Jane Dotson
Medicaid is a federal-state program that provides health coverage to over 77.9 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. Eligibility for Medicaid is determined by income and resource limits, and some individuals may be able to “spend down” their income to qualify. If an individual's situation changes and they are no longer eligible for Medicaid, they may request to have their insurance coverage removed. This can occur if their income increases above the state's Medicaid limit or if they gain access to other health insurance options, such as employer-provided insurance or Medicare. It is important for individuals to explore alternative health insurance options promptly to avoid a gap in coverage.
| Characteristics | Values |
|---|---|
| Losing Medicaid Coverage | If you lose Medicaid coverage, you can re-apply through your state at any time to find out if you still qualify. |
| Medicaid Renewal Process | Your state regularly checks if you're still eligible to keep your Medicaid coverage. |
| Applying for a Marketplace Plan | You can apply and enroll in a Marketplace plan as early as 60 days before your Medicaid coverage ends to avoid a gap in coverage. |
| Special Enrollment Period | You usually have 60 days to enroll in a new plan after losing Medicaid coverage. |
| Medicaid and CHIP | If you don't end your Marketplace coverage when you get Medicaid or CHIP and continue to get the premium tax credit, you may be asked to end your Marketplace coverage within 30 days, or the premium tax credit and extra savings will stop. |
| Medicaid and Medicare | If you have both Medicare and full Medicaid coverage, Medicare pays first when you get Medicare-covered services. |
| Medicaid Eligibility | To be eligible for Medicaid, you must meet your state's resource limit and income limit. Some states let you "spend down" the amount of your income that's above the state's Medicaid limit. |
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What You'll Learn
Losing Medicaid coverage
Reasons for Losing Medicaid Coverage:
There can be various reasons why someone might lose their Medicaid coverage. One common reason is an increase in income, as Medicaid is designed to provide health insurance for people with low incomes. When your income rises above a certain level, you may no longer be eligible for Medicaid. Additionally, changes in your household size, moving to a different state, or adjustments to the Medicaid program itself can also impact your eligibility.
Notification and Renewal Process:
States regularly check if you're still eligible to keep your Medicaid coverage through a renewal process. They will reach out to you if they need additional information or if your situation has changed. It's important to promptly complete and submit any forms or renewal materials requested by your state to ensure your coverage continues without disruption. Keep your contact information up to date to avoid missing any important notifications.
Transitioning to Alternative Coverage:
If you lose your Medicaid coverage, it's important to act quickly to get alternative health insurance. You usually have a special enrollment period, often 60 days before or after losing your Medicaid coverage, to enroll in a new plan. You can explore options such as your employer's health insurance plan or visit your state's official Affordable Care Act marketplace to shop for quality, affordable coverage. These marketplaces often offer free enrollment assistance and can help you determine if you qualify for financial help or premium tax credits.
Impact of Work Requirements:
Recent proposals for work requirements in Medicaid have raised concerns about millions of people potentially losing their health coverage. While the intention is to encourage people to move away from financial situations that qualify them for Medicaid, the reporting requirements can be overly burdensome, leading to confusion and administrative barriers. This has resulted in eligible individuals losing their coverage due to procedural or paperwork issues.
Available Resources:
If you're facing the loss of Medicaid coverage, there are resources available to help you navigate your options. You can contact a Marketplace assister or certified application counselor in your community, who can provide free help in understanding your coverage options and enrolling in a new plan. Additionally, websites like HealthCare.gov offer comprehensive information on staying covered after losing Medicaid, including details on special enrollment periods and available savings.
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Applying for a Marketplace plan
If you are no longer eligible for Medicaid, it is important to get other health insurance. You can apply for a Marketplace plan as early as 60 days before your Medicaid coverage ends to avoid a gap in coverage. You can also apply for a Marketplace plan after your Medicaid coverage ends—you have 90 days after submitting your application to enroll in a plan that will start at the beginning of the next month after you complete your enrollment.
To apply for a Marketplace plan, you can use HealthCare.gov to create an account and apply for health coverage, compare plans, and enroll online. You can also apply by phone or get in-person help with your application. You can also contact your state's Health Insurance Marketplace, as each state's Marketplace has its own enrollment instructions.
When you apply to the Marketplace, you’ll find out if you qualify for a premium tax credit. This is a tax credit you can use to lower your monthly insurance payment. You may also qualify for extra savings or cost-sharing reductions, which lower the amount you have to pay for deductibles, copayments, and coinsurance.
