You got your coverage, now what?
We understand that getting enrolled in your health insurance plan was the easy part. Now you are left with a daunting task…understanding your coverage, your benefits, and how to address any changes that might affect your coverage. Below are links and videos that we hope will help answer some of the most frequent questions that our Health Coverage Guides and Enrollment Navigators are asked every day. Some of these documents were created by our team and others were created by other health organizations such as Health & Human Services. Almost all of the following links will open a document or website that offers both English and Spanish translations.
As we identify community needs, this page will be updated so check back later for more information. It should also be noted that information that is supplied by other organizations often include their phone numbers. Please don’t hesitate to contact us, your local resource, if you have additional questions. We can be reached at 970-708-7096.
From Coverage to Care – How it works
This “roadmap” explains what health coverage is, and how to use it to get the primary care and preventive services to help you and your family get the most out of your coverage. Click here to download a copy of come by our office for a hard copy!
LINKS SPECIFIC TO COLORADO’S MARKETPLACE
Calculate Potential Savings and Narrow Down Preferences
Check if you’re eligible for financial assistance to help lower your monthly costs (including Medicaid and CHP+) and view plans that include your preferred doctors, hospitals/facilities and medications. To get an estimate of what you might qualify for including Medicaid and CHP+ , click here.
Life Change Events and Special Enrollment Periods
A life change event is a change in circumstances that may affect your health insurance plan. When a life change event occurs, you should contact your local Health Coverage Guide, 970-708-7096, or Connect for Health Colorado Customer Service at 1-855-PLANS-4-YOU (1-855-752-6749) to report the event and make any necessary changes to your policy. You must report this change within 60 days of the qualifying event. To read more about qualifying life change events, click here. The Department of Health and Human Services also created a video on this subject (English). Click here to view.
Reporting a Change in Income
Your eligibility for certain programs may change based on your income. You might fall in or out of Medicaid eligibility or your tax credits might be increased or reduced. Your tax liability at the end of the year could be in jeopardy based on whether or not you accurately report your income. Click here to view a short TCHNetwork video about how and when to report an change in your income.
If you have health insurance under your parent’s plan and are turning 26 this year, you have options for coverage. Your options will depend on whether your parent’s plan is through their job or the Health Insurance Marketplace. Click here to learn more about what you need to do to get yourself covered.
HEALTH INSURANCE LITERACY LINKS
Understanding your Health Insurance Costs
Baffled by premiums, deductibles and out-of-pocket maximums? Here is an overview of health insurance that will help clear things up and give you a better sense of how your money is spent: Click here for a short video.
Learn More About a Health Savings Account (HSA)
Health Savings Accounts, along with a Qualified Health Plan, can be a good option for some people. It is important to understand how they work. Check with your insurance broker and/or tax adviser to see if HSAs, along with a high-deductible qualified health plan are a good fit for you. Click here for a short video that will teach you more about HSAs.
Understand How your Health Insurance Covers Prescription Drugs
The amount you pay for your medicines will depend on the health insurance plan you select. Before selecting a plan, make sure you understand how your prescription is listed. Click here for a short video about prescription drug coverage.
Who is in your plans Network & Why it’s important
Your insurance company contracts with medical providers, facilities and suppliers. Generally you will pay less if you use providers, facilities or suppliers in your plan’s network. Networks can change during the life of your plan. Check your Summary of Benefits or call your insurance company if you have more questions. Click here for a short video.
Basic Insurance Terms
Understanding basic insurance terms will take you a long way in understanding how your health insurance works. This short video by TCHNetwork will help you better understand these basic terms. If you still have questions, call us — we’re here to help! Click here for our short video.
LINKS REGARDING CITIZENSHIP & HEALTH INSURANCE
An immigrant who has been legally present for less than 5 years and does not qualify for Medicaid or CHP+ might qualify for lower cost health insurance through the marketplace. Click here to learn more about how you might qualify for Medicaid, CHP+, or marketplace insurance.
Emergency Medicaid: short term coverage for immigrants without legal permanent residency or Naturalization status
Emergency Medicaid is short term coverage for immigrants without legal permanent residency or Naturalization status. Emergency Medicaid only covers life and limb threatening situations, and does not cover doctor appointments or routine care. To apply you must visit your local Health & Human Services Office. Click here to find your local office. For more information contact one of Tri-County Health Network’s bilingual enrollment navigators: Pedro Maquera at 970.901.4335, Kody Gerkin at 970.708.0938, or Claudia Gamez at 970.708.4456.
