Haris Ashley
If your Medicaid coverage ends, you can apply for a Marketplace plan. 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. If you qualify for Medicaid, you are not eligible for savings on a Marketplace plan. However, if you have limited Medicaid coverage, you can fill out an application through the Marketplace and find out if you qualify for full-benefit coverage through either Medicaid or a Marketplace insurance plan with savings based on your income.
| Characteristics | Values |
|---|---|
| Can I get marketplace insurance when my Medicaid runs out? | Yes, you can apply for a Marketplace plan after your Medicaid coverage ends. |
| How soon can I apply? | You can apply as early as 60 days before your Medicaid coverage ends to avoid a gap in coverage. |
| How long do I have to enroll in a plan? | 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. |
| What if I don't qualify for Medicaid based on income? | You should still apply as you may qualify for your state's program, especially if you have children, are pregnant, or have a disability. |
| What if I have limited Medicaid coverage? | You can fill out an application through the Marketplace and find out if you qualify for full-benefit coverage through either Medicaid or a Marketplace insurance plan with savings based on your income. |
| What if I want to keep both my Marketplace and Medicaid plans? | You may no longer qualify for CHIP if you keep your Marketplace plan. If you have qualifying health coverage through Medicaid or CHIP, you'll pay full price for your Marketplace plan premium and covered services. |
| How do I apply for Marketplace coverage? | You can apply for Marketplace coverage by logging into your Marketplace account. |
| Where can I get help with my application? | Marketplace assisters are trained to give you free, accurate information about your health coverage options, answer your questions, and help you enroll in a plan. |
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What You'll Learn
Applying for Marketplace coverage
If you lose your Medicaid or CHIP coverage, your state will securely send your contact information to the Marketplace. You will receive a letter about Marketplace coverage, and they may also follow up with you by phone, text, or email. You can apply for Marketplace coverage by logging into your Marketplace account. If you don't have a Marketplace account, you can create one.
When you apply to the Marketplace, you will find out if you qualify for a premium tax credit or extra savings/cost-sharing reductions. A premium tax credit is a discount that lowers your monthly insurance payment. Extra savings/cost-sharing reductions are discounts that lower the amount you pay for deductibles, copayments, and coinsurance.
If you have limited Medicaid coverage, you can fill out an application through the Marketplace and find out if you qualify for full-benefit coverage through either Medicaid or a Marketplace insurance plan with savings based on your income. Most people whose incomes are just above the level to qualify for Medicaid can pay very low premiums and out-of-pocket costs for private health insurance through the Marketplace.
You can also apply for a Marketplace plan after your Medicaid or CHIP 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.
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Income and eligibility
Medicaid and the Children's Health Insurance Program (CHIP) are federal programs that provide free or low-cost health coverage to certain individuals and families who meet specific income criteria. Eligibility is typically based on income levels, family size, and specific state guidelines. Some states have expanded their Medicaid programs to cover all individuals below certain income thresholds, including low-income adults, families, children, pregnant women, the elderly, and people with disabilities.
If an individual's income is slightly above the level required to qualify for Medicaid, they may still be able to obtain affordable health insurance through the Marketplace. The Marketplace offers private health insurance plans with low premiums and out-of-pocket costs for those who are just above the Medicaid income threshold. However, the cost of a Marketplace plan is generally higher than Medicaid, and it may not offer additional coverage or benefits.
When an individual's Medicaid coverage ends, they can apply for Marketplace coverage. The state typically sends the individual's information to the Marketplace, and they will receive a letter about applying for Marketplace coverage. It is advisable to apply for Marketplace coverage as early as 60 days before the end of Medicaid coverage to avoid any gaps in health insurance.
Additionally, individuals who have lost their Medicaid coverage may be eligible for savings on their Marketplace plan. They may qualify for a premium tax credit, which lowers their monthly insurance payment, or extra savings through cost-sharing reductions, which decrease the amount they pay for deductibles, copayments, and coinsurance.
It is important to note that eligibility for Medicaid and Marketplace plans can vary from state to state. Some states have different Medicaid programs, and coverage and costs may differ. Therefore, it is recommended to check with the specific state's Medicaid agency to understand the eligibility requirements and available options.
