Eligibility

What is a mixed eligibility household?

This is when one or more family members are approved for a Qualified Health Plan, Premium Tax Credits, and/or Cost-Sharing Reductions and other members of the same household are approved for Health First Colorado or Child Health Plan Plus (CHP+).

Mixed eligibility households should report all changes and do their annual redetermination through Program Eligibility and Application Kit (PEAK), the online application for Health First Colorado and other state assistance programs. Connect for Health Colorado’s Medical Assistance (MA) Site will provide support for case maintenance for mixed eligibility households.

Household members on different programs may have different renewal and certification timelines.  Check your PEAK account for Health First Colorado/CHP+ redetermination date and your Connect for Health account for information specific to your Marketplace plan.

Related FAQs:
Am I eligible for subsidies (financial help) to help pay for health insurance?
What is Health First Colorado (Colorado’s Medicaid Program)?
What is an Advance Premium Tax Credit?
What is a cost-sharing reduction?

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What if I am eligible for Medicare but have stayed in my Marketplace plan?

You may be entitled to have any Medicare late enrollment penalty waived if you disenroll from your Connect for Health Colorado plan and enroll in Medicare. Learn more

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What is the Federal Poverty Level?

A definition of FPL can be found in our Glossary of Terms. When you fill out your application for financial assistance, the Marketplace will use your income and household size to calculate your FPL and determine your eligibility for financial assistance programs.

Related FAQs:
Am I eligible for subsidies (financial help) to help pay for health insurance?
What is Health First Colorado (Colorado’s Medicaid Program)?
What is an Advance Premium Tax Credit?
What is a Cost-Sharing Reduction?

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How do I appeal my eligibility results?

You have the right to appeal certain determinations made by Connect for Health Colorado.

  • To appeal an eligibility determination you received through Connect for Health Colorado, please follow the instructions provided to you in your determination notice. You can find instructions on how to file an appeal. If you have questions on how to appeal, call the Client Service Center at 1-855-PLANS-4-YOU (855-752-6749).
  • To appeal your eligibility determination for an exemption from the requirement to have health insurance, please follow the instructions provided to you in your determination notice. This determination is made by the federal government, and questions on how to appeal should be directed to 1-800-318-2596 (TTY: 1-855-889-4325).

Related FAQs:
How can I submit a complaint?

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What are COBRA and Colorado Continuation?

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal law that gives certain employees and their dependents the right to choose to continue group health coverage (e.g. health coverage through their employer) provided by their group health plan for a limited period of time under certain circumstances, such as job loss or a reduction in work hours. Keep in mind:

  • If you lose job-based health insurance, you do not have to enroll in COBRA coverage. This circumstance is considered a Life Change Event, which means you will be eligible for a Special Enrollment Period. During this period, you can shop for a new health insurance plan.
  • Colorado Continuation and Conversion was created by the Colorado legislature to fill gaps left by COBRA. If you work for a small business, you may be offered Colorado Continuation and Conversion coverage.
  • Connect for Health Colorado does not administer COBRA or Colorado Continuation. Learn more about COBRA and Colorado Continuation by visiting the Department of Labor’s website.

Related FAQs:
How does eligibility for and/or enrollment in other coverage affect my eligibility?
What is an Open Enrollment Period?
What is a Special Enrollment Period?
Am I required to have health insurance?

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Who should I include on my application for financial assistance?

Tax Dependents

  • In general, who you should include on your application is based on your tax household – you (the taxpayer), your spouse/partner (if you file taxes jointly), and whoever is claimed as a dependent on your tax return. All individuals who fit these criteria should be included whether or not they have taxable income and whether or not they are applying for health insurance. You will be able to select different plans for each member of the household.

Adult Children Up to Age 26

  • Even if you no longer claim your adult child on your tax return, you can include them on your application and enroll them in your family health insurance plan. You will want to provide their address, income, and tax filing status on the application, which means they may qualify for different financial help programs, or a different amount, than the rest of the household. However, you will have the chance to buy a plan together when you begin shopping.

Other Circumstances

  • If you are a couple who doesn’t file taxes together and wants to buy a health insurance plan together, you do not need to submit two applications. For example, if you are in a domestic partnership with someone who you do not file taxes with but you want to enroll in a health plan together.
  • If the parent who is claiming the child would like to seek coverage for that child, the other parent will need to fill out an application including the child whom is their tax dependent.

Victims of Domestic Violence and/or Spousal Abandonment

  • If you are a victim of domestic violence and/or spousal abandonment, you will be eligible for Premium Tax Credits even if you are married and filing separately. This is referred to as “exceptional circumstances.”
  • If this description matches your circumstances and you have been denied financial help, please contact our Client Service Center. They can make changes to your account so you are approved for financial help. There is no verification necessary for “exceptional circumstances”- we take your attestation.

