Haris Ashley
If you're planning to switch from a Marketplace insurance plan to Medicaid, there are a few things you should know. Firstly, you need to officially cancel your Marketplace plan; simply stopping payments will not be enough, and you may be pursued for any outstanding payments. You can cancel your Marketplace plan online or over the phone, but make sure you do so at least 14 days before you want your coverage to end. It's also important to remember that once you cancel your Marketplace plan, you may have to wait for the next Open Enrollment Period to enroll again, so don't cancel your current plan until you know when your Medicaid coverage will begin to avoid a gap in coverage.
| Characteristics | Values |
|---|---|
| When to cancel Marketplace insurance | When Medicaid or CHIP coverage starts |
| How to cancel Marketplace insurance | Online, on the phone, or through the Marketplace center |
| When to expect a response | Within 30 days |
| What to do if you want to keep both Marketplace and Medicaid | Inform your state agency |
| What happens if you don't cancel your Marketplace insurance | You may have to pay back some or all of the premium tax credit |
| When can you re-enroll in Marketplace insurance | The next Open Enrollment Period (November 1 – January 15) |
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What You'll Learn
Cancelling your Marketplace plan
If you have Marketplace coverage and become eligible for Medicaid or the Children's Health Insurance Program (CHIP), you may want to end your Marketplace plan. Medicaid and CHIP provide free or low-cost health coverage to Americans, including low-income people, families and children, pregnant women, the elderly, and people with disabilities.
Before you cancel your Marketplace plan, you should consider the following:
- Once you cancel your coverage, you might have to wait for the next Open Enrollment Period to enroll again.
- There are significant health and financial benefits to having health coverage, and risks if you don't. Medical care without insurance is very expensive, so it's important to have protection if the unexpected happens.
- Do not simply stop paying the premium for your Marketplace health plan as a way to terminate coverage. Non-payment will eventually cause your coverage to end, but your insurer might still try to collect from you if they think you just got behind on your premium payments.
- If the government continues to pay premium tax credits on your behalf to your insurer for another month after you intended for your Marketplace plan coverage to end, you might end up having to repay some or all of that amount to the IRS.
If you still want to go ahead and cancel your Marketplace plan, you can do so by ending your Marketplace coverage when your Medicaid or CHIP coverage starts. The date your plan coverage ends depends on whether you're ending it for everyone or just some people on the application. You can check if you qualify for Medicaid or CHIP, and if so, you can renew, change, or update your plan.
If you reside in a State-based Marketplace, you can click on the link that will take you to the website for your State-based Marketplace.
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Qualifying for Medicaid
Medicaid is a joint federal and state program that provides health coverage to Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. To be eligible for Medicaid, individuals must meet specific non-financial eligibility criteria and be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents.
Medicaid beneficiaries must generally be state residents and meet specific income and family size requirements. Eligibility rules differ among states, and some have expanded their Medicaid programs to cover adults below a certain income level. States have the option to establish a "medically needy program" for individuals with significant health needs whose income is too high to qualify for Medicaid under other eligibility groups.
To apply for Medicaid, individuals can create an account with the Health Insurance Marketplace and fill out an application. If it appears that anyone in the household qualifies for Medicaid or the Children's Health Insurance Program (CHIP), the application will be forwarded to the state agency for a final eligibility decision.
Once an individual is determined eligible for Medicaid, coverage is effective from the application date or the first day of the application month. Benefits may also be covered retroactively for up to three months before the application month if the individual would have been eligible during that period.
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Understanding the Open Enrollment Period
The Open Enrollment Period is an annual window of time, typically in the fall, when you can sign up for health insurance, adjust your current plan, or cancel your plan. It usually lasts a few weeks, from November 1 to either January 15 or 16, depending on the state. During this time, you can explore the various insurance plans available in your area and choose the one that best suits your needs and budget.
If you get health insurance through your job, your employer sets the open enrollment period, usually in the fall, so that your benefits can start at the beginning of the calendar year. Medicare's Annual Enrollment Period is from October 15 to December 7, and the Initial Enrollment Period is around the age of 65.
If you miss the Open Enrollment Period, you may have to wait until the next one begins to make any changes or sign up for health insurance. However, there are exceptions to this rule. You may qualify for a Special Enrollment Period if you experience certain life changes, such as getting married, having a baby, moving, or losing health coverage, including Medicaid. Additionally, changes in your income level may also qualify you for a Special Enrollment Period, allowing you to enroll outside of the standard Open Enrollment Period.
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State-based Marketplaces
A State-Based Marketplace (SBM) is a government agency that offers subsidized Affordable Care Act (ACA) plans for individual states. SBMs are similar to Healthcare.gov but are created and maintained by each state. They assist citizens and legal residents in applying for marketplace coverage to comply with the ACA.
The following states currently use State-Based Health Insurance Marketplaces:
- California: Covered California
- Colorado: Connect for Health Colorado
- Connecticut: Access Health CT
- District of Columbia: DC Health Link
- Idaho: Your Health Idaho
- Kentucky: Kynect (Kentucky Health Benefit Exchange)
- Maine: CoverME
- Maryland: Maryland Health Connection
- Massachusetts: Health Connector
- Minnesota: MNsure
- Nevada
The launch of the ACA has influenced the evolution of State-Based Marketplaces, as their technology and operations have had to adapt to meet changing market demands and state-specific requirements.
When it comes to cancelling insurance through a State-Based Marketplace, the process may vary slightly depending on the state and the specific circumstances. However, some general guidelines apply. Firstly, it is important to know when your new coverage starts before ending your current Marketplace plan to avoid a gap in coverage. Once you cancel your Marketplace coverage, you may have to wait until the next Open Enrollment Period to enroll again, which typically occurs annually from November 1 to January 15. Additionally, when you become eligible for Medicaid, you may no longer qualify for savings on your Marketplace plan, and it may be advisable to end your Marketplace coverage.
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The Children's Health Insurance Program (CHIP)
CHIP provides comprehensive coverage, including routine "well child" doctor and dental visits, which are free under the program. The costs are different in each state, but families won't have to pay more than 5% of their annual income for coverage. In some states, CHIP also covers pregnant women.
If you qualify for CHIP, your coverage can start immediately, and you can apply at any time of year. To apply, you can fill out an application through the Health Insurance Marketplace. If it looks like anyone in your household qualifies for CHIP, your information will be sent to your state agency, and they will contact you about enrollment.
If you have a Marketplace health plan and qualify for CHIP, you will no longer be eligible for savings on your Marketplace plan. You will have to pay full price for your Marketplace plan premium and covered services. Therefore, it is important to end your Marketplace coverage when your CHIP coverage starts. If you don't, you may have to pay back some or all of the premium tax credit you used when filing your federal taxes.
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Frequently asked questions
You can cancel your Marketplace plan online or over the phone. You will need to contact the Consumer Assistance Center at 1-888-687-1501 and request a termination. You can also cancel your Marketplace plan by enrolling in Medicaid or CHIP.
You can cancel your Marketplace plan at any time throughout the year, but you must do so at least 14 days before you want your coverage to end. It is important to note that once you cancel your Marketplace coverage, you might have to wait until the next Open Enrollment Period to enroll again.
If you don't end your Marketplace coverage when your Medicaid or CHIP coverage begins, you may have to pay back some or all of the premium tax credit you used when filing your federal taxes.
