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

If your income ends up being just slightly above the Medicaid eligibility limit, you’ll qualify for a significant premium tax credit to help you purchase a private plan in the health insurance marketplace.

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?

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An executive order signed by President Biden has authorized a COVID-related special enrollment period on The SEP will run from February 15 to May 15.

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 health insurance 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 2021 coverage, that’s December 15, 2020 in most states, although eleven state-run exchanges have later deadlines, and a few others may join them as time goes by (most states use, and thus cannot unilaterally extend open enrollment, but DC and 14 states have their own exchange platforms, so they can set their own enrollment deadlines).

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. And the opposite of that is also true: If you’re initially eligible for a subsidy in the exchange but then your income drops into the Medicaid-eligible level later in the year, you’ll be able to transition to Medicaid at that point.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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