As a result of health care reforms, it is estimated 70% – 90% of justice involved people are now eligible for health insurance. The majority will be eligible for Health First Colorado (Colorado’s Medicaid Program) and eligibility will be based on income, household size, and an individual’s status in the criminal justice system. Most justice involved individuals will be eligible for coverage through either Health First Colorado (Colorado’s Medicaid Program), Medicare, or the Connect for Health Colorado exchange marketplace.

Learn more about the types of health care coverage, find resources, and locate assistance to help determine which option is best for you:

Health First Colorado (Colorado’s Medicaid Program)

You may now be able to get insurance through Health First Colorado (Colorado’s Medicaid Program) to cover health care services, drug and alcohol treatment, and dental care. Health First Colorado (Colorado’s Medicaid Program) is a health insurance program for low-income Coloradans. Eligibility is based on income, household size, and criminal justice status.

Health First Colorado (Colorado’s Medicaid Program) is low cost health insurance for Coloradans who qualify. Health First Colorado can help pay for doctor visits, dental care, and drug and mental health treatment.

You can find more information about applying for and using Health First Colorado by visiting the Colorado Department of Health Care Policy & Financing website.

Being able to get Health First Colorado depends on the amount of money you make and the number of people you claim on your taxes. For example, an individual can make about $1,500/month or less and be able to get Health First Colorado. A married couple with two children can make between $2,000 – $2,200/month. If someone is considered an “inmate” they are not eligible for Health First Colorado.

You can find more information about applying for and using Health First Colorado by visiting the Colorado Department of Health Care Policy & Financing website.

There are a lot of people and places you can contact to help you find out if you are able to apply for Health First Colorado. You can contact your local county Department of Human Services, which can also talk with you about other help like food and cash assistance. You can also call your local medical assistance/application assistance sites to schedule an appointment. People can also apply for Health First Colorado online by visiting the Colorado PEAK website.

You can find more information about applying for and using Health First Colorado by visiting the Colorado Department of Health Care Policy & Financing website.

If you make too much money to be able to get Health First Colorado, you might be able to get help to buy private health insurance on Connect for Health Colorado. Connect for Health Colorado is Colorado’s health insurance marketplace.

Health First Colorado members are assigned a primary care provider, which is the doctor that you see the most. Your primary care provider will belong to one of seven regional organizations. You will want to make sure you are connected with your regional organization. Your regional organization will hook you up with what is called a “care coordinator.” This person will be able to help you find a behavioral health therapist, set up an appointment and get you plugged in to other services you may need. You can call Health First Colorado Enrollment at 303-839-2120 (in Denver) or 1-888-367-6557 (outside of Denver) to find out who your regional organization is if you don’t know. Health First Colorado Enrollment can also help you change who your primary care provider is. You can also call your regional organization directly for more information.

Most likely you will have to reapply. If you are only incarcerated for a few days, you will probably still have Health First Colorado when you are released. If you are incarcerated for more than 30 days, you should check with your local county department of human services once you are released to make sure you are still covered. Don’t be surprised if you need to reapply.

That’s fantastic! The first step in getting health care is getting enrolled and a card. Now that you have health insurance, we want to make sure you know all the benefits that you can use such as seeing a doctor, going to a dentist, or getting drug treatment. The following information will help you get started:

  1. Make sure you are connected with your regional organization. You are automatically plugged into a regional organization based on who your primary care provider is. A primary care provider is the doctor that you see the most. Health First Colorado members will all have a primary care provider who belongs to a regional organization. Your regional organization can hook you up with what’s called a “care coordinator.” This person will be able to help you find a behavioral health therapist, set up an appointment and get you plugged in to other services you may need. If you don’t know who your regional organization is, you can call Health First Colorado Enrollment at 303-839-2120 (in Denver) or 1-888-367-6557 (outside of Denver). You can also call your regional organization directly for more information.
  2. If you want to find a primary care provider or mental health provider on your own, you can go to the Colorado Department of Health Care Policy and Financing website to Find a Provider near you. You can also go to the Behavioral Health Administration OwnPath website and search for behavioral health services near you.

There are a lot of people and places you can contact who will help you find out if you are able to get on Health First Colorado.

If you have health insurance through a private health insurance plan, please contact your health plan and they can help you find a mental health or drug treatment provider.

