This page lists most of the benefits and services covered by Health First Colorado. You may qualify for more.
Health First Colorado coverage gives you 3 kinds of basic benefits: 1. Physical health benefits, 2. Dental benefits, 3. Behavioral health (mental health and substance use benefits).
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For some services, you may have a co-pay. A co-pay is a fixed amount you pay when you get a covered health care service. You never have to pay more than the co-pay for covered services.
Get more information about your benefits by contacting your primary care provider, regional organization, or the Member Contact Center.
Health Care Provider Visits
Before your in-person or telehealth appointment: Get Ready For Your Visit
Benefit Description Co-pays Limit Exclusions Prior Authorization Needed? For More Information Primary Care Medical Provider Visit Primary Care Medical Provider Visit for Illness or injury No co-pays One visit to a provider for the same issue per day. Investigative and experimental treatments are not covered No Talk to your primary care provider or regional organization. Specialist Visits Specialist visit examples include being seen by a urologist, cardiologist or endocrinologist and others No co-pays One visit to a provider for the same issue per day. Investigative and experimental treatments are not covered No Talk to your primary care provider or regional organization. Home Health Home health allows patients to get some care they need at home No co-pays For a member’s acute care home health needs lasting 60 days or less, members can get all necessary services without prior authorization or approval. Members can get longer home health if you develop a new issue or a current problem gets worse.
For member’s long term home health needs, you must get prior authorization or approval. Prior authorization is approved for 6-12 months at a time, but a client can get an unlimited number of prior authorizations.
Yes Talk to your primary care provider or regional organization. Telemedicine Telemedicine is a way of helping to get services to members who live far away from the providers they need to see. No co-pay for telemedicine but co-pays may apply for other services provided.
Children under age of 19 and pregnant members do not have co-pays.
No limits Members must be part of the telemedicine appointment. No Learn more about telemedicine.
Talk to your primary care provider or regional organization.
Vision Care Adult vision care benefit includes medically necessary eye exams, glasses and contact lenses only after surgery. No co-pays No limits Does not include orthoptic or eye training therapy. Learn more about Vision Benefits.
Talk to your primary care provider or regional organization.
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Dental Services
Benefit Description Co-pays Limit Exclusions Prior Authorization Needed? For More Information Dental Services Services include cleanings, fillings, root canals, crowns, and partial dentures. No co-pays No annual benefit limit for adults or children. None Sometimes Learn more about Adult Dental Benefits and DentaQuest. Contact DentaQuest to find out more: 1-855-225-1729, TTY: 711
For more information regarding your overall health care talk to your primary care provider or regional organization.
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Hospitalization, Emergency Services, Transportation and Other Services
Benefit Description Co-pays Limit Exclusions Prior Authorization Needed? For More Information Emergency Room Emergency room visits No co-pays if determined an emergency; $8 per visit if not emergency.
Children under age of 19 and pregnant members do not have co-pays.
No limits None No Learn more about Hospital Emergency Services.
Talk to your primary care provider or regional organization.
Ambulance Services Ambulance services and other non-emergent transportation No co-pays No limits None Prior authorization is not required for emergency ambulance services. Prior authorization is only required when it is non-emergent, like being transferred to a new hospital. Learn more about Hospital Emergency Services.
Talk to your primary care provider or regional organization.
Non-Emergent Medical Transportation Rides to medical appointments No co-pays No limits None No Learn more about Non-Emergent Medical Transportation.
Talk to your primary care provider or regional organization.
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Urgent care centers/facilities Visits to an urgent care center No co-pays No limits None No Talk to your primary care provider or regional organization. Outpatient surgery at an Ambulatory Surgery Center Outpatient surgery that takes place at an Ambulatory Surgery Center No c-pays No limits None Yes Talk to your primary care provider or regional organization. Outpatient Hospital Services Outpatient hospital services that do not require you to be admitted to the hospital No co-pays No limits None No Talk to your primary care provider or regional organization. Inpatient Medical/Surgical Care Inpatient Medical or Surgical Care that requires you to be admitted to the hospital No co-pays No limits Cleft palate surgery, bariatric surgery and dental anesthesia may be covered. No Talk to your primary care provider or regional organization. Organ and Transplants Organ and transplant services No co-pays No limits None Yes Talk to your primary care provider or regional organization. Anesthesia Anesthesia No co-pays No limits No Talk to your primary care provider or regional organization. Breast reconstruction Breast reconstruction surgery No co-pays No limits Breast reconstructive surgery may be covered for members with a history of breast disease diagnosis and surgical procedure within the prior 5 years. Yes Talk to your primary care provider or regional organization. Hospice Hospice No co-pays No more than 9 months. Adults must forego curative care No Talk to your primary care provider or regional organization. Private Duty Nursing Private Duty Nurse who provides one-on-one care to patients No co-pays Private duty nursing is limited to 23 hours a day for adults.
