If you enrolled in a Marketplace health plan and get a determination that you are eligible for Medicaid or the Children’s Health Insurance Program (CHIP), there are several things that will take place related to this change in your healthcare. Enrollment in either of these programs will meet the requirements for qualifying health coverage under the Affordable Care Act and you will not have to pay a penalty due to lack of coverage when you switch over.
This also means that if you are receiving premium tax credits and savings on out-of-pocket costs, they will end and you should immediately stop your ACA coverage for anyone in your household who is eligible or who have already enrolled in Medicaid or CHIP. If you decide that you still want a Marketplace plan after you’re found eligible for Medicaid or CHIP, you will have to pay full price for your plan without any cost savings.
In most instances, Medicaid will be considered minimum essential coverage, but in a few instances, your Medicaid coverage may not count as qualifying health coverage. If this is the case, you can still get premium tax credits and other savings with a Marketplace health insurance plan, if you qualify based on other criteria. To find out if your Medicaid coverage counts as minimum essential coverage and what steps you should take, go here.
If you get a notice from the Marketplace
Records are cross-checked several times a year, and if that process determines you are enrolled in both a Marketplace plan with premium tax credits and other costs savings as well as also being enrolled in Medicaid or CHIP, you may be asked to end your enrollment in your Marketplace plan within 30 days. If you choose to stay in your Marketplace plan, your eligibility for financial assistance will be recalculated.
If you want to be proactive and see if you or others in your household are enrolled in Medicaid or CHIP, you can contact the office in your state.
If you still want coverage through a Marketplace plan
Some people choose to have both Marketplace coverage and Medicaid or CHIP coverage. But in doing so, eligibility for premium tax credits or other savings will not be available to help in paying for the Marketplace plan.
If you want to keep Marketplace coverage, and…
…you are on an application with others who are also enrolled in Marketplace coverage, you will need to report a life change to the Marketplace by updating your application. You can do this either online, by phone or in person. For details on how to report a change to the Marketplace, go here.
…you are the only person on the Marketplace application, you will need to end your Marketplace plan with premium tax credits and submit a new application for coverage without tax credits. You can only enroll in Marketplace coverage during the annual open enrollment period or if you qualify for a special enrollment period.
When to end your Marketplace coverage
Before ending your Marketplace plan, you will want to make sure that you have confirmation that you are eligible for Medicaid or CHIP. In some instances, you may get a notice that says you “may be eligible” for these programs, but it is best to wait to make sure you have confirmed eligibility before moving forward with Marketplace plan cancellation.
If you end your Marketplace plan prematurely and are later found to be ineligible for Medicaid or CHIP, you cannot re-enroll for the Marketplace plan unless you qualify for a special enrollment period. If you don’t qualify, you will have to wait until the next open enrollment period, and that could result in a gap in your healthcare coverage.
If the notice you get says you “are eligible” for Medicaid or CHIP, or you or others in your household are enrolled in Medicaid or CHIP, you will want to end your Marketplace coverage immediately. Before doing so, you need to determine if some or all of the members of your household are eligible or enrolled in Medicaid or CHIP before taking action.