Jeffrey Wade
Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage for low-income people, families, children, pregnant women, the elderly, and people with disabilities. If you have marketplace insurance and become eligible for Medicaid, you must end your marketplace coverage when your Medicaid coverage starts. You can apply for a marketplace plan after your Medicaid coverage ends, and you have 90 days to enroll in a plan.
| Characteristics | Values |
|---|---|
| When to end Marketplace coverage | When your Medicaid or CHIP coverage starts |
| What to do if you want to keep both Marketplace and Medicaid | Tell your state agency. You may no longer qualify for CHIP and you'll pay full price for your Marketplace plan premium and covered services |
| What to do if you don't end your Marketplace coverage | You may have to pay back some or all of the premium tax credit when you file your federal taxes |
| How to 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 |
| How to apply for a Marketplace plan before your Medicaid or CHIP coverage ends | Apply as early as 60 days before your Medicaid or CHIP coverage ends to avoid a gap in coverage |
| Who Marketplace assisters are | People trained and certified by the Marketplace to provide free help, also called "navigators," "enrollment assisters," or "certified application counselors" |
| Who to contact for help with your coverage options or to apply for Marketplace coverage | Local help near you or the Marketplace Call Center |
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What You'll Learn
End marketplace coverage when Medicaid begins
If you have marketplace insurance and become eligible for Medicaid, you should end your marketplace coverage. This is because you will no longer qualify for the premium tax credit or extra savings to lower the cost of your marketplace plan. If you don't end your marketplace coverage, you may have to pay back some or all of the premium tax credit when you file your federal taxes.
To end your marketplace coverage, wait until you have a final decision from your state agency that says you're eligible for Medicaid. If you end your marketplace plan before getting this confirmation, you may have to wait to re-enroll and experience a gap in your coverage. Once you have confirmation of your Medicaid eligibility, you can proceed to cancel your marketplace plan.
If you want to keep both your marketplace and Medicaid coverage, you can do so, but you should inform your state agency. However, you will no longer qualify for CHIP if you keep your marketplace plan. Additionally, you will have to pay the full price for your marketplace plan premium and covered services.
It's important to note that if you lose your Medicaid coverage in the future, you can re-apply through your state at any time to see if you still qualify. You may also be able to get low-cost, quality health coverage through the marketplace. 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.
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You may no longer qualify for CHIP
If you are eligible for Medicaid, you may no longer qualify for CHIP. The Children's Health Insurance Program (CHIP) is a federal-state scheme that provides health coverage for children in families with incomes too high to qualify for Medicaid but too low to afford private or group health insurance. CHIP eligibility is based on financial and non-financial criteria.
Financial eligibility is based on Modified Adjusted Gross Income (MAGI) and non-financial eligibility criteria include state residency and US citizenship or qualified non-citizen status. Some eligibility groups are limited by age or pregnancy status. For example, infants who were covered under CHIP may become eligible for Medicaid at birth.
If you are eligible for Medicaid, you must end your Marketplace coverage. If you do not, you may have to pay back some or all of the premium tax credit when you file your federal taxes. If you want to keep both, you must inform your state agency. However, you may no longer qualify for CHIP if you keep your Marketplace plan, and you will have to pay full price for your Marketplace plan premium and covered services.
If you lose your Medicaid or CHIP coverage, you can apply for a Marketplace plan within 90 days of submitting your application. You can also apply for Marketplace coverage as early as 60 days before your current coverage ends to avoid a gap in coverage.
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Apply for a marketplace plan after Medicaid ends
If you lose your Medicaid coverage, you can apply for a Marketplace plan. In fact, you can apply 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, but you only have 90 days to enrol in a plan that will start at the beginning of the next month.
To apply 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. You can apply for a Marketplace plan at healthcare.gov.
If you have qualifying health coverage through Medicaid, you no longer qualify for the premium tax credit or extra savings to lower the cost of your Marketplace plan. If your Medicaid program doesn't count as qualifying health coverage, you may qualify for lower costs on your Marketplace plan based on your income and other factors.
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. If you want to keep both coverages, you should tell your state agency. However, you may no longer qualify for CHIP if you keep your Marketplace plan, and you will have to pay full price for your Marketplace plan premium and covered services.
If your state says you're no longer eligible for Medicaid coverage, you can re-apply through your state at any time to find out if you still qualify.
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You may qualify for a premium tax credit
If you have Medicaid, you are not eligible for the premium tax credit. However, if you lose your Medicaid coverage, you may qualify for a premium tax credit when you apply for a Marketplace plan. This is a refundable credit that helps eligible individuals and families cover the premiums for their health insurance purchased through the Health Insurance Marketplace.
To be eligible for the premium tax credit, you must meet certain requirements and file a tax return with Form 8962, Premium Tax Credit (PTC). For tax years 2021 and 2022, the American Rescue Plan Act of 2021 (ARPA) temporarily expanded eligibility for the premium tax credit by eliminating the rule that a taxpayer with a household income above 400% of the federal poverty line cannot qualify.
For tax years other than 2020, if you receive advance credit payments in any amount or plan to claim the premium tax credit, you must file a federal income tax return and attach Form 8962 to your return. You must also reconcile the credit with the amount of your advance credit payments for the year on Form 8962. If your advance credit payments are more than the allowed premium tax credit, you will have to repay some or all of the excess for any tax year other than 2020.
If you are married and file your tax return using the status of married filing separately, you may still be eligible for the Premium Tax Credit if you meet the criteria in section 1.36B-2(b)(2) of the Income Tax Regulations. This allows certain victims of domestic abuse and spousal abandonment to claim the Premium Tax Credit using the married filing separately status.
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Marketplace assister can help with coverage
If you lose your Medicaid or CHIP coverage, you can apply for a Marketplace plan. You may be able to get low-cost, quality health coverage through the Marketplace, which covers things like prescription drugs, doctor visits, urgent care, and hospital visits. You can apply and enroll in a Marketplace plan as early as 60 days before your Medicaid or CHIP coverage ends to avoid a gap in coverage.
Marketplace assisters (also called "navigators," "enrollment assisters," or "certified application counselors") are people trained and certified by the Marketplace to provide free help with coverage. They can help you understand your coverage options and apply for Marketplace coverage. They are available in your community and may contact you by phone, text, or email. You can also find local help near you or contact the Marketplace Call Center.
Additionally, some states run their own Marketplaces, and you can find a directory of certified navigators and assisters on your state Marketplace website. For example, in Virginia, you can contact a navigator at Enroll Virginia to get free help online or in person from trained experts to sign up for health insurance.
Remember, always confirm the assister's identity before providing any personal information, and never pay them directly as their services are free of charge.
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Frequently asked questions
The Health Insurance Marketplace is a federal program that allows people to shop for and enroll in health insurance. It is available at HealthCare.gov, although some states run their own marketplaces.
You should end your Marketplace coverage when your Medicaid coverage starts. If you don't, you may have to pay back some or all of the premium tax credit when you file your federal taxes.
You may keep both, but you must inform your state agency. You will pay full price for your Marketplace plan premium and covered services. You may also no longer qualify for CHIP.
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.
You will pay your monthly premiums directly to the insurance company — not to the Marketplace. Your coverage won't start until you pay your first premium.