Children can get up to 24 hours of private duty nursing each day up to their 21st birthday.
None Yes Talk to your primary care provider or regional organization. Radiation therapy and Chemotherapy services Radiation therapy and Chemotherapy services No co-pays No limits None No Talk to your primary care provider or regional organization.
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Maternity and Newborn Care
Benefit Description Co-pays Limit Exclusions Prior Authorization Needed? For More Information Prenatal and postpartum care Prenatal and postpartum care and provider visits before and after a patient’s baby is born Pregnant and parenting members do not have to pay co-pays. 1 comprehensive (or complete) visit and 7-13 prenatal visits that last the whole pregnancy plus 60 days after giving birth
Members who’ve declared their pregnancy will also be guaranteed coverage for the 12 months after their pregnancy ends.
Only for women of childbearing age No Talk to your primary care provider or regional organization. Delivery and inpatient maternity services Delivery and inpatient maternity services Pregnant and parenting members do not have to pay co-pays. No limits None No Talk to your primary care provider or regional organization. Newborn child coverage Newborn child coverage after a baby is born Pregnant and parenting members do not have to pay co-pays. Coverage for the whole first year after a baby is born Limited to newborns born to mothers on Health First Colorado. No Talk to your primary care provider or regional organization. Breast Pumps Pregnant members may receive a pump as early as the 28th week of pregnancy.
Postpartum members may receive a pump at any time.
Both manual and electric breast pumps are covered.
Pregnant members do not have to pay co-pays. Breast pumps must be prescribed by a physician, physician assistant, or nurse practitioner.
Breast pumps must be provided by an approved supplier, which are often pharmacies.
None No Talk to your primary care provider or regional organization. Specialty Programs – Nurse Home Visitor Program Nurse Home Visitor Program for first time mothers Pregnant and parenting members do not have to pay co-pays. Home visits until the child turns two years old. Program is only available to first-time pregnant members. No Talk to your primary care provider or regional organization. Specialty Programs – Prenatal Plus Prenatal Plus Program for at risk pregnant members and babies Pregnant members do not have to pay co-pays. Pregnant members can be in the program for their whole pregnancy plus 60 days after giving birth. None No Talk to your primary care provider or regional organization. Specialty Programs – Special Connections Special Connections Program is for pregnant members who struggle with alcohol and/or drug misuse. Pregnant members do not have to pay co-pays. Pregnant and parenting members can be in the program for their whole pregnancy and until their child turns one year old. None No For more information see the Special Connections page.
Call the Department of Human Services’ Office of Behavioral Health at 303-866-7400 to find a provider in your area.
Talk to your primary care provider or regional organization.
