Orlando Harmon
Medicaid is a government-sponsored health insurance program that provides coverage to roughly 84 million people, including low-income individuals, families, children, pregnant women, the elderly, and people with disabilities. However, eligibility for Medicaid is dependent on certain factors, such as income, address, and household size. If an individual's circumstances change and they no longer meet the eligibility criteria, they may lose their Medicaid coverage. This is known as disenrollment or being kicked off Medicaid. During the COVID-19 pandemic, disenrollment from Medicaid was paused, but as states resume checking eligibility, millions of people are at risk of losing their coverage. This has raised concerns about potential increases in the number of uninsured individuals and the impact on their access to healthcare.
| Characteristics | Values |
|---|---|
| Reasons for losing Medicaid coverage | Making too much money, gaining health care coverage through an employer, or moving to a new state |
| Risk factors | Being an older adult, having children |
| Options after losing coverage | Re-apply for Medicaid, apply for a Marketplace plan, apply for Medicare, get a job-based plan |
| Time to apply for a Marketplace plan | As early as 60 days before Medicaid coverage ends |
| Time to enroll in a Marketplace plan | 60 days after submitting the application |
| Cost of Marketplace plans | Less than $10 a month |
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What You'll Learn
Losing Medicaid coverage due to increased income
Medicaid is an insurance program that provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Many people who no longer qualify for Medicaid coverage due to increased income can turn to the Affordable Care Act's marketplace for coverage, where they can find healthcare coverage options that may cost less than $10 a month. The coverage available on the marketplace will differ from what is offered through Medicaid, with higher out-of-pocket expenses and co-pays. People will need to check if the insurance plans offered through the marketplace will cover their doctors.
If you lose your Medicaid coverage, your state will send your contact information to the Health Insurance Marketplace, which will mail you a letter about Marketplace coverage. You may also be contacted by phone, text, or email by a Marketplace assister in your community. You don't need to wait for them to contact you to apply for coverage, and you may be able to get low-cost, quality health coverage through the Marketplace. All Marketplace plans cover 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 coverage ends to avoid a gap in coverage.
If your income increases and you lose Medicaid coverage, you can re-apply through your state at any time to find out if you still qualify. You can also decide between a job-based plan or Marketplace coverage if your employer offers health insurance. If you are 65 or older, you can sign up for Medicare.
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Losing coverage due to moving states
Medicaid is a government-sponsored health insurance program that provides coverage to over 80 million Americans. The federal government jointly funds the program with state governments, and each state runs its own Medicaid program. This means that each state sets its own eligibility rules and requirements, within certain parameters established by the federal government.
If you move to a different state, you cannot simply transfer your Medicaid coverage from your previous state to your new one. You will need to cancel your coverage in your original state and reapply for coverage in your new state. The eligibility criteria vary across states, and the way a state determines one's level of care needs also varies. Therefore, even if you were eligible in your previous state, you may not be eligible in your new state.
For example, if you move from a state that has expanded Medicaid eligibility under the Affordable Care Act (ACA) to a state that has not, you will likely no longer be eligible for Medicaid. As of 2024, ten states have not expanded their Medicaid eligibility rules. These states include Florida, Texas, and Nevada. Additionally, some states, like Texas and Nevada, require individuals to reside in a nursing home for 30 continuous days before they can apply for Nursing Home Medicaid.
To ensure a smooth transition and avoid a lapse in coverage, there are several steps you can take when moving to a new state:
- Before moving, call the local Medicaid office in your new state to inquire about the correct coverage group and eligibility requirements.
- Have a functional assessment completed in your new state to determine if you are functionally eligible for Medicaid there.
- Plan your move accordingly. Some states won't close out current coverage until the end of the month, so it may be best to cancel your coverage in your original state at the end of the month and apply for coverage in your new state as soon as possible.
- Some states require a letter proving cancellation of Medicaid in your prior state, so be prepared to provide this documentation.
- Consider speaking with a Certified Medicaid Planning Professional or a Professional Medicaid Planner to ensure the transition goes smoothly and to help navigate the complexities of different state requirements.
While it can be challenging to relocate from one state to another and maintain Medicaid coverage, it is possible. Most states allow Retroactive Medicaid coverage, which can provide up to three months of coverage immediately prior to the month of Medicaid application. This can help prevent a gap in coverage while you transition to your new state.
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Losing coverage as a parent but retaining it as a child
Medicaid is a government-sponsored program that provides health care coverage to roughly 84 million people. The federal government prohibited states from discontinuing Medicaid coverage during the COVID-19 pandemic, even if the beneficiaries were no longer eligible. However, as the pandemic restrictions ease, states will resume reviewing eligibility, which may result in many people losing their Medicaid coverage.
If you are a parent who loses Medicaid coverage, it is important to understand that your child may still be eligible for the program. Children can qualify for Medicaid at higher income levels than adults. The Children's Health Insurance Program (CHIP) is a federal-state initiative that provides health insurance to children from households with incomes too high to qualify for Medicaid but insufficient to afford private insurance.
If you receive a notice of discontinued Medicaid coverage, it is crucial to verify whether your child will remain on the plan. This verification is essential because Medicaid and CHIP are not family plans, and eligibility criteria differ between adults and children. Even if your child is no longer eligible for Medicaid, they may qualify for CHIP.