More Resources

Information about tax households, the definition of a dependent, and other tax filing topics can be found on the IRS website.

Related FAQs:
Am I eligible for subsidies (financial assistance) to help pay for health insurance?
When do I report changes to Connect for Health Colorado?
Are there certain documents or information I need to fill out an application, and how do I submit them?
What income should I include on my application for financial assistance?

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What is Medicare and how do I find out if I’m eligible?

Medicare is a health insurance program administered by the federal government for individuals who are age 65 or older, certain people with disabilities and other special populations. Connect for Health Colorado does not administer Medicare. Learn more about Medicare eligibility and enrollment, and how Medicare coverage may affect your coverage options through the Marketplace:

General Information on Medicare
Information on Medicare and the Marketplace

Related FAQs:
How does eligibility for and/or enrollment in other coverage affect my eligibility?
How do I apply for an exemption from having health insurance?

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How does eligibility and/or enrollment in other coverage affect my eligibility?

Employer-sponsored coverage: If you are eligible for coverage through an employer (yours, or a household member’s) that is affordable and provides minimum essential coverage, then you are not eligible for financial assistance through the Marketplace. Please see the “How do I know if my employer-sponsored plan is affordable?” FAQ to find out more about affordability of employer-sponsored coverage.

Health First Colorado (Colorado’s Medicaid Program): If you are eligible for Health First Colorado, then you are not eligible for financial assistance through the Marketplace. You are welcome to purchase a health insurance plan through the Marketplace at full price. If you are receiving financial assistance and become eligible for Health First Colorado , your eligibility for financial assistance will end and you may want to cancel your private insurance plan to avoid being charged full price.

Medicare: If you are enrolled in either Medicare Part A or Medicare Part B, you are ineligible to purchase a plan through the Marketplace. However, if you have Premium Part A Medicare (not free Part A Medicare), you may choose to drop your Premium Part A (or choose not to enroll when eligible) and can then enroll in a plan through the Marketplace.

The choice of dropping Part A Medicare when an individual is entitled to it is an important decision and should be carefully considered. Individuals who do not enroll in Medicare when first eligible may have to pay late enrollment penalties if they later apply for both Premium Part A and Part B. Also, if an individual is entitled to free Part A Medicare and drops it, this could result in loss of retiree benefits and paying back all retirement benefits received and costs incurred by the Medicare program. Please also be aware that Medicare enrollment periods and start dates for coverage are not the same as those available on the Marketplace.

Retirement Benefits or Other Coverage: If you are enrolled in a retiree health plan or other minimum essential coverage, you may not be eligible for financial assistance through the Marketplace. For a list of other types of minimum essential coverage options, please see the “What is Minimum Essential Coverage?” FAQ.

Related FAQs:
Am I eligible for financial assistance to help pay for health insurance?
How do I know if my employer-sponsored plan is affordable?
What is Minimum Essential Coverage?

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How do I know if my employer-sponsored plan is considered affordable?

An employer-sponsored plan is considered “affordable” based upon the percentage the employee is required to contribute to the premiums for self-only coverage (by salary reduction or otherwise). The self-only coverage premium standard applies, even if the employer offers the coverage to other family members. In order to be considered affordable, the employee should not have to contribute more than a certain “contribution percentage” of their total household Modified Adjusted Gross Income.

For 2018, the contribution percentage is 9.56% (this percentage will increase annually).

Furthermore, your employer-sponsored plan must also provide “minimum value.”

If the coverage your employer offers is not affordable or does not meet the standard of minimum value, you may be eligible to purchase a Qualified Health Plan through the Marketplace and see if you are eligible for Premium Tax Credits and Cost-Sharing Reductions.

To see if your employer-sponsored plan is affordable and adequate, download our  Employer Coverage Tool.

Note: Whether or not your employer-sponsored plan is affordable does not affect your eligibility for Health First Colorado (Colorado’s Medicaid Program) or Child Health Plan Plus.

Related FAQs:
Am I eligible for financial assistance to help pay for health insurance?
How does eligibility for and/or enrollment in other coverage affect my eligibility?
What is Minimum Essential Coverage?

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Can I enroll in a health plan outside of the Open Enrollment Period?

To buy a health insurance plan outside of the Open Enrollment Period, you must qualify for a Special Enrollment Period. Having a Life Change Event, such as losing health insurance coverage from a job, moving, getting married or having a baby, may allow for a Special Enrollment Period. Please see the “What is a Life Change Event?” FAQ for more information on Life Change Events.

Note: You can enroll in Health First Colorado (Colorado’s Medicaid Program) or Child Health Plan Plus anytime. Open enrollment periods do not apply to these programs.

Related FAQs:
Am I eligible to purchase insurance through the Marketplace?
What is a Life Change Event?
What is a Special Enrollment Period?
When do I report changes to the Marketplace?

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