If you are on Health First Colorado and need to see a therapist or counselor for drug or mental health treatment, you can call your regional organization and they will also help you find a behavioral health provider and get you set up with an appointment.

If you want to find a mental health provider on your own, you can go to the Colorado Department of Health Care Policy and Financing website to Find a Provider near you. You can also go to the Behavioral Health Administration OwnPath website and search for behavioral health services near you.

  • Yes. As long as a person meets the income requirement, people on residential or non-residential status in Community Corrections facilities in Colorado, except for people living in Gateway: Through the Rockies in Colorado Springs, are eligible for Health First Colorado.
  • People living in federal residential reentry centers (RRCs) are not eligible for Health First Colorado per federal policy. People who live in federal RRCs should have their health care services covered by the Bureau of Prisons.

Yes. People on probation are able to get Health First Colorado if they don’t make too much money.

There are a lot of people and places you can contact to help you find out if you are able to apply for Health First Colorado. You can contact your local county Department of Human Services, which can also talk with you about other help like food and cash assistance. You can also call your local medical assistance/application assistance sites to schedule an appointment. People can also apply for Health First Colorado online by visiting the Colorado PEAK website.

You can find more information about applying for and using Health First Colorado by visiting the Colorado Department of Health Care Policy & Financing website.

Yes. People on parole are able to get Health First Colorado if they don’t make too much money.

There are a lot of people and places you can contact to help you find out if you are able to apply for Health First Colorado. You can contact your local county Department of Human Services, which can also talk with you about other help like food and cash assistance. You can also call your local medical assistance/application assistance sites to schedule an appointment. People can also apply for Health First Colorado online by visiting the Colorado PEAK website.

You can find more information about applying for and using Health First Colorado by visiting the Colorado Department of Health Care Policy & Financing website.

Yes. People on parole are able to get Health First Colorado if they don’t make too much money.

There are a lot of people and places you can contact to help you find out if you are able to apply for Health First Colorado. You can contact your local county Department of Human Services, which can also talk with you about other help like food and cash assistance. You can also call your local medical assistance/application assistance sites to schedule an appointment. People can also apply for Health First Colorado online by visiting the Colorado PEAK website.

You can find more information about applying for and using Health First Colorado by visiting the Colorado Department of Health Care Policy & Financing website.

No. People who are in jail or prison are not able to get Health First Colorado. If someone in jail or prison is in the hospital for more than 24 hours, they may be able to get Health First Colorado to pay the hospital bill.

No. People are still considered “inmates” and not able to get Health First Colorado even though they are allowed to leave jail to go to work.

Medicare

Understanding and getting healthcare insurance can be confusing at any age. For people who are 65 years of age or older it can feel like a choose your own adventure given how difficult it can be to understand Medicare. This webpage contains basic information to help you begin to understand and navigate Medicare. There are a lot of links to websites and resources that will provide you more detailed information if you need assistance or if you’re interested in learning more.

  • State Health Insurance Programs (SHIP) are able to help you enroll in Medicare and talk with you about health insurance options that will best meet your needs. Contact the SHIP agency in your county where you live to ask for help with Medicare and other support services.
  • You may also contact the Colorado Association of Area Agencies on Aging to find the appropriate contact for the local Area on Aging agency in the county you live in to receive assistance related to Medicare and other support services.
  • In some counties, the SHIP agency and the AAA agency are the same agency. In other counties the SHIP office and AAA office may provide different services, so you may want to contact both to find out what help they may be able to provide.
  • If you are 65 years of age or older and need help finding health insurance options, you can also contact the Colorado Division of Insurance, Medicare & State Health Insurance Assistance Program if you have any specific questions or would like more information.
  • Medicare also publishes a Medicare and You book which is a comprehensive overview of everything you’d want to know about Medicare. You can download a copy online or order a hard copy delivered to you for free. The book comes in a variety of different languages and formats and is a comprehensive overview of the Medicare program.

Medicare is a federal health insurance program for people 65 years of age or older, some younger people who have a disability, and people with end-stage renal disease.

