Jane Dotson
If you are offered health insurance through your job, you may be wondering if you can keep your Medicaid coverage. The answer depends on various factors, including your income, family size, and state-specific eligibility criteria. In general, Medicaid eligibility is based on income, and an increase in income from a new job may impact your eligibility. However, it is important to note that Medicaid coverage will not be automatically taken away just because you start working or receive an offer for job-based insurance.
| Characteristics | Values |
|---|---|
| Can I keep Medicaid if my job offers insurance? | Yes, you can keep your Medicaid and not take the insurance through your job. |
| Will I lose my Medicaid coverage if I work? | No, working does not necessarily mean losing access to federal or state healthcare benefits. |
| What are the eligibility factors for Medicaid? | Income, household size, disability status, and other factors. |
| What if I lose my Medicaid eligibility? | You may qualify for other health insurance options, such as coverage through the Health Insurance Marketplace or other state-based programs. |
| What if I can't afford my employer's insurance? | You may be able to waive your coverage, but you won't be able to cover your dependents under the plan either. |
| What if I want to keep my Medicaid and not my employer's insurance? | You can keep your Medicaid, but you may not be able to receive a stipend from your employer. |
| What if I have both Medicaid and employer insurance? | You can use Medicaid as a secondary insurance to cover co-pays, deductibles, and insurance premiums. |
| What if I need services that my employer's insurance doesn't cover? | You can check if you're eligible for Medicaid, which may provide more affordable coverage for certain services. |
| Are there any state-specific programs? | Yes, each state administers its Medicaid program, and there may be variations. For example, Arizona's Medicaid program includes the Arizona Long-Term Care System (ALTCS). |
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What You'll Learn
Medicaid and employer insurance can be held simultaneously
It is possible to have both Medicaid and employer insurance simultaneously. However, there are a few things to keep in mind. Firstly, Medicaid eligibility is based on several factors, including income, household size, and other specific criteria. If your income increases due to a new job, it is crucial to notify your state's Medicaid office promptly, as this may impact your eligibility and coverage. Failing to report changes in income or employment status could lead to complications with eligibility and coverage.
Secondly, if you have job-based insurance or are offered job-based insurance, you may no longer qualify for savings on a Marketplace plan, even if you don't accept the job-based coverage. This means that you might not be eligible for premium tax credits if you buy a Marketplace insurance plan instead of accepting your employer's insurance. However, if your employer's insurance is too expensive or does not meet your needs, you can choose to waive your coverage. In this case, you can explore alternative options like Medicaid, Marketplace plans, or state assistance programs.
Additionally, some states offer transitional Medicaid coverage for individuals transitioning from Medicaid to employer-sponsored health insurance. This provides temporary coverage during the transition period. There are also premium assistance programs in some states that help with premiums and other costs associated with transitioning from Medicaid to employer-sponsored insurance. It is important to note that each state administers its Medicaid program, and the details can vary, so be sure to contact your state's Medicaid office for specific information.
Furthermore, qualified low-income families and individuals might be able to use Medicaid as a secondary insurance to cover co-pays, deductibles, and insurance premiums. However, Medicaid is typically the last resort payer if you have coverage through another agency, meaning it covers smaller amounts like coinsurance or co-pays while primary insurance covers more significant costs. Nevertheless, Medicaid can still be a valuable option to help manage healthcare expenses, especially if your employer's insurance has high out-of-pocket costs.
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Medicaid While Working and other Work Incentives
Medicaid While Working, or Section 1619(b) of the Social Security Act, is a valuable safety net that allows you to keep your Medicaid coverage while working, even if your earnings become too high to receive SSI. This provision ensures that you can pursue your career goals while still receiving the healthcare support you need. To be eligible for this Work Incentive, you must meet certain requirements, such as having been eligible for an SSI cash payment for at least one month and having gross earnings that do not exceed the state threshold for eligibility.
Each state has its own threshold amount, which is calculated based on SSI cash benefits, Medicaid benefits, and publicly funded personal or attendant care benefits. Even if you earn above this threshold, you may still qualify for Medicaid While Working if you have publicly funded personal attendant expenses or medical expenses that exceed your state's average. Additionally, some states offer a Medicaid Buy-In Program, allowing you to purchase Medicaid from the state agency if you are no longer eligible for free Medicaid due to your employment status.
Social Security's Ticket to Work Program is another Work Incentive that supports career development for individuals aged 18 to 64 who receive Social Security disability benefits (SSDI/SSI) and aspire to work. This program is free and voluntary, assisting individuals with disabilities in achieving financial independence and connecting them with essential services and support to excel in the workforce.
It is important to note that work requirements for Medicaid have been a topic of legislative discussion, with proposals aiming to reduce federal spending on the program. However, data shows that the majority of Medicaid enrollees are already working, and losing Medicaid coverage could make employment more challenging or impossible for some individuals with disabilities. As of 2025, Georgia is the only state with a work requirement waiver in place, but other states are anticipating policy changes that may implement similar waivers.
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Medicaid eligibility factors
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. While eligibility rules differ among states, there are some mandatory eligibility groups that all states must cover. These include low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI).
The Affordable Care Act of 2010 allowed states to expand Medicaid coverage to nearly all low-income Americans under 65. Eligibility for children was extended to at least 133% of the federal poverty level (FPL) in every state, and states were given the option to extend eligibility to adults with incomes at or below 133% of the FPL. Most states have chosen to expand coverage to adults, and those that have not yet expanded may do so at any time.