To maintain continuous coverage for your child, it is recommended to update your contact information with the state, including mailing addresses, phone numbers, and emails. This ensures that you receive important notices and can take prompt action. Additionally, keeping your information current enables the state to notify you about the renewal process for Medicaid or CHIP coverage.
If you lose Medicaid coverage, there are alternative options to consider. You can explore the Affordable Care Act's marketplace, which offers health care coverage options with monthly premiums that may cost less than $10. You can also re-apply for Medicaid through your state or explore job-based plans if your employer offers health insurance. These options can help bridge the gap and ensure that you and your family continue to have access to essential health care services.
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Applying for a Marketplace health plan
If you lose your Medicaid or CHIP coverage, you can apply for a Marketplace health plan. The federal government operates the Health Insurance Marketplace, available at HealthCare.gov, for most states. Some states run their own marketplaces.
The Marketplace is a one-stop-shop where you can compare and shop for health insurance. 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 any time after your Medicaid or CHIP coverage ends. You have 60 days after submitting your application to enroll in a plan, and your coverage starts the month after you complete your enrollment.
Marketplace plans cover things like prescription drugs, doctor visits, urgent care, and hospital visits. Most people qualify for savings to lower what they pay for their monthly premium and when they get care. You can use the plan comparison tool to help decide on the plan that’s right for you.
If you purchased health care insurance through the Marketplace, you should receive a Form 1095-A, Health Insurance Marketplace Statement, at the beginning of the tax filing season. If you chose to have advance payments of the premium tax credit paid directly to your insurance company, you must complete Form 8962, Premium Tax Credit, and file a federal income tax return.
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Applying for Medicare
Medicaid is a government-sponsored health insurance program that covers around 84 million people in the United States. It provides free or low-cost health coverage to low-income individuals, families, children, pregnant women, the elderly, and people with disabilities. However, eligibility for Medicaid is periodically reassessed, and individuals may lose their coverage if they no longer meet the eligibility criteria.
If you are at risk of losing your Medicaid coverage or have already lost it, there are several options to stay covered. One option is to apply for Medicare, a health insurance program for individuals aged 65 or older or those with certain disabilities or permanent kidney failure. Here is a step-by-step guide on applying for Medicare:
- Determine your eligibility: Before applying for Medicare, ensure that you meet the eligibility criteria. Medicare is typically available to individuals aged 65 or older, but it is also offered to younger people with certain disabilities, permanent kidney failure, or Lou Gehrig's Disease (ALS).
- Choose your coverage: Medicare has several parts that offer different types of coverage. Part A covers hospital insurance, and you may be automatically enrolled in it if you receive Social Security retirement benefits or qualify for certain disability benefits. Part B covers medical insurance, and you must sign up for it separately. If you live in Puerto Rico or outside the United States, you need to specifically sign up for Part B. There is also Medicare Part C (Medicare Advantage Plans), which is a private insurance option covering hospital and medical costs, and Part D, which covers prescription medications.
- Enroll during the Initial Enrollment Period: The Initial Enrollment Period for Medicare begins 3 months before you turn 65 and ends 3 months after your 65th birthday. If you miss this initial period and do not sign up for Part B within 3 months of turning 65, you may have to pay a late enrollment penalty.
- Apply online or by phone: The easiest and fastest way to sign up for Medicare is by applying online through the Social Security website. You will need to create a secure my Social Security account to complete the application process. Alternatively, you can call the Social Security Administration at 1-800-772-1213 or TTY 1-800-325-0778 if you are deaf or hard of hearing.
- Receive your welcome package and Medicare card: After enrolling in Medicare, you will receive a welcome package and your Medicare card about 2 weeks to 3 months before your coverage starts. This package will contain important information about your benefits and coverage.
- Explore Medicare Savings Programs: If you have concerns about the cost of Medicare, look into Medicare Savings Programs. These programs have income and asset limits that determine eligibility for financial assistance with Medicare costs.
- Consider Medicare Part C and Part D: Depending on your specific needs, you may want to explore Medicare Part C (Medicare Advantage Plans) offered by private insurance companies. These plans cover hospital and medical costs. Additionally, consider enrolling in Medicare Part D if you require coverage for prescription medications.
Remember that losing Medicaid coverage can be a challenging transition, but there are options available to ensure you maintain access to healthcare services. Medicare is one of those options, and by following the steps outlined above, you can navigate the application process effectively.
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Frequently asked questions
Some reasons for losing Medicaid coverage include earning too much money, gaining health care coverage through an employer, or moving to a new state.
In the year following a disenrollment from Medicaid, about two-thirds of people experienced a period of uninsurance. About four in ten people who lost Medicaid coverage eventually re-enrolled in the program within a year.
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 re-apply for Medicaid through your state at any time to see if you qualify.
The Marketplace is the Health Insurance Marketplace, a federal government program that helps people shop for and enroll in health insurance. All Marketplace plans cover things like prescription drugs, doctor visits, urgent care, and hospital visits.
Alternatives to Marketplace coverage include job-based plans, Medicare (if you qualify), or CHIP, which covers children whose families make too much money to qualify for Medicaid but not enough to buy private insurance.
