Key Takeaways
- Health First Colorado (Colorado Medicaid) provides coverage to low-income residents
- CHP+ (Child Health Plan Plus) covers children and pregnant women above Medicaid limits
- Connect for Health Colorado is the state health insurance marketplace
- The Colorado Life and Health Insurance Protection Association provides guaranty fund coverage
- Colorado participates in the Long-Term Care Partnership Program for Medicaid asset protection
Colorado State Insurance Programs
Colorado operates several state programs that insurance producers should understand when helping clients evaluate coverage options.
Health First Colorado (Medicaid)
Health First Colorado is Colorado's Medicaid program:
Who's Covered
| Population | Income Limit (approx.) |
|---|---|
| Adults | 138% Federal Poverty Level |
| Pregnant Women | 195% FPL |
| Children | Higher limits by age |
| Seniors/Disabled | SSI-related eligibility |
Health First Colorado Benefits
- Doctor visits
- Hospital care
- Prescription drugs
- Mental health services
- Dental (adults and children)
- Vision services
- Long-term care
Exam Tip: Health First Colorado is Colorado's name for Medicaid. It's important to know this when clients ask about coverage options.
CHP+ (Child Health Plan Plus)
CHP+ covers children and pregnant women with income above Medicaid limits:
CHP+ Eligibility
| Who | Income Limit |
|---|---|
| Children (0-18) | Up to 260% FPL |
| Pregnant Women | Up to 260% FPL |
CHP+ Benefits
- Comprehensive health coverage
- Doctor and specialist visits
- Hospital care
- Prescription drugs
- Dental and vision
- Mental health services
- Low-cost premiums and copays
Connect for Health Colorado
Connect for Health Colorado is the state's health insurance marketplace:
What It Offers
| Feature | Description |
|---|---|
| Individual Plans | Qualified Health Plans |
| Small Business (SHOP) | Plans for small employers |
| Premium Tax Credits | Federal subsidies |
| Cost-Sharing Reductions | Lower out-of-pocket for Silver |
Metal Tiers
| Tier | Actuarial Value |
|---|---|
| Bronze | 60% |
| Silver | 70% |
| Gold | 80% |
| Platinum | 90% |
Special Enrollment Periods
Outside open enrollment, individuals can enroll if:
- Loss of other coverage
- Marriage, divorce, or domestic partnership
- Birth or adoption
- Move to new area
- Citizenship status change
Colorado Long-Term Care Partnership Program
Colorado participates in the LTC Partnership Program:
How It Works
- Purchase Partnership-qualified LTC policy
- Use benefits for qualifying care
- If benefits exhaust, apply for Medicaid
- Asset protection: Keep assets equal to benefits received
Partnership Benefits
| Without Partnership | With Partnership |
|---|---|
| Spend down to $2,000 | Protect assets up to benefits |
| May lose home equity | Keep home and assets |
| Standard Medicaid rules | Enhanced protection |
Policy Requirements
- Meet federal and Colorado requirements
- Inflation protection (age-based)
- Sold by certified producers
- Partnership-certified
Colorado Life and Health Insurance Protection Association
Colorado's guaranty fund protects policyholders when insurers fail:
Coverage Limits
| Policy Type | Maximum Coverage |
|---|---|
| Life Insurance Death Benefit | $300,000 |
| Life Insurance Cash Value | $100,000 |
| Annuity Present Value | $250,000 |
| Health Insurance | $500,000 |
| Disability Income | $300,000 |
| Long-Term Care | $300,000 |
What's Covered
- Individual life insurance
- Group life (Colorado residents)
- Annuities
- Health insurance
- Disability insurance
- Long-term care insurance
What's NOT Covered
- Surplus lines policies
- Self-funded plans
- Variable product investment portions
- Amounts above limits
- Unlicensed insurer policies
Producer Restrictions
Producers CANNOT:
- Use guaranty fund as selling point
- Advertise guaranty protection
- Compare to FDIC
- Imply policies are "guaranteed"
Exam Tip: Colorado's $300,000 life insurance death benefit limit is important to know. Producers cannot advertise guaranty fund coverage.
Producer Responsibilities
What Producers Should Do
- Know about state programs
- Refer appropriately to resources
- Compare private vs. state options
- Stay current on program changes
What Producers Should NOT Do
- Guarantee eligibility for state programs
- Provide tax or legal advice
- Discourage appropriate private coverage
- Make false statements about programs
What is Health First Colorado?
What is CHP+ in Colorado?
What is the Colorado guaranty fund limit for life insurance death benefits?
Can producers use Colorado's guaranty fund as a selling point?
What is Connect for Health Colorado?
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