Income is a significant factor in determining eligibility for Medicaid. The Modified Adjusted Gross Income (MAGI) methodology, established by the Affordable Care Act, is used to determine financial eligibility. MAGI considers taxable income and tax filing relationships and has replaced the former process, which allowed for income disregards that varied by state or eligibility group. While income is a crucial factor, it is not the only criterion for Medicaid long-term care eligibility; there is also an asset limit and level of care requirement. Additionally, some individuals are exempt from the MAGI-based income counting rules, including those whose eligibility is based on blindness, disability, or age (65 and older).
It is important to note that working does not necessarily mean losing access to Medicaid. There are protections in place, called Work Incentives, that help individuals who work and receive disability benefits retain their healthcare benefits. For example, Social Security's Ticket to Work Program supports career development for people aged 18-64 who receive Social Security disability benefits and want to work.
To summarize, eligibility for Medicaid is based on various factors, including income, family size, disability status, age, and state-specific criteria. Each state has different threshold amounts, and individuals can refer to resources like Social Security's Red Book to find their state's specific threshold. Additionally, certain states have expanded their Medicaid programs to cover other adults below a certain income level, and there are Work Incentives in place to support those who are employed and receiving disability benefits.
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Medicaid Buy-In Program
In the United States, you can keep your Medicaid coverage if your employer offers insurance, but you may have to pay a premium for it. This will depend on your income, family size, and other factors. You should check with your state's Medicaid office to see if you qualify.
The Medicaid Buy-In Program is a federal initiative that allows people with disabilities who are working and earning more than the allowable limits for regular Medicaid to retain their healthcare coverage through Medicaid. This program is designed to help working people with disabilities earn more income without risking the loss of vital healthcare coverage.
To qualify for the Medicaid Buy-In Program, you must meet certain criteria. Firstly, you must have non-exempt resources that do not exceed the Medicaid resource limit, which is $31,175 for a one-person household and $42,312 for a two-person household. Retirement accounts are disregarded when determining eligibility for this program. Secondly, you must be determined to be disabled by the Social Security Administration (SSA) or, if you have not been certified as disabled through SSA, by your state's disability review team.
The Medicaid Buy-In Program typically does not offer family coverage, so if you have a family, you may need to keep your employer's insurance or explore other state insurance programs. There may be a modest premium based on your income for the Medicaid Buy-In Program, but this will be determined when you apply. At present, there is a moratorium on premiums.
If you believe you may qualify for the Medicaid Buy-In Program, you should contact your State Medicaid Program and your Local Department of Social Services to review your application and determine your eligibility.
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Losing Medicaid eligibility
Work and Income:
Firstly, it's a common misconception that starting a new job or earning an income will automatically result in losing Medicaid coverage. Working does not necessarily mean losing access to federal or state healthcare benefits. There are protections in place, known as Work Incentives, that help individuals who work and receive disability benefits maintain those benefits. For example, Social Security's Ticket to Work Program supports career development for people receiving Social Security disability benefits who want to work and maintain their healthcare coverage.
State Thresholds and Eligibility:
Eligibility for Medicaid While Working is determined by state threshold amounts, which vary across states and are calculated based on factors such as SSI cash benefits, Medicaid benefits, and publicly funded personal care benefits. Even if you earn above your state's threshold, you may still be eligible for Medicaid While Working if you have certain expenses, such as publicly funded personal attendant expenses or medical expenses above your state's average. Additionally, some states offer a Medicaid Buy-In Program, allowing individuals who are no longer eligible for free Medicaid due to their income to purchase Medicaid from the state.
Other Coverage Options:
If you do lose Medicaid coverage due to increased income or other factors, there are several options to stay covered:
- Marketplace Health Plan: You can apply for a Marketplace health plan through HealthCare.gov or your state's Marketplace. Most people qualify for savings to lower their monthly premiums and out-of-pocket costs. You can apply up to 60 days before your Medicaid coverage ends to avoid a gap in coverage.
- Re-apply for Medicaid: Even if your income increases, you may still qualify for Medicaid. Re-applying through your state can help determine if you're still eligible.
- Job-based Plan: If your employer offers health insurance, you can consider enrolling in their plan.
- Medicare: If you meet certain criteria, such as being 65 or older, you may be eligible to sign up for Medicare.
In summary, losing Medicaid eligibility doesn't have to result in a loss of healthcare coverage. By understanding your state's eligibility criteria, taking advantage of Work Incentives, and exploring alternative coverage options, you can ensure that you maintain access to the healthcare services you need.
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Frequently asked questions
Yes, you can keep your Medicaid and not take the insurance offered by your employer. However, if you lose your Medicaid coverage for any reason, you may have missed the open enrollment period with your employer.
If you lose your Medicaid eligibility, you may qualify for other health insurance options, such as coverage through the Health Insurance Marketplace or other state-based programs.
If you are offered insurance through your employer but can't afford it, you may be able to waive your coverage. However, you won't be able to cover your dependents under the plan.
Yes, qualified low-income families and individuals might be able to cover co-pays, deductibles, and insurance premiums by using Medicaid as a secondary insurance.
Medicaid eligibility is based on factors such as income, household size, and other specific criteria. Each state has a different threshold amount, which you can find in Social Security's Red Book.
