How to Apply for Medicare and Medicaid in Colorado: It Is Three Applications

It is three applications, not one

This is the thing nobody tells you, and it is the reason people end up with half of what they qualify for.

Getting Medicare and Medicaid working together is not one form. It is up to three separate applications, submitted to three different organizations, with three different sets of rules. Nobody connects them for you. There is no single desk where a person looks at your situation and starts all three.

• Health First Colorado — Colorado's Medicaid program. Applied for through the state.
• A Medicare Savings Program — four federal programs that pay Medicare costs. Medicare's wording is "You'll apply for Medicare Savings Programs through your state," so this one also goes through Colorado.
• Extra Help — the federal subsidy for Part D, the prescription part of Medicare. This one is Social Security's.

If you have full Medicaid you get Extra Help automatically — Medicare says you "automatically get Extra Help with your drug costs." So for some people it is two applications rather than three. But you do not know which case you are in until the first one comes back, which is why the order below matters.

The order to do them in

Start with the state. Health First Colorado and the Medicare Savings Programs both run through Colorado, and the state application is the one that determines the most. Start there even if you think you will not qualify.

Then Extra Help, unless the state application already got you full Medicaid. If it did, Extra Help arrives on its own and you do not need to apply.

The Medicare plan itself comes last. Which plan makes sense depends on what the first two produce, and people who do it in the other order end up in a plan chosen on the wrong facts.

Applying to Health First Colorado

Colorado publishes four routes, and they are not equivalent in speed.

Online — the state's own recommendation. PEAK, at co.gov/peak. The state's wording is "PEAK is the fastest way to apply." If someone in the household is comfortable online, this is the route.

By phone. 1-800-221-3943, State Relay 711. Phone applications are available Monday through Friday from 8 a.m. to 4 p.m. Note the 4 p.m., because it is earlier than people expect.

By post. A paper application can be downloaded and printed from the state's forms page.

In person. At your county of residence's local county office, or at a local application assistance site. The state publishes a map of locations.

The in-person route is worth more than it looks. An application assistance site is staffed by people who do this every day, and the rules about what counts as income and what counts as a resource are exactly the kind of thing that goes better with a person sitting across from you.

Applying for Extra Help

This one is Social Security, not Medicare and not the state.

• Online through Social Security's own secure portal
• By phone on 1-800-772-1213, Monday to Friday, 8 a.m. to 7 p.m.
• TTY 1-800-325-0778

Social Security suggests having your financial paperwork to hand before you start: bank statements, tax returns, any IRA or 401(k) balances, and pension or benefit statements. Gathering those first turns a frustrating hour into a straightforward twenty minutes.

What to have in front of you before you start any of them

Every one of these applications asks versions of the same questions. Assemble this once and you can do all three off the same pile.

• Your Medicare card, and your Medicare number as printed on it.
• Your Social Security number, and your spouse's if you are married.
• Proof of income — the Social Security award letter or benefit statement, any pension statements, any wages.
• Bank statements, most recent.
• Retirement account balances — IRA, 401(k), anything similar.
• Life insurance policies, if you have them, with the face value.
• Your address history, if you have moved recently.
• Your medication list. Not required for the applications, but it is what decides the plan question at the end, and you will want it anyway.

Do not stop assembling this because one item looks bad. The counting rules are not what people assume, and a house and a car are not treated the way cash is.

The mistake that costs the most

Not applying.

Medicare's own page on the Savings Programs says two things that almost no other website will tell you:

"Even if you don't think you qualify, you should still apply."

"You may still qualify for these programs in your state even if your income or resources are higher than the federal limits listed."

States are permitted to be more generous than the federal floor. So the calculation you did in your head, against a number you found online, is not the calculation that decides it. The application is the calculation.

How long it takes, and what to do while you wait

We are not going to print a processing time. Colorado does not publish one that we could verify, and a number invented for an article is exactly how somebody ends up ringing a county office on the wrong day, angry.

What we can tell you is what to do in the meantime:

• Keep your Medicare coverage exactly as it is. Do not drop anything, do not stop paying a premium, and do not let a plan lapse because you are expecting help. Nothing here is retroactive in a way you can count on in advance.
• Keep a copy of everything you submitted, and the date you submitted it.
• Write down who you spoke to. A name and a date settles a surprising number of later disagreements.

When the answer comes back

If you are approved, the next question is whether your Medicare coverage still makes sense given what changed — because it usually does not, and because you now have a monthly opportunity to change plans that other people on Medicare do not have. What you are entitled to at that point is set out in what dual eligibility actually pays for, and the plan type built for this situation is described on our dual eligible and Special Needs Plan page.

If you are denied, read the letter for the reason rather than the conclusion. A denial on a countable-resource question is a very different thing from a denial on income, and some denials turn on a document that was missing rather than on your actual situation.

Why we lay it out this way

Haven Health Plans was started by the pharmacists at Good Day Pharmacy, which operates a network of local community pharmacies across Colorado, Wyoming and Nebraska. Behind a counter you see the end of this process rather than the start of it — somebody who qualified for help two years ago and never applied, because the first thing they found was a form that turned out to be the wrong form.

We do not pick plans around pharmacies. A recommendation rests on your medication list, your doctors and your budget.

There is no charge for a review, and there is no commission for us in any of the three applications above. If you would rather have somebody work through which of the three apply to you before you start filling anything in, that is a reasonable use of an afternoon.