If you count on Medicaid for your health care, losing it can be a stressful and confusing experience. Millions of low-income people and families depend on Medicaid for essential health insurance, which provides them with access to the medical services they need without the high out-of-pocket costs. If you’ve lost your Medicaid insurance and need insurance, you need to know your options and what steps you can take to get alternative coverage.
In this article, we look at what to do if you have lost Medicaid, how to get new insurance when you’ve lost Medicaid, and other ways to keep yourself covered for health care.
Understanding the Loss of Medicaid
Medicaid is a government health insurance program for individuals and families with low incomes. Medicaid is run by each state and has different eligibility requirements and coverage options for each. However, there are a few common reasons why people lose their Medicaid coverage, including:
1. Income Changes
A change in income is one of the most common reasons a person loses Medicaid coverage. The primary basis for Medicaid eligibility is income, so if your income goes up you may not qualify anymore. It can happen if you just get a new job, get a raise, or any other change that raises your household income to above the eligibility threshold for Medicaid.
2. Aging Into Not Covering Medicaid.
When they turn 18 or 21, depending on the state, some Medicaid recipients lose their coverage. In particular, this is common among children or young adults who enrolled in Medicaid because their family has a low income. However, they may no longer meet the program’s eligibility criteria when they become adults, and therefore they have to find alternative insurance.
3. Changes in Residency
Because Medicaid is a state-run program, you have to live in the state you are on Medicaid to remain eligible. If you move to another state, you might no longer be able to get Medicaid in your new place. In this case, you would need to cancel your current Medicaid coverage and apply for Medicaid only in the state where you now live.
4. Failure to Renew or Otherwise Update Information
Medicaid coverage, however, typically comes with periodic renewals and if you don’t update your records or provide the needed documents, you can lose your insurance. You might lose your Medicaid coverage if you don’t pay within the deadline for renewing or if you don’t respond to a request for information.
5. Eligibility Reviews or Program Changes
Medicaid eligibility requirements may change or the program may undergo review to make sure that beneficiaries continue to meet the required criteria. You could lose your coverage if you no longer meet these requirements or if your state reduces Medicaid eligibility. For states that didn’t expand Medicaid under the Affordable Care Act, that means some people might not have access to coverage.
What to Do When You Lose Medicaid Coverage
If you have lost your Medicaid insurance and need insurance, you need to act fast to avoid gaps in coverage. Read on to find out what to do when you find yourself in this situation.
1. Confirm the Loss of Coverage
You want to make sure that you’ve been cut off from your Medicaid coverage, the first thing you should do. Check your state’s Medicaid office to see if you’ve gotten a letter or notification explaining why you lost your coverage. If you don’t know why you’ve lost Medicaid or think you made a mistake, call your state’s Medicaid office right away to find out for sure.
You should also make sure you’re eligible for Medicaid reinstatement. But if your loss of coverage is a temporary thing, such as a missed renewal, you may be able to reinstate your coverage.
2. Check Your Eligibility for Other Programs
If you’ve lost your Medicaid coverage because your income has changed or for some other reason, you may still be eligible for other kinds of help. Below are some options to explore if you need insurance after losing Medicaid:
a) ACA Marketplace Plans
If you’re no longer eligible for Medicaid but need affordable health coverage, you can apply for a plan through the Health Insurance Marketplace (also referred to as ACA Marketplace). Under the Affordable Care Act, there was a system of subsidized health insurance plans set up to help people and families who don’t qualify for Medicaid get health insurance at affordable prices.
If you lose Medicaid coverage you may be eligible to enroll in an ACA Marketplace plan through a Special Enrollment Period. You may also qualify for premium subsidies that can reduce the cost of your premiums depending on your income.
b) Children’s Health Insurance Program (CHIP)
If you have children who were covered by Medicaid and who lose eligibility, they may still be eligible for the Children’s Health Insurance Program (CHIP). CHIP (Children’s Health Insurance Program) provides low-cost or no-cost health insurance for children in families with incomes too high to qualify for Medicaid, but too low to afford private coverage. Depending on where you live, you apply for CHIP through your state’s Medicaid office.
c) Medicare Savings Programs
You may be eligible for Medicare if you’re over 65 or have a qualifying disability. Depending on your income, you may be able to get coverage of your Medicare premiums, copayments, and deductibles through Medicare Savings Programs (MSPs). Not all MSPs are a direct replacement for Medicaid, but they do help people who are Medicare-eligible but have out-of-pocket expenses they can’t cover.
3. Consider Short Term Health Insurance
If you are in transition to another insurance plan, short-term health insurance can be a good option for you if you need temporary coverage. Short-term plans are designed for coverage for a short period ranging up to 12 months with more affordable premiums. However, these plans may or may not include all the services that Medicaid or ACA Marketplace plans provide, including preventative care or pre-existing conditions.
Shorter-term health plans can be a great stopgap, but they may not be the best permanent solution so if you are going to need ongoing coverage then you will want to explore other options.
4. Get Help from an Insurance Broker or Navigator
Losing your Medicaid coverage can feel overwhelming, and navigating the world of health insurance can be too. If you don’t have insurance, or you are not satisfied with your coverage, an insurance broker or navigator can help you navigate your options to find the best plan based on your income, health needs, and where you live. These professionals can assist you in applying for Medicaid, ACA plans, CHIP, or other health coverage programs.
In addition, insurance brokers and navigators can advise you whether you may qualify for a Special Enrollment Period (SEP) for an ACA plan, or even supply the paperwork for other programs.
5. Think about Employer-Sponsored Insurance
When you get a new job you may lose Medicaid, but you may have employer-sponsored health insurance. If you’re eligible, many employers offer health insurance as a benefit, and your coverage may be more comprehensive than what you had through Medicaid. If your employer offers insurance, then you will be able to enroll in that plan during open enrollment periods or a special enrollment window if you lost Medicaid.
It’s important to remember that Medicaid will cost less than employer-sponsored insurance, so make sure your premiums are within your budget and will cover the care you need.
How to Prevent Future Loss of Medicaid Coverage
It’s frustrating to lose Medicaid coverage but you can do a few things to prevent losing it again. Here are some tips to help ensure that you maintain continuous health coverage:
1. Stay on Top of Eligibility Reviews.
You are periodically reviewed to see if you qualify for Medicaid and it’s important to respond to any requests for information or renewals in a timely manner. If you don’t update your information or don’t renew on time, you could lose your Medicaid coverage.
2. Report changes in income and household size quickly.
If you change your income or household size, report the change to your state Medicaid office as soon as possible. It can help you avoid unexpected loss of coverage and keep you qualified to be in the program.
3. Medicaid Expansion in Your State
The Affordable Care Act has extended Medicaid to some people in some states. If you lose Medicaid because your income goes up or down, find out if your state has expanded Medicaid eligibility. You may even qualify for Medicaid again, even if you had coverage lost at some point.
Conclusion
Medicaid insurance can be lost, and it is stressful and difficult, but you do have options to maintain health coverage if you lose Medicaid insurance. If you don’t qualify for ACA Marketplace plans, CHIP, Medicare Savings Programs, or other alternatives, then acting quickly to find out what you qualify for will enable you to avoid a coverage gap.
If you follow the steps outlined in this article and if you need help from insurance professionals along the way, you can find new insurance and get the healthcare you need to remain healthy.