If you have an offer of health coverage from your employer that is considered affordable and meets certain minimum value standards, you will not be eligible for a tax credit for your Marketplace coverage and may wish to enroll in your employer’s health plan. However, if your employer does not offer coverage or the coverage is not affordable or does not meet minimum value standards, you may be eligible for a tax credit if you do not enroll in the employment-based health plan.
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Re-applying for Medicaid
If you lose your Medicaid coverage, you can re-apply through your state at any time to see if you still qualify. Medicaid is a federal insurance program that provides free or low-cost health coverage to low-income people, families and children, pregnant women, the elderly, and people with disabilities.
Your state will regularly check if you are still eligible to keep your Medicaid coverage. This is called the renewal process. If you are deemed no longer eligible, you will be notified and it is important to get other health insurance. You usually have 60 days to enrol in a new plan, called a "special enrollment period". You can apply for a Marketplace plan as early as 60 days before your Medicaid coverage ends to avoid a gap in coverage. You can also apply for a Marketplace plan after your Medicaid coverage ends—you have 90 days after submitting your application to enrol in a plan that will start at the beginning of the next month.
If you have a Marketplace health plan, you may be able to lower your costs with a premium tax credit. If you don't end your Marketplace coverage when your Medicaid coverage starts, you may have to pay back some or all of the premium tax credit when you file your federal taxes. You will also have to pay full price for your Marketplace plan. If you want to keep both, tell your state agency. However, you may no longer qualify for CHIP if you keep your Marketplace plan.
If you are no longer eligible for Medicaid, you can ask your employer about a work-based health plan. You can also visit your state's official Affordable Care Act marketplace to shop for quality, affordable coverage. These services offer free enrolment assistance and can help you find out if you qualify for financial help.
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Job-based health insurance plans
Losing Medicaid coverage can happen for several reasons, including an increase in income or a change in one's household situation. When this happens, it is important to quickly get other health insurance. One option is to ask your employer about a work-based health plan.
If you have job-based health insurance, you won't qualify for savings on a Marketplace plan. In 2025, a job-based health plan is considered "affordable" if your share of the monthly premium in the lowest-cost plan offered by your employer is less than 9.02% of your household income. Most job-based plans meet these standards. If you have job-based coverage, you might be able to change to a Marketplace plan, but you will need to update your Marketplace application to see how the offer impacts your savings.
If you lose your job-based health insurance, you can enroll in a Marketplace plan. You will qualify for a Special Enrollment Period to get coverage for the rest of the year, and you must apply within 60 days of losing your previous coverage. You may also be able to keep your job-based health plan through COBRA continuation coverage, which lets you pay to stay on your job-based health insurance for a limited time after your job ends (usually 18 months). You usually pay the full premium yourself, plus a small administrative fee.
If you have a Marketplace plan and are offered job-based health insurance, you may want to cancel your Marketplace plan for yourself and anyone else in your household eligible for the new job-based coverage. You can end your Marketplace plan at any time without penalty, but you will have to pay full price for your Marketplace plan if you keep it alongside your job-based coverage.
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Medicare
Medicaid is a federal program that offers health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. However, the criteria and coverage vary from state to state, and eligibility in one state does not transfer to another. For instance, Virginia requires individuals to apply specifically for Virginia Medicaid.
If you are no longer eligible for Medicaid, you should seek alternative health insurance options. You usually have 60 days to enroll in a new plan, known as a "special enrollment period." You can ask your employer about health insurance or visit the official Affordable Care Act marketplace for your state.
If you have both Medicare and full Medicaid coverage, you are considered "dually eligible." Medicare pays first for Medicare-covered services, and Medicaid pays last, after Medicare and any other health insurance. If you are dually eligible, Medicare will cover your prescription drugs through a Medicare drug plan.
To maintain Medicaid coverage, you must undergo a renewal process, where your state regularly checks if you are still eligible. If your state deems you ineligible, you can reapply through your state at any time to determine if you qualify.
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Frequently asked questions
If you lose your Medicaid coverage, you can apply for a Marketplace plan 60 days before your Medicaid coverage ends to avoid a gap in coverage. You can also apply for a plan after your coverage ends, but you have 60 days to do so. You can also re-apply for Medicaid through your state.
If you are no longer eligible for Medicaid, you can look into other health insurance options, such as a job-based plan or Marketplace coverage. You can also sign up for Medicare if you are 65 or older.
Medicaid is a joint federal and state program that provides health coverage to Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. A Marketplace plan is typically used by those who earn too much money to qualify for Medicaid but not enough to buy private insurance.
Eligibility for Medicaid is based on Modified Adjusted Gross Income (MAGI) and considers taxable income and tax filing relationships. Some states also allow individuals to \"spend down\" their income to qualify for Medicaid by paying non-covered medical expenses.
