorado coverage terminates.
- You must be enrolled in both Medicare Part A and Medicare Part B to enroll in a Medicare Supplement Plan.
- This six-month guarantee issue period for a Medicare Supplement Plan also applies if you did not sign up for Medicare Part A and Part B when you first became eligible because you remained enrolled in Medicaid during the COVID-19 Public Health Emergency, but are now enrolling in both Medicare Part A and Part B.
3.) If you have been enrolled in both Medicare and Health First Colorado, but you are no longer eligible for Health First Colorado, you can:
- Join a Medicare Advantage Plan with drug coverage or Medicare drug plan (Medicare Part D), if you don’t already have one.
- Change your current Medicare Advantage Plan or Medicare drug plan.
- You have 3 months to make these changes, either three months from the date you’re notified that your Health First Colorado coverage is ending or three months from the date your Health First Colorado coverage actually ends, whichever is later.
- Note: If you drop a Medicare Advantage Plan, you have the option to return to Original Medicare.
4.) For people who lose Health First Colorado or CHP+ coverage and are not eligible for Medicare, they can find more information about other types of health insurance coverage here. People can also contact the Division’s Consumer Services Team with insurance questions at 303-894-7490 or DORA_Insurance@state.co.us.
Questions: about Medicare Coverage?
- Contact the Colorado State Health Insurance Assistance Program (SHIP) at 888-696-7213 for free, personalized help. .
- The SHIP personnel can explain the details of Medicare, while also giving you specific information about the plans available in your area of Colorado.
End of Public Health Emergency & Eligibility Redeterminations
- In January 2020, the U.S. Department of Health and Human Services (HHS) declared a public health emergency (PHE) in response to the outbreak of COVID-19. Congress passed legislation that ensured anyone enrolled in Health First Colorado (Colorado’s Medicaid program) was guaranteed to keep their health coverage during the PHE. This was known as the “continuous coverage requirement” and also applied to kids and pregnant people covered by Child Health Plan Plus (CHP+).
- Congress recently passed a bill that ends the continuous coverage requirement in spring 2023, so after more than three years of continuous coverage, the Department of Health Care Policy & Financing (HCPF) has resumed standard eligibility renewal and disenrollment processes in May 2023 for Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+).
- HCPF began notifying Health First Colorado and CHP+ members in March, and will go month by month (based on members' anniversary dates), for the next 14 months to complete the renewal process for all 1.75 million Coloradans currently covered under these programs. Members who receive a renewal packet must return it by the deadlines listed within this important renewal communication.
- For more information about the renewal process and frequently asked questions visit this website. There are also videos in English and Spanish about the renewal process at HealthFirstColorado.com/renewals.
About the Division of Insurance:
The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), regulates the insurance industry and assists consumers and other stakeholders with insurance issues. Visit doi.colorado.gov for more information or call 303-894-7499 / toll free 800-930-3745.
DORA is dedicated to preserving the integrity of the marketplace and is committed to promoting a fair and competitive business environment in Colorado. Consumer protection is our mission. Visit dora.colorado.gov for more information or call 303-894-7855 / toll free 800-886-7675.