Medicaid Costs and Coverage in Colorado

“How much is Medicaid in Colorado?” may be a question you are asking if you are looking for affordable health care. Knowing the answer to “How much does Medicaid cost in CO?” is an important step in knowing what your household expenses will be. Medicaid cost estimates in the state are typically low as these benefits are intended for low-income Colorado residents who meet specific eligibility requirements. This article will outline Health First Colorado coverage , which is also known as Medicaid, and discuss the costs of this medical benefits program and what you, the patient, will be expected to pay.

How much does Medicaid cost in Colorado?

The cost of Medicaid coverage in Colorado is dependent on multiple factors, including copayments, coinsurances, deductibles and other similar charges. The first factor of your Medicaid cost estimates after completing the application process is your copayment, which is a set amount of money you have to pay each time you visit your doctor. This amount is determined by the insurance company that provides your Medicaid coverage. Your copayment is also based off of your allowable cost, which is the maximum amount your insurance plan will pay for certain medical services. A payment type similar to a copayment is a coinsurance payment. The coinsurance payment is a percentage of your Medicaid insurance benefits asks you to pay is a percentage of your allowable cost. The amount of your copayment or coinsurance payment is determined by the service you need and who you receive it from. For example, the Medicare coverage benefits copayment and coinsurance amounts for your doctor’s visits may differ than those you pay for a visit to your dentist.

Note: You may have to pay either a copayment or a coinsurance payment, depending on the services you require at the time of your visit.

The second factor used to determine your Medicaid coverage costs is your deductible, which is a fixed amount that you have pay for your health care before your Medicaid coverage insurance plan takes over the costs of your medical care. Once you have paid the full amount of your deductible, you will only have to pay either your copay or your coinsurance amount.

What services are covered by Medicaid in Colorado?

In Colorado, there are two types of Medicaid coverage benefits that the program covers: Mandatory and optional. Federal law requires states to provide certain benefits to anyone enrolled in Medicaid and receiving Medicaid benefits. Once they have those benefits on offer, each state is free to decide what other coverage they would like to provide their residents with. The following section of this article will discuss the differences between mandatory and optional services and what they are.

Mandatory

Mandatory Medicare services are the Medicaid benefits that every state must offer its residents, as they have been instructed by the United States government, who regulate the Medicaid program’s benefits, to do so. In Colorado, the mandatory services that the Medicaid program offers include a wide variety of Medicaid program benefits:

  • Professional Certified midwife services

  • Child health services

  • Family planning services

  • Home health services

  • Dentistry services, including medical and surgical

Optional

Optional services are the services that Colorado does not have to cover under their Medicaid coverage, but chooses to anyway. Health First Colorado optional benefits outnumber their mandatory benefits. Some of the optional services you can choose from are:

  • Chiropractic services

  • Dental services

  • Hospice services

  • Prescription drugs

  • Medicare crossovers

As with mandatory Medicaid benefits, most of the optional services do not have an age limit. However, some do. Different types of hearing aid services and various therapy services, such as occupational, physical and speech require the patient to be under the age of 21.

Medicaid coverage will provide you with coverage for anything your provider deems medically necessary. This includes Health First Colorado programs, products or services that will or are expected to prevent, cure, diagnose, correct, lower or help with anything relating to pain and suffering or any physical, mental and cognitive effects that may stem from an illness or injury.

Health benefits that your Medicaid coverage covers include: allergies testing, transportation to and from appointments, emergency room visits, family planning, home health care, rehabilitation therapies, hospice care, prescription drugs, urgent care and women’s health services. Before your benefits will cover some of these services, you may need to get some of these services preapproved

The dental benefits your Medicaid coverage covers include dentures, diagnostic and preventative services, emergency dental care, restorative care and any basic dental care you require. Behavioral health benefits that are included in your Medicaid benefits include drug and alcohol help, behavioral assessments, emergency and crisis services, inpatient psychiatric services, outpatient services, medication for the treatment of your mental health and school-based health services.

For more details on that Medicaid covers, download our comprehensive guide.

What does Medicaid not cover in Colorado?

While Health First Colorado covers many services and programs, they do not cover everything. Medicaid does not cover treatments that are untested or that are still in the testing phase, anything that your Medicaid coverage plan does not considered medically effective, a treatment that is not considered normal for your illness or injury and any services that do not have guidelines to regulate them. Your Medicaid coverage also does not cover any kind of cosmetic surgeries that you would use to improve your appearance, private nursing services, massage therapy, chiropractic care or medical services given by a family or friend.

While Medicaid coverage includes prescription drugs, it might not include all of them. For instance, fertility drugs, cosmetic drugs and weight loss drugs are not covered under your Medicaid plan for any reason.

Types of Medicaid Insurance in Colorado

Health First Colorado offers a wide variety of different services and programs, some of which have already been discussed in this article. Some other types of Medicaid insurance are as follows:

  • Program of All-Inclusive Care for the Elderly (PACE)

  • Workers with Disabilities program

  • Mental Health and Substance Disorder Services

The Program of All-Inclusive Care for the Elderly (PACE) is a Medicaid program under Health First Colorado that provides comprehensive health and social services benefits that include coordinating primary, preventative, acute and LTSS care for individuals who require the assistance of nursing homes.

The Health First Colorado Workers with Disabilities program is for individuals ages 16 to 64 who are disabled but are still working, either part time or full time. There is no minimum amount or hours or minimum amount you must be paid in order to qualify for the program, but you do need to live below the Federal Poverty Level and need to show proof of your employment.

Mental Health and Substance Use Disorder Services benefits is a program under Health First Colorado that provides comprehensive substance use disorder services. Your Medicaid coverage will include services such as outpatient services, withdrawal management, recovery management and physician consultations.

Download our comprehensive guide for more details on what Medicaid covers and the costs associated with these benefits.