  • Medicare has four parts that cover different benefits:
    • Part A – Hospital insurance
    • Part B – Medical insurance
    • Part C – Medicare Advantage Plan (private health insurance you can buy into)
    • Part D – Prescription Drug insurance
  • There are two main ways you can get Medicare by either choosing:
    1. Original Medicare (Part A & Part B), or
    2. Medicare Advantage Plan (Part C), which is buying Medicare through a private health insurance company.

You can also choose to have Medicare prescription drug insurance (Part D). You will have to pay a monthly cost to have Original Medicare, a Medicare Advantage Plan and/or Part D. If you are eligible, Medicaid or a Medicare Savings Program may help pay for some of the cost to have Medicare.

Having a criminal background does not necessarily impact your ability to get Medicare. Everyone is eligible for Medicare when they turn 65 years old. How much you will have to pay on a monthly basis for Medicare will depend on how much you worked and paid taxes throughout your life. Being incarcerated for a significant amount of time or working a job where you didn’t pay taxes could impact how affordable your Medicare is.

People who are 65 years of age and older are eligible for Medicare.

  • You may also be eligible if you are:
    • Under 65 years old and on Social Security Disability Income (SSDI) for 24 months,
    • Have End Stage Renal Disease (ESRD),
    • Have ALS – Lou Gehrig’s Disease, or
    • A US Citizen or lawfully admitted resident of the U.S. for 5 continuous years

Medicare Part A and Part B cover certain medical services and supplies in hospitals, doctors’ offices, and other health care facilities. Medicare Part D covers prescription drugs.

Part A (Hospital Insurance) helps pay for:

  • Inpatient care in a hospital
  • Inpatient care in a skilled nursing facility
  • Hospice care
  • Home health care
  • Inpatient care in a religious non-medical health care institution

Medicare Part B (Medical Insurance) helps pay for doctor visits, outpatient care, home health services, durable medical equipment, mental health services, and other medical services. Part B also pay for many preventive services.

If you’d like help paying for prescription drugs, you will also have to enroll in and pay for Medicare Part D insurance.

You will most likely have to pay a co-pay to receive any of these services. A co-pay means you will have to pay a certain amount to go to the doctor, get a test done, or other service. In addition, to paying a monthly bill to have Medicare insurance, you may also need to pay after your visit to the doctor or medical service. This is called co-insurance.

Some of the items and services that Original Medicare doesn’t pay for include:

  • Most dental care, including dentures
  • Eye exams
  • Long-term care
  • Routine physical exams
  • Hearing aids and exams for fitting them
  • Contact your local SHIP or AAA office to help you apply for Medicare.
  • You may also contact the Colorado Gerontological Society to discuss Medicare as well as learn about other potential benefits and services for older adults.
  • Most people will be automatically enrolled in Part A, but the remaining process can be confusing, so it’s best to work with someone who knows how to help you apply.
  • If you didn’t work and pay taxes for at least 10 years, you’ll have to pay for Part A and WILL NOT be automatically enrolled, which means the SHIP and AAA offices are essential to helping you figure out what makes the most sense.

Initial Enrollment Period

  • There is an initial enrollment period for Part A and/or Part B during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
  • If you sign up for Part A and/or Part B during the first 3 months of your Initial Enrollment Period, in most cases, your Medicare begins the first day of your birthday month.

General Enrollment Period

  • There is a General Enrollment Period every year between January 1st and March 31st.
  • If you didn’t sign up for Original Medicare during your Initial Enrollment Period OR if you don’t qualify for a Special Enrollment Period (see below), you can sign up during the General Enrollment Period.

 Please note: You may have to pay more monthly for Part A and/or Part B if you don’t enroll during your Initial Enrollment Period. If you are eligible for both Medicare and Medicaid, Medicaid may be able to pay for some of the monthly cost of being on Medicare.

Beginning January 1, 2023, when you sign up during the General Enrollment Period, your coverage starts the first day of the month after you sign up.

Special Enrollment Period

  • There are certain times you may be able to enroll in Medicare outside of the Initial or General Enrollment Periods due to changes in your life circumstances.
  • Being released from prison or jail DOES NOT QUALIFY for a Special Enrollment Period for Original Medicare.
  • If you pay for Part A and Part B coverage while incarcerated, you qualify for a Special Enrollment Period for 2 months upon release to enroll in a Medicare Advantage Plan (Part C) or Medicare Prescription Drug Coverage (Part D).