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Mental Health, Substance Use Disorder, or Behavioral Health Services
Benefit Description Co-pays Limit Exclusions Prior Authorization Needed? For More Information Alcohol and/or drug assessment Alcohol and/or drug assessment No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Physical assessment of detoxification progression including vital signs monitoring Physical assessment of detoxification progression including vital signs monitoring No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Behavioral health counseling and therapy, individual Behavioral health counseling and therapy, individual No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Alcohol and/or drug services, group counseling by a clinician Alcohol and/or drug services, group counseling by a clinician No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Alcohol and/or drug services, targeted case management Alcohol and/or drug services, targeted case management No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Safety assessment including suicide ideation and other behavioral issues Safety assessment including suicide ideation and other behavioral issues No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Level of motivation assessment for treatment evaluation Level of motivation assessment for treatment evaluation No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Drug screening and monitoring Drug screening and monitoring No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Medication-assisted treatment Medication-assisted treatment No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Inpatient Hospital Inpatient Hospital stays No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Outpatient Psychotherapy Outpatient Psychotherapy No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Group Psychotherapy Group Psychotherapy No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Family Psychotherapy Family Psychotherapy No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Mental Health Assessment Mental Health Assessment No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Pharmacologic Management Pharmacologic Management of a patient’s medications No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Outpatient Day Treatment, non-residential Outpatient Day Treatment, non-residential No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Emergency/Crisis Services Emergency/Crisis Services No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Clinic Services, Case Management Clinic Services, Case Management No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Biologically-based mental illnesses and disorders Biologically-based mental illnesses and disorders No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Mental Health and Substance Use Disorder – Outpatient hospital and physician Mental Health and Substance Use Disorder – Outpatient hospital and physician No co-pays No limits None Sometimes Talk to your primary care provider or regional organization. Mental Health and Substance Use Disorder – Inpatient hospital Mental Health and Substance Use Disorder – Inpatient hospital No co-pays No limits None Concurrent Authorization Talk to your primary care provider or regional organization. Substance Use Disorder – Residential Treatment Residential Treatment for Substance Use Disorder No co-pays No limits None Yes Talk to your primary care provider or regional organization. Substance Use Disorder – Withdrawal Management Withdrawal Management (Detox Services) for Substance Use Disorder No co-pays No limits None No Talk to your primary care provider or regional organization. School-based mental health services School-based mental health services No co-pays No limits Only available to children with Individual Education Programs No Find out more about School Health Services.
Talk to your primary care provider or regional organization.
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Pharmacy and Durable Medical Equipment Benefits
Benefit Description Co-pays Limit Exclusions Prior Authorization Needed? For More Information Prescription Drugs For a list of covered prescription drugs, please see the Pharmacy Benefits Page.
You can also learn about Mail Order Prescriptions.
No co-pays Please see the Pharmacy Benefits Page Please see the Pharmacy Benefits Page The generic equivalent will be given without prior authorization. Non-generic drugs are given only with prior authorization or if there is no equivalent. Please see the Pharmacy Benefits Page.
Talk to your primary care provider or regional organization.
Durable Medical Equipment Durable medical equipment that can be reused and is prescribed by a provider such as wheelchairs, crutches, oxygen, gait trainers, and others. No co-pays No limits Dental and/or prosthodontics services are covered under the dental benefit. The generic equivalent will be given without prior authorization. Non-generic drugs are given only with prior authorization or if there is no equivalent. Talk to your primary care provider or regional organization.
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Physical, Occupational or Speech Therapy
Benefit Description Co-pays Limit Exclusions Prior Authorization Needed? For More Information Home Health Therapies (Physical therapy/ Occupational therapy/ Speech therapy) Acute Home Health Therapies (Physical therapy/ Occupational therapy/ Speech therapy) Acute No co-pays 60 days of treatment per acute (serious) condition None No Talk to your primary care provider or regional organization. Home Health Therapies (Physical therapy/ Occupational therapy/ Speech therapy) Long Term Home Health Therapies (Physical therapy/ Occupational therapy/ Speech therapy) Long Term No co-pays No limits Only available to children 20 years old and younger Yes Talk to your primary care provider or regional organization. Outpatient Speech Therapy Speech therapies provided in the office, clinic, or outpatient hospital setting No co-pays Some daily limits apply.
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No limits for children. Children may qualify for rehabilitative and Habilitative therapy.
Adults limited to rehabilitative therapy only. Some adults qualify for Habilitative therapy.
None Yes Habilitative therapies may be available. Talk to your provider for more information.
Talk to your primary care provider or regional organization.
Inpatient Speech Therapy Inpatient Speech Therapy No co-pays No limits None No Talk to your primary care provider or regional organization. Outpatient Physical therapy/ Occupational therapy Physical and Occupational therapies provided in the office, clinic, or outpatient hospital setting No co-pays Some daily limits apply. None Authorization may be required Habilitative therapies may be available. Talk to your provider for more information.
Talk to your primary care provider or regional organization.
Inpatient Physical therapy/ Occupational therapy Inpatient Physical therapy/ Occupational therapy No co-pays No limits None No Talk to your primary care provider or regional organization.
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Laboratory Services
Benefit Description Co-pays Limit Exclusions Prior Authorization Needed? For More Information Lab and Radiology Lab and radiology test such as x-rays and blood work No co-pays No limits Sometimes Get more information about Lab and Radiology services.
Talk to your primary care provider or regional organization.
