Key differences
| Medicare | Medicaid (Health First Colorado) | |
|---|---|---|
| Run by | Federal government | State of Colorado (with federal funding) |
| Who qualifies | People 65+, certain disabilities | Low-income individuals and families |
| Based on | Age or disability | Income and resources |
| Premiums | Yes — Part B premium for most | Little to none |
| Coverage | Hospital, medical, drugs | Comprehensive including dental, vision, long-term care |
| Provider choice | Any provider that accepts Medicare | Must use Medicaid providers |
| Apply through | Social Security (ssa.gov) | Colorado PEAK or county office |
Health First Colorado (Colorado's Medicaid)
In Colorado, Medicaid is called Health First Colorado. It provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.
Health First Colorado covers services that Medicare does not, including:
- Dental care for adults
- Vision and eye care
- Long-term care services
- Non-emergency medical transportation
- Mental health and substance use treatment
- Home and community-based services
Dual eligibility: Having both Medicare and Medicaid
If you qualify for both Medicare and Medicaid, you're considered "dual eligible." Being dual eligible provides significant financial advantages:
- Medicare premiums paid — Medicaid may pay your Part B premium, Part A premium (if applicable), and Part D premium.
- Cost-sharing covered — Medicaid can cover Medicare deductibles, coinsurance, and copayments.
- Extra benefits — Access to Medicaid services that Medicare doesn't cover, like dental and long-term care.
- Part D Extra Help — Automatic enrollment in the Low-Income Subsidy (LIS) program that reduces prescription drug costs.
How it works together: When you're dual eligible, Medicare is the primary payer — it pays first. Medicaid then acts as secondary insurance, covering costs that Medicare doesn't pay and providing additional services.
Medicare Savings Programs in Colorado
Even if you don't fully qualify for Medicaid, Colorado offers Medicare Savings Programs (MSPs) that help with Medicare costs based on income:
| Program | What it pays |
|---|---|
| QMB (Qualified Medicare Beneficiary) | Part A premium, Part B premium, deductibles, coinsurance, copayments |
| SLMB (Specified Low-Income Beneficiary) | Part B premium only |
| QI (Qualifying Individual) | Part B premium only |
| QDWI (Qualified Disabled and Working Individual) | Part A premium only |
To apply for Medicare Savings Programs in Colorado, contact your county Department of Human Services or apply online through Colorado PEAK.
How to check your eligibility
If you think you may qualify for Medicaid or a Medicare Savings Program in Colorado:
- Online — Apply through Colorado PEAK
- Phone — Call Health First Colorado at 1-800-221-3943
- In person — Visit your county Department of Human Services
- Compare plans — Call a licensed insurance agent at 970-SENIORS (970-736-4677), TTY 711, to compare Medicare plans, including plans for people with both Medicare and Health First Colorado, at no cost to you
Don't assume you won't qualify. Income limits for Medicare Savings Programs are higher than many people expect. Even if you're above the poverty line, you may qualify for help with your Part B premium. It's always worth checking.
Frequently asked questions
What is the difference between Medicare and Medicaid?
Medicare is federal health insurance based on age (65+) or disability. Medicaid is state-run coverage based on income. Medicare is administered by CMS; Medicaid in Colorado is called Health First Colorado.
Can you have both Medicare and Medicaid in Colorado?
Yes. Medicaid can pay your Medicare premiums, deductibles, and copays, and provides additional benefits like dental and long-term care.