Medicare Advantage Plans, called “Part C” is basically Medicare insurance that is purchased through a private health insurance company.

  • Most Medicare Advantage Plans include Part A and Part B benefits, but instead of being “Original Medicare” your benefits are provided through the Medicare Advantage Plan.
  • It is very similar to buying “regular” health insurance versus Original Medicare, which is bought and managed by the federal government.
  • Most Medicare Advantage Plans also include Part D (prescription drugs) as part of their benefits.
  • You will have to pay a monthly cost to have a Medicare Advantage Plan and will have to already have Part A and Part B coverage in order to purchase a Medicare Advantage Plan.
  • Your local SHIP or AAA office can help you decide if it makes sense to pay for Original Medicare or for a Medicare Advantage Plan.
  • Medicare Advantage Plans provide all of your Part A and Part B benefits, excluding a few services. You will want to contact your health insurance plan if you have questions about covered services.

That is a complicated question. How much you pay every month will depend on a few factors.

  • Your monthly bill will be less expensive if you get free Part A coverage and if you enrolled in Part B during your Initial Enrollment Period.
  • If you have to pay for Part A coverage and/or if you have any penalties for enrolling late for Part A or Part B, your monthly bill may cost more.
  • If you chose Part C coverage and/or if you have Part D coverage that will also impact how much you pay monthly.
  • If you’re eligible for Medicaid AND Medicare, Medicaid may also be able to cover some of the monthly costs for Medicare, so it’s hard to give an exact number of how much you will owe.
  • You’ll want to make sure to work with your local SHIP or AAA office to determine how much you can afford and what you will have to pay.

The answer is yes, but it is a little more complicated than that.

  • If you turn 65 and qualify for Medicare while incarcerated, you should actively enroll in Medicare Parts A and B during your Initial Enrollment Period (IEP). You will not be eligible for automatic enrollment while you are incarcerated. If you enroll during your IEP, you can avoid late enrollment penalties and gaps in coverage when your incarceration ends.
  • To enroll in Part A and Part B, send a signed and dated letter to the Social Security Administration (SSA) that includes your name, Social Security number, clear statement that you want to enroll, and the date coverage should be effective. Be sure to keep a copy of the letter that you send. If possible, it is best to send paperwork via certified mail to ensure their delivery. Your application must contain your signature in order to be valid.
  • If you fail to enroll into Medicare while incarcerated, you may go months without health coverage upon your release and you may end up paying more for health insurance upon release.
  • You can learn more by visiting: Becoming Medicare-eligible while incarcerated.

Being incarcerated in prison or jail can affect your Medicare coverage.

  • Your Medicare can also be affected if you are residing in and under the supervision of a community corrections program.
  • If you had Medicare before your arrest, you will remain eligible for the program while you are incarcerated. However, you will have to pay your monthly bill for Medicare even though the correctional facility will be providing your healthcare services while you are incarcerated. Once you are released, Medicare will resume coverage if you remained enrolled. (Note: Community Corrections programs DO NOT provide or cover your healthcare needs while in a program. You may need to find assistance to help you access healthcare services while in a Community Corrections program.)
  • Once you are incarcerated for 30 days or more and are convicted of a crime, any Social Security retirement benefits or Social Security Disability Insurance (SSDI) you receive will stop.
  • You can keep your Medicare Part A and Part B coverage while you are incarcerated. Most people pay no premium for Part A but do pay a monthly premium for Part B.
  • To keep Part B benefits while incarcerated, you will need to keep paying your Part B monthly payments. For those who are not incarcerated, these monthly payments are deducted from Social Security benefits each month. Since incarcerated individuals have their Social Security benefits suspended, you would need to pay the Part B premium by setting up direct payment with Medicare. You can do this by calling 1-800-MEDICARE within 30 days of your conviction.
  • If you cannot afford to continue paying the Part B premium during your incarceration:
    • You should actively withdraw from Part B instead of being disenrolled to avoid owing premiums to SSA. If you do nothing, SSA will continue to bill you for Part B and disenroll you after you fail to pay your premiums. When you re-enroll in Part B upon release, SSA will deduct any unpaid premiums from your Social Security benefits.
  • You can learn more by visiting: Medicare Coverage During Incarceration
  • Contact your local SHIP or AAA office to help you enroll or reenroll in Medicare.
  • Yes. Depending on how much your monthly income is and whether you have any assets, you may be able to have both Health First Colorado benefits AND Medicare benefits.
  • In addition, there are Medicare Savings Programs, which is when Health First Colorado will help pay for some of your Medicare costs though you will not actually have Health First Colorado benefits. Whether you are eligible for a Medicare Savings Program also depends on your monthly income and whether you have any assets.
  • You should contact your local SHIP or AAA office to help you figure out what Medicare/Health First Colorado plan you may be eligible for and to help you apply.

