Medicare and Medicaid
Having Medicare and Medicaid both
Figures on this page checked . Medicare and marketplace numbers reset every year — if you are reading this long after that date, call and we will tell you what moved.
Four programs, and what each one pays
These are called Medicare Savings Programs. Health First Colorado runs them, they are separate from full Medicaid, and you can qualify for one without qualifying for the other.
- QMB pays your Part A and Part B premiums, your deductibles, and your coinsurance. This is the one that changes a household budget.
- SLMB pays your Part B premium.
- QI-1 also pays your Part B premium, funded from a fixed pot each year — apply early in the year rather than late.
- QDWI pays the Part A premium for people under 65 who returned to work and lost premium-free Part A.
Enrolling in any of the first three also enrolls you automatically in Extra Help for prescriptions. That is one application doing two jobs, and it is the reason to start here.
The 2026 Colorado limits
Monthly income, as Colorado applies it. Every figure below already includes the $20 unearned income disregard the state applies before it compares.
- QMB: $1,350 for one person, $1,824 for a couple
- SLMB: $1,616 for one person, $2,184 for a couple
- QI-1: $1,816 for one person, $2,455 for a couple
- QDWI: $2,660 for one person, $3,607 for a couple
- Extra Help for prescriptions: $2,015 for one person, $2,725 for a couple
Savings and other countable resources have to be under $11,450 for one person or $17,910 for a couple. Your home does not count. Neither does one car. QDWI has no resource test at all.
Apply anyway if you are close
These thresholds move every year, some kinds of income are not counted, and the figures above already build in a disregard most people do not know exists. Deciding you are ineligible by comparing your bank balance to a number on a web page is how people go years without help they qualified for the whole time. The application is free.
The bill you do not have to pay
If you have QMB, federal law says a QMB has no legal liability to pay a provider for Medicare cost-sharing. Not that you should dispute the bill. That you have no legal liability for it.
Providers send those bills regularly anyway, usually because their billing system does not know your status rather than out of any bad intent. Most people pay them, because a bill arrived and paying bills is what you do.
In plain terms
“What do I do with the bill?” Call the provider, tell them you are a QMB, and ask them to rebill Medicare and Medicaid. Keep your notice from Health First Colorado where you can find it. If they keep billing you, 1-800-MEDICARE takes that complaint and it is the right place for it.
Extra Help, and what prescriptions cost after it
Extra Help is the Part D subsidy. It covers the plan premium up to a benchmark amount, removes the deductible, and drops what you pay at the counter to a few dollars per prescription.
It also carries something no other Medicare program does: a window that opens every month. If you have Extra Help, you can move to a different standalone Part D plan once a calendar month, all year. Nobody tells people this, and it means a plan that drops one of your medications in March is a problem you can fix in March.
What that window does not do
It moves your drug plan, not your health plan. The monthly window covers standalone Part D — and if you have both Medicare and Health First Colorado, a second monthly window covers the dual-eligible plans built to combine them. Neither one moves you into an ordinary Medicare Advantage plan. That still waits for Annual Enrollment, October 15 to December 7.
Which matters more than it sounds, because of what happens if you use the wrong one. If you are on a Medicare Advantage plan with drug coverage built in and you sign up for a standalone drug plan, you are generally dropped out of the Advantage plan and returned to Original Medicare. One application, and your doctors, your network, and your out-of-pocket cap all change. Call before you fill anything in.
These windows became monthly on January 1, 2025, replacing a quarterly one. Plenty of pages still describe the quarterly version, and some of them belong to companies that should know better.
Applying is free, it goes through Social Security, and qualifying for a Medicare Savings Program gets you enrolled automatically.
Plans built for people with both
Some Medicare Advantage plans accept only people who have both Medicare and Medicaid. They coordinate the two programs, and they usually add dental, vision, hearing, transport to appointments, and an over-the-counter allowance.
They are not automatically the right answer. They run networks, and a network that excludes the specialist managing your condition is a bad trade for a dental benefit. We check your doctors and your prescriptions against the plan before recommending one, and sometimes the recommendation is to stay where you are.
If you have both Medicare and full Health First Colorado benefits, you can move between these plans once a calendar month, so you are not locked in for a year the way most people are. The same window does not reach a regular Medicare Advantage plan — that one waits for autumn.
How to apply, and who to call
- Medicare Savings Programs and Health First Colorado: through your county human services department or Colorado PEAK online.
- Extra Help: through Social Security, at 1-800-772-1213 or online. Separate application, though a Savings Program approval triggers it.
- Free help with either: the State Health Insurance Assistance Program counsels at no cost and sells nothing.
We can help with the Medicare plan that sits on top of all this. We cannot approve you for Medicaid or Extra Help, and any agent who implies otherwise is overselling what an agent does.
Questions about having both
My income is a little over the limit. Should I bother?
Yes. The published figures already build in a disregard the state applies before comparing, some income does not count toward the test at all, and the thresholds rise every year — Colorado's income limits update each April and the resource limits each January.
People decide they are ineligible by comparing a bank statement to a number on a screen, and a fair number of them were eligible. The application costs nothing but time.
I have QMB and a provider sent me a bill. Do I owe it?
For Medicare cost-sharing, no. Federal law says a qualified Medicare beneficiary has no legal liability to pay a provider for those amounts, and the combined Medicare and Medicaid payment counts as payment in full.
Call the provider, tell them you have QMB, and ask them to rebill. If the bills continue, report it to 1-800-MEDICARE. Do not pay it to make it stop — that is the outcome the protection exists to prevent.
Will a dual-eligible plan let me keep my doctors?
Sometimes, and it is the first thing to check rather than the last. These plans run networks, and the extra benefits people are drawn to — dental, transport, an over-the-counter card — are worth less than continuity with a specialist who knows your history.
Send us your list of doctors and your prescriptions and we will check them against the plans available in your county before you decide anything. If the answer is that your current arrangement is better, that is what we will tell you.
Can I change plans outside the usual enrollment windows?
Your drug plan, yes — once a calendar month, all year, if you have Extra Help. If you have both Medicare and full Health First Colorado benefits, a second monthly window lets you move between the dual-eligible plans that combine the two programs.
Neither window reaches a regular Medicare Advantage plan. That change still waits for Annual Enrollment in the autumn, and signing up for a standalone drug plan while you are on an Advantage plan will usually drop you out of it altogether. Call us before you change anything — this is the part people get wrong on their own.
One correction worth having: these became monthly windows on January 1, 2025. If you read somewhere that you get one every quarter, that page is describing a rule that no longer exists.
CMS-required disclaimer
We do not offer every plan available in your area. Currently we represent 7 organizations which offer 45 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.