Alyssa Lane
If you are uninsured or underinsured, there are still avenues to get health coverage. Hospitals that accept federal money are required to provide a certain amount of free or reduced-fee care. It is recommended to check with the hospital's financial aid department to see if you qualify for reduced or charity care. Additionally, you can apply for a Marketplace plan, which covers prescription drugs, doctor visits, urgent care, hospital visits, and more. If you are already covered by Medicare, no action is needed, but if you are not, you can create an account with the Health Insurance Marketplace and fill out an application.
| Characteristics | Values |
|---|---|
| If you lose Medicaid or CHIP | You can apply for a Marketplace plan as early as 60 days before your Medicaid or CHIP coverage ends to avoid a gap in coverage. |
| 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. | |
| You can apply for or re-enroll in Medicaid or CHIP any time of year. | |
| You can apply for Marketplace coverage by logging into your Marketplace account. | |
| If your income is too high for Medicaid, your child may still qualify for the Children's Health Insurance Program (CHIP). | |
| If you can’t afford health insurance and don’t qualify for Medicaid, there are resources to help you pay for your plan. | |
| You may not qualify for a health insurance subsidy if you can get coverage elsewhere, have a household income that’s outside the qualification limits or for a variety of other reasons. | |
| If your state hasn’t expanded Medicaid and your state agency said you’re not eligible under its current rules, you may have fewer options for coverage. | |
| If you currently pay for health insurance or Medicare coverage or have the option of getting that coverage but cannot afford the payment, Medicaid can pay the premiums under certain circumstances. |
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What You'll Learn
Apply for Medicaid even if you're not sure you qualify
Even if you are unsure about your qualification for Medicaid, it is recommended that you apply anyway. This is because Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to some low-income people, families, and children, as well as pregnant women, the elderly, and people with disabilities.
Eligibility for Medicaid is dependent on certain criteria, including financial and non-financial factors. Financially, one's income must be below a certain level to qualify for Medicaid. This level varies from state to state, as each state has different eligibility rules and programs. For instance, some states have expanded their Medicaid programs to cover all people below certain income levels, while others have not. Additionally, some states have established medically needy programs for individuals with significant health needs whose income is too high to qualify under other eligibility groups. Non-financial eligibility criteria include being a resident of the state in which one is applying for Medicaid, and being either a US citizen or a qualified non-citizen, such as a lawful permanent resident.
To apply for Medicaid, one must create an account with the Health Insurance Marketplace and fill out an application. If it appears that anyone in the applicant's household qualifies for Medicaid, their information will be sent to their state agency, who will then contact them about enrollment. The documentation required for the application process may vary depending on the state.
It is important to note that one can apply for or re-enroll in Medicaid at any time during the year. Additionally, if one has limited Medicaid coverage, they can apply for full-benefit coverage through either Medicaid or a Marketplace insurance plan with savings based on their income.
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Apply for CHIP, the Children's Health Insurance Program
If you are uninsured and ineligible for Medicaid, your child or teen may still be able to receive health coverage through the Children's Health Insurance Program (CHIP). CHIP is a federal program that is managed and partly funded by individual states, and it provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but cannot afford private coverage. Each state has its own rules about who qualifies for CHIP, and costs differ between states, but you won't have to pay more than 5% of your family's income for the year.
CHIP covers children's regular check-ups with the doctor and dentist, prescription drugs and vaccines, hospital care and services, x-rays and lab tests, vision and hearing care, access to medical specialists and mental health care, and treatment of special health needs and pre-existing conditions. If your child had Medicaid before and now has CHIP, you might be able to keep your health plan and your doctor.
To apply for CHIP, you can fill out an application through the Health Insurance Marketplace. If it looks like anyone in your household qualifies for Medicaid or CHIP, your information will be sent to your state agency. You can also call 1-800-318-2596 (TTY: 1-855-889-4325) to apply for Medicaid coverage to your state agency and find out if your children qualify for CHIP.
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Seek free help from a Marketplace assister
If you're uninsured or lose your Medicaid coverage, you can seek free help from a Marketplace assister (also known as a "navigator" or "certified application counselor"). These individuals are trained and certified by the Marketplace to provide free assistance to those who need health insurance. They can help you apply and enroll in a Marketplace health plan, as well as help you find any eligible savings or apply for free or low-cost coverage through Medicaid or CHIP.