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Cost of Marketplace plans
The cost of Marketplace health insurance plans varies depending on several factors, including your income, household size, and state of residence. Here is a detailed overview of the costs associated with Marketplace plans:
Marketplace plans are generally more expensive than Medicaid and typically offer similar coverage and benefits. Individuals with incomes slightly above the Medicaid qualification threshold can often obtain private health insurance through the Marketplace with very low premiums and out-of-pocket expenses. The cost of a Marketplace plan will depend on your income and whether you qualify for any savings or subsidies.
When transitioning from Medicaid to a Marketplace plan, it is important to note that you will likely pay the full price for your Marketplace coverage. This is because qualifying for Medicaid or receiving limited Medicaid benefits makes you ineligible for savings on a Marketplace plan. Therefore, you will be responsible for the entire premium and any additional costs, such as deductibles, copayments, and coinsurance.
To determine the cost of a Marketplace plan, you can visit Healthcare.gov to preview health plans and price quotes in your area. Each state has its own Marketplace with specific enrollment instructions. By creating an account and providing information about your income, household size, and state, you can explore the available plans and their associated costs. Additionally, you can seek assistance from trained professionals, known as "navigators" or "enrollment assisters", who can provide free and impartial guidance on choosing a suitable Marketplace plan based on your circumstances.
It is worth mentioning that the Children's Health Insurance Program (CHIP) provides low-cost health coverage for children in families who earn too much to qualify for Medicaid but not enough to afford private insurance. In certain states, CHIP may also cover pregnant women. Therefore, if you meet the income criteria, CHIP could be a more affordable alternative to a Marketplace plan.
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Medicaid and CHIP coverage
Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Some states have expanded their Medicaid programs to cover all people below certain income levels.
If you lose your Medicaid or CHIP coverage, your state will securely send your contact information to the Marketplace. You will receive a letter about applying for Marketplace coverage. You can apply for Marketplace coverage by logging into your Marketplace account. Your application will be pre-filled with the information you gave the state agency. You can apply for a Marketplace plan after your Medicaid or CHIP 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.
If you have limited Medicaid coverage, you can fill out an application through the Marketplace and find out if you qualify for full-benefit coverage through either Medicaid or a Marketplace insurance plan with savings based on your income. If you qualify for Medicaid, you are not eligible for savings on a Marketplace plan. You would have to pay full price for a plan. If you don't end your Marketplace coverage when your Medicaid or CHIP coverage starts, you may have to pay back some or all of the premium tax credit you used when you file your federal taxes.
If you want to keep both Marketplace and Medicaid or CHIP coverage, you should tell your state agency. However, you may no longer qualify for CHIP if you keep your Marketplace plan. If you have qualifying health coverage through Medicaid or CHIP, you will pay full price for your Marketplace plan premium and covered services.
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Getting help from assisters
If you've lost your Medicaid or CHIP coverage, you can apply for a Marketplace plan. You can apply up to 90 days in advance of your Medicaid ending to ensure there is no gap in coverage. You can also apply for a Marketplace plan after your Medicaid or CHIP coverage ends, and you have 90 days after submitting your application to enroll.
When you apply to the Marketplace, you'll find out if you qualify for a premium tax credit to lower your monthly insurance payment, as well as extra savings or cost-sharing reductions. These include discounts on deductibles, copayments, and coinsurance.
If you need help with your coverage options or applying for Marketplace coverage, you can find local help near you or contact the Marketplace Call Center. You may also be contacted by a Marketplace assister, also known as a "navigator," "enrollment assister," or "certified application counselor." These assisters are trained and certified by the Marketplace to provide free, fair, and impartial help. They will never ask for your credit card information or any form of payment. They will always provide a Privacy Notice Statement and get your consent before discussing your personal information. Before providing any information, be sure to confirm who they are by asking for their name, who they work for, and their organization's contact information.
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Frequently asked questions
Yes, you can 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.
You can apply for Marketplace coverage by logging into your Marketplace account. If you don't have an account, you can create one.
If you qualify, you can use a premium tax credit to lower your monthly insurance payment. You may also qualify for extra savings or cost-sharing reductions, which lower the amount you pay for deductibles, copayments, and coinsurance.
If you don't end your Marketplace coverage when your Medicaid starts, you may have to pay back some or all of the premium tax credit when you file your federal taxes.