Medicare Savings Programs (MSP) help people with limited income and resources pay for some or all of their Medicare premiums (monthly cost) and may also pay for other costs associated with Medicare. Colorado residents can apply for MSP if they have Medicare. (Source: Colorado Healthcare Policy & Financing – Medicare Savings Programs).

  • If you are eligible and able to get enrolled in a MSP, here is what you can expect:
    • The state will pay the Medicare Part B monthly cost for members on regular Health First Colorado (Colorado’s Medicaid program), or those enrolled in a MSP.
    • If you do not get Part A for free, the state will pay your Part A monthly cost if you are in the Qualified Medicare Beneficiary (QMB) tier of the Medicare Savings Program.
    • If you get Part A free, the state can still pay the Part B monthly cost even if you have refused or terminated Part B.

There are four different types of Medicare Savings Programs:

  1. Qualified Medicare Beneficiary (QMB) program,
  2. Specified Low-income Medicare Beneficiary (SLMB) program,
  3. Qualifying Individual (QI-1) program, and
  4. Qualified Disabled and Working Individual (QDWI) program.

There is also the Low-income Subsidy program (sometimes called “Extra Help”, which helps pay for Part D prescription drug coverage. Each program has its own monthly income limit and benefits. There is also a resource or asset limit that is taken into consideration when deciding which program you may be eligible for.

  • Contact your local SHIP or AAA office to help you learn if you are eligible for a MSP and to help you get enrolled.

Original Medicare pays for a lot, but not all, of the cost for health care services and supplies.

  • Medicare Supplement Insurance or a Medigap plan is private health insurance that you can buy which can help pay some of the remaining health care costs for covered services and supplies.
  • Talk to your local SHIP or AAA office to decide if buying a Medigap plan is right for you.

An appeal is an action you can take if you disagree with a coverage or payment decision by Medicare or your Medicare plan. For example, you can appeal if Medicare or your plan denies:

  • A request for a health care service, supply, or drug you think Medicare should cover.
  • A request for payment of a health care service, supply, item, or drug you already got.
  • A request to change the amount you must pay for a health care service, supply, or drug.

For more information on how to file an appeal, please visit: How Do I File An Appeal?

  • You can appoint a representative to help you file an appeal. Your representative can be a family member, friend, advocate, attorney, financial advisor, doctor, or someone else who will act on your behalf.
  • You can also get help filing an appeal from your local SHIP office.

This is a bit of a gray area.

  • If you are in a community corrections program as a Condition of Parole or are still under the authority of DOC, you are not eligible to receive Medicare or Social Security benefits.
  • If you are directly sentenced to community corrections, you should be able to enroll in Medicare.
  • Some people get Medicare while they’re in community corrections programs even though they technically aren’t supposed to. If you use Medicare when you shouldn’t, you could be responsible for repaying any healthcare bills.

Most people who are incarcerated in jails or prisons and are not eligible for Supplementary Security Income (SSI). Most people residing in a community corrections program will not be eligible for SSI. If you are incarcerated for more than 30 days, your benefits are suspended or terminated.

For more information about Social Security and how incarceration impacts your benefits visit: Benefits After Incarceration: What you need to know

Connect for Health Colorado (Marketplace)

Health Insurance Marketplaces (aka Marketplace) were established by the Affordable Care Act. Colorado’s Marketplace is called Connect for Health Colorado. A Marketplace is an online resource where you can shop for different health plans. Depending on how much income you make, you may be able to get help to buy health insurance on the Marketplace.

If you are denied by Health First Colorado (Colorado’s Medicaid Program) because you make too much money, you may be able to receive financial help to buy private health insurance through Connect for Health Colorado. For more information, please visit: https://connectforhealthco.com/

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