Marketplace assisters are required to provide fair, impartial, and accurate information. They will never ask you to pay them directly for their services. When you enroll in a health plan, you will pay your premiums directly to the insurance company, not to the assister.
To find a Marketplace assister, you can search online or get in touch with your local community organizations. You can also contact the Marketplace Call Center, which is available every day (except certain holidays) and offers assistance in multiple languages. They can help answer your questions, start or complete your application, compare plans, and enroll you in a suitable health plan.
Remember to always confirm the identity of the assister before providing any personal information. Ask for their name, the organization they work for, and their contact details. Compare this information to the organization listed in the letter you received from the Marketplace to ensure they are legitimate.
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Consider other ways to shop for insurance
If you are not eligible for Medicaid or CHIP, you can consider other ways to shop for insurance. The Health Insurance Marketplace, also known as SHOP, is a federal government-operated service that helps people shop for and enroll in health insurance. The Marketplace is available in most states, while some states run their own Marketplaces.
The Marketplace offers a range of plans, including medical, dental, and vision coverage. All Marketplace plans cover prescription drugs, doctor visits, urgent care, and hospital visits. You can apply for a Marketplace plan if your Medicaid or CHIP coverage ends, and you have 90 days after submitting your application to enroll.
The Marketplace also offers tax credits and cost-sharing reductions that can lower your monthly insurance payments and the amount you pay for deductibles and copayments. If you receive advance payments of the premium tax credit, you must file a federal income tax return and complete Form 8962 to reconcile these payments with the premium tax credit you compute for your tax return.
In addition to the Marketplace, you can explore other options for insurance. For example, your employer may offer health insurance, and you can find out how to decide between job-based or Marketplace coverage. If you are a small business owner, you can consider the Small Business Health Options Program Marketplace (SHOP), which helps small businesses provide health coverage to their employees.
Finally, you can also look into state-specific options. For instance, New York State of Health offers individuals, families, and small businesses the opportunity to shop, compare, and enroll in low-cost quality health insurance plans.
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Apply for a Marketplace plan after losing Medicaid
If you have lost your Medicaid coverage, you can apply for a Marketplace plan. Firstly, you must meet the requirements to sign up for a Marketplace plan: you must live in the United States, be a U.S. citizen or national (or be lawfully present), and not be incarcerated.
If you meet these criteria, 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 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.
When you apply, you will find out if you qualify for a premium tax credit, which lowers your monthly insurance payment, as well as extra savings or cost-sharing reductions, which lower the amount you pay for deductibles, copayments, and coinsurance.
If you are a member of a federally recognized tribe or an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder, you may be able to get additional cost savings when you enroll in a qualified Marketplace health plan.
You can find local help near you or contact the Marketplace Call Center to get help with your coverage options or to apply for Marketplace coverage. You may also be contacted by a Marketplace assister, who can provide free, impartial help with your application.
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Frequently asked questions
If you have no insurance or Medicaid, you can apply for Medicaid and CHIP at any time of the year. You can also check if you qualify for savings on a Marketplace plan. Additionally, if you are unemployed, your employer may offer health insurance. If you are under 18 years old, you may qualify for coverage under your state's Children's Health Insurance Program (CHIP). If you are unable to afford health insurance, you can look into low-cost health care at a community health center.
The Health Insurance Marketplace is a federal government-operated service that helps people shop for and enroll in health insurance. It is available at HealthCare.gov for most states, while some states have their own Marketplaces.
CHIP, or the Children's Health Insurance Program, provides health coverage to children in families with incomes too high to qualify for Medicaid but too low to afford private coverage.
The Affordable Care Act, also known as Obamacare, has evolved over the years to make healthcare more accessible for low-income households. It has expanded eligibility for health insurance subsidies and tax credits, making health insurance more affordable.
If you are still unable to afford insurance, you can look into cost-sharing subsidies, which can help offset out-of-pocket healthcare expenses. Hospitals that accept federal money must also provide a certain amount of free or reduced-fee care, so you can check with the hospital's financial aid department to see if you qualify for reduced or charity care.
