If I qualify for Medicaid, should I worry about the January 31 deadline for open enrollment?

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  • healthinsurance.org contributor
  • January 31, 2017

Q. I’ve heard that Medicaid enrollment is year-round. So if I qualify for Medicaid, I don’t need to worry about the January 31 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 January 31 at the latest!

[note that the November 1 – January 31 open enrollment window was used for 2016 and 2017 coverage, and is scheduled to be used to 2018 coverage as well. After that, open enrollment is scheduled to become shorter, running from November 1 to December 15 each year. But all of that is based on current regulations pertaining to the ACA, and those regulations are likely to change under the Trump Administration.]

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.

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