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Preventive and Wellness Services
Benefit Description Co-pays Limit Exclusions Prior Authorization Needed? For More Information Preventive and wellness services and chronic disease management Preventive and wellness services and chronic disease management such as aspirin use, blood pressure screening, breast cancer screening, cholesterol screening, depression screening, healthy diet counseling, sexually transmitted disease prevention counseling, tobacco use screening and counseling and others. No co-pays 1 adult annual physical per year.
Counseling to help quit smoking is limited to three times per year for adults.
Some services require prior authorization Get help with quitting smoking.
Talk to your primary care provider or regional organization.
Immunizations Immunizations and vaccines such as influenza, chicken pox, measles and others. Get more information. No co-pays None Talk to your primary care provider or regional organization. Colorectal cancer screening Colorectal cancer screening No co-pays No limits None Talk to your primary care provider or regional organization. Screening mammography Screening mammography No co-pays 1 screening per year Limited to women age 40 and older and for younger women who are high risk. Talk to your primary care provider or regional organization. Audiology Audiology services such as hearing aids and cochlear implants. No co-pays Hearing aids: 1 set per 3-5 years Audiology benefit includes hearing aids for ages 20 and under. Covers supplies. Replacements expected every 3-5 years. Hearing aids may be replaced when they no longer fit, have been lost or stolen, or the current hearing aid is no longer medically appropriate for the child. No ear molds for swimming/noise reduction.
Covers Cochlear implants for only ages 20 and under, replacement when current unit is broken/non-functional.
All ages: Replacement for current cochlear implant if broken/lost.
Talk to your primary care provider or regional organization. Allergy testing and injections Allergy testing and shots No co-pays No limits Investigative and experimental treatments are not covered. Talk to your primary care provider or regional organization. Screening Pap tests Cervical and vaginal cancer screenings such as a pap smear test No co-pays 1 test per year None Talk to your primary care provider or regional organization. Gynecological exam Gynecological exams No co-pays 1 exam per year None Talk to your primary care provider or regional organization. Prostate cancer screening Prostate cancer screening for men No co-pays 1 exam per year None Talk to your primary care provider or regional organization. Routine foot care Routine foot care No co-pays 1 service every 60 days Acute care (serious) issues allow any amount of medically necessary podiatric services Talk to your primary care provider or regional organization.
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Family Planning Services
Benefit Description Co-pays Limit Exclusions Prior- Authorization Needed? For More Information Office Visits and Counseling Family planning office visits and counseling services focused on preventing, delaying or planning for a pregnancy. No co-pays 1 annual family planning visit, at least 10 months apart. Additional family planning follow-up visits and services are covered when medically necessary. None Talk to your primary care provider or regional organization. Surgical Sterilization Surgical sterilization, including tubal ligation and vasectomies No co-pays Available only to clients 21 years of age and older regardless of gender. Informed Consent Form required for surgical sterilization. Member must be 21 years or older and mentally able to give informed consent. Procedure may be provided 30 days after informed consent, but within 180 days. Requires Client Consent Form Talk to your primary care provider or regional organization. Contraceptives Contraceptives (birth control) No co-pays All FDA approved contraceptive methods are covered.
12-month supply of oral pill, vaginal ring, or topical contraceptives.
Certain types of contraceptives such as condoms or shots may have different limits.
None None Talk to your primary care provider or regional organization. Long Acting Reversible Contraceptives (LARCs) Intrauterine devices (IUDs) and implants No co-pays Long-acting, reversible contraceptives (LARC) such as intrauterine devices (IUDs) and implants. Coverage includes the device, insertion, removal and re-insertion at any time. Immediate postpartum LARC insertion is covered. None None Talk to your primary care provider or regional organization. Emergency Contraceptives Emergency contraceptives, including over the counter with a prescription No co-pays 1 package per fill. Requires a prescription from a doctor or a pharmacist. None None Talk to your primary care provider or regional organization. Fertility Assessments Basic fertility assessments and counseling to evaluate a member’s ability to become pregnant No co-pays Services to identify potential causes or reasons an individual is unable to become pregnant Treatment for infertility causes is not covered. None Talk to your primary care provider or regional organization.
These services are examples of benefits that may be available to you and your family. You may qualify for more benefits and services. Some services may require prior authorization or approval from Health First Colorado. Additionally, there are limits on some services and benefits. If you have children, your kids may qualify for more benefits and services. If you have questions about the services Health First Colorado covers please contact your doctor or the Member Contact Center.
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