LINKS SPECIFIC TO COLORADO MEDICAID & CHP+
Colorado Accountable Care Collaborative (ACC)
This animated video explains how Colorado Medicaid’s Accountable Care Collaborative works to coordinate care between clients, medical, and non-medical service providers. Colorado’s ACC program helps each client using a ‘whole person’ approach to connect them to the right doctors, coordinates care with other health care providers, and helps find support services in their area such as housing, food assistance and child care. Click here to view.
Need Help Printing your Medicaid Card?
Your Medicaid card should arrive in 7-10 days and will be sent to the address on your application. You do not need a copy of your Medicaid card to get medical services, you only need your State ID Number. You can also print your Medicaid card through PEAK. Click here for more information – scroll through the slides using the ARROW buttons on your computer’s keyboard.
Health First Colorado: Colorado’s Medicaid
If you live in Ouray or San Miguel Counties you are a member of the Accountable Care Collaborative (ACC). The ACC is Colorado Medicaid’s primary health care program. Click here to watch a short video and learn more about the ACC. If you live in Montrose County you are a member of the ACC Rocky Mountain Health Plan (RMHP) PRIME. Click here to learn more about ACC RMHP Prime.
Health First Colorado: Colorado’s Medicaid – Benefits & Services Overview
This is straightforward list that lays out your benefits, co-payments, dental benefits and more. Click here to learn about your Medicaid benefits.
Health First Colorado: Colorado’s Medicaid – Adult Dental Benefits
Yes! You read this right! If you are an adult and you qualify for Medicaid, you will receive dental benefits. Click here to learn more!
Health First Colorado: Colorado’s Medicaid – Child Dental Benefits
Children on Health First Colorado are entitled to preventive services including exams, cleanings, x-rays, sealants, space maintainers, fluoride treatments and more. Click here to learn about your child’s benefits!
Child Health Plans Plus (CHP+ or CHIP)
Child Health Plan Plus (CHP+) is public low-cost health insurance for certain children and pregnant women. It is for people who earn too much to qualify for Medicaid, but not enough to pay for private health insurance. CHP+ costs vary depending on your household size and income. CHP+ members may have to pay an annual enrollment fee. This fee is due within 30 days of your CHP+ approval. To learn more about the benefits of CHP+, click here.
Click here to learn more about your CHP+ service area, specialty care and specialty services.
CHP+ Child Dental Benefits
Delta Dental of Colorado provides dental benefits to all eligible and enrolled CHP+ child members. These benefits include preventive and diagnostic services, restorative services, endodontic, periodontic, prosthodontic, oral surgery, and limited orthodontic services. There will be a maximum allowable of $1000.00 per child per calendar year (January 1 – December 31). As with all CHP+ benefits, higher income families may be required to pay a small fee when they receive services. Delta Dental has an interactive website that can give you more information, just click here
Find a Medicaid Doctor, Specialist or Dentist
The Colorado Medicaid website (Colorado Department of Health Care Policy & Financing) can help you locate all types of doctors, specialists and dentists that accept Medicaid. The website tool is user friendly and can be found if you click here.
LINKS SPECIFIC TO REMAINING UNINSURED
Penalty for Remaining Uninsured & the Penalty Calculator
If you can afford health insurance but choose not to buy it, you must pay a fee called the individual shared responsibility payment. This fee is sometimes called the “penalty,” “fine,” or “individual mandate.” The penalty for not having health insurance in 2017 is $695 per uninsured person or 2.5% of your household income, whichever is greater. Before you decide to remain uninsured, use the Penalty Calculator to estimate the cost of this choice.
Exemption from a Penalty
Health coverage exemptions are available for a variety of reasons: certain life events, health coverage or financial status, group membership, and more. In some cases, you may be able to get an exemption from the penalty for remaining uninsured, which means you wouldn’t have to pay the penalty. To learn more about the exemption from penalty, click here. Wondering if you qualify for an exemption? Healthcare.gov offers a useful tool: Click here to learn more.
INCOME TAX QUESTIONS?
Employees of Tri-County Health Network are not tax accountants. We can, however, offer you the following information on the documents you will need when reconciling your taxes:
- 1095A – This document is necessary to reconcile your taxes if you received a Marketplace tax credit. You will find it in the MY DOCUMENTS folder of your connectforhealthco.com account. If this form is not found in MY DOCUMENTS, contact Connect for Health Colorado at 855-752-6749.
- 1095B – This document proves that you were enrolled into a qualified health plan for the tax year. You will receive this document from Medicaid/CHP+ or your health insurance carrier. If you do not receive this document, contact your local Health and Human Services office.
- 1095C – This document is necessary if you receive employer sponsored health coverage. Your employer will supply this document.