If I qualify for Medicaid, should I worry about the deadline for open enrollment?

Q. I’ve heard that Medicaid enrollment is year-round. So if I qualify for Medicaid, I don’t need to worry about the December 15 end of open enrollment?

A: It’s true that Medicaid and CHIP enrollment are year-round. But that doesn’t mean that you should disregard the end of open enrollment for private plans (QHPs) in the exchange

This is especially important in states that have expanded Medicaid, for people with incomes that hover around the 138 percent of federal poverty level (FPL) threshold for Medicaid/QHP subsidy eligibility. If your income ends up being just slightly above the Medicaid eligibility limit, you’ll qualify for a significant premium tax credit (and cost-sharing subsidies) to help you purchase a private plan in the exchange, instead of Medicaid.

But if you wait until after open enrollment ends because you believe that your income makes you eligible for Medicaid – and then it turns out that you’re slightly over the limit – you will not be able to get covered by a subsidized exchange plan until the following year (unless you have a qualifying event).

If you’re in a state that has not expanded Medicaid, exchange subsidy eligibility begins at 100 percent of federal poverty level. Contact the exchange or a navigator in your area to see if you’re eligible for subsidies – again, you must do this by the end of open enrollment. For 2018 coverage, that’s December 15, 2017 in most states, although ten state-run exchanges have later deadlines, and residents of several other states can enroll until as late as December 31, 2017, due to hurricanes in 2017. In future years, open enrollment is expected to run from November 1 to December 15 each fall, with extensions only available on a case-by-case basis (another hurricane, for example).

If you’re definitely eligible for Medicaid rather than an exchange subsidy, you’ll know for certain once you begin the enrollment process through the exchange. And the sooner you enroll in Medicaid, the sooner you’ll have the peace of mind that comes with being insured.

If you’re deemed eligible for Medicaid and your income increases during the year to make you eligible for premium subsidies in the exchange instead, you’ll have a special enrollment period during which you can switch to an exchange plan.

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Related terms

cost-sharing subsidies

open enrollment

premium subsidies

qualified health plan