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A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1994.
If you think you may be at risk of losing health benefits due to Medicaid redeterminations, you have options. Learn more about the process and explore health insurance plans below.
We can help you understand how to stay covered.
During the federal public health emergency for COVID-19, people could keep their Medicaid coverage longer than normal. The continuous Medicaid coverage requirement helped millions of people continue to access the healthcare they needed during the pandemic.
That requirement is now ending because of a change in federal policy and as a result, an estimated 15 million people could lose Medicaid coverage. If your coverage was continued under Medicaid because of the public health emergency, you may now lose coverage if you no longer qualify. But even if you still qualify for Medicaid, you may need to take steps to verify your eligibility.
Medicaid redetermination – sometimes called Medicaid renewal – is the process states use to confirm people still qualify for Medicaid. Medicaid eligibility is based on financial and other criteria, and redetermination helps ensure people meet the criteria.
Medicaid redeterminations were put on hold for three years during the public health emergency to help ensure ongoing access to healthcare services.
Now states are returning to normal processes to check Medicaid eligibility and update their Medicaid rolls. If you are enrolled in Medicaid, you may need to go through your state’s renewal process to show you are still Medicaid eligible.
Steps to take if you currently have Medicaid
Update your contact information
Make sure your address and contact information are up to date with the Medicaid department for your state.
Keep an eye on your mailbox
Carefully read any notices, letters or forms you get in the mail about your Medicaid coverage. Take action and reply promptly to any requests for information.
Appeal the decision, if necessary
If you receive a notice saying your coverage has been terminated, you may be able to appeal the decision. You may need to provide an account number or a case number.
Get other coverage
If you no longer qualify for Medicaid, review other coverage options. This may include Marketplace health insurance, an employer plan or Medicare.
(NOTE: The unwinding of continuous Medicaid coverage does not impact the Supplemental Nutrition Assistance Program (SNAP), although the additional pandemic-related SNAP benefits ended in February. And the scheduled end of the federal public health emergency on May 11, 2023, will affect SNAP eligibility for some people. Watch for letters and notices from your state to stay up-to-date on what you need to know about SNAP.)
Get an ACA Marketplace plan
Losing Medicaid will make you eligible for a special enrollment period in the Affordable Care Act (ACA) Marketplace. An estimated 2.7 million Americans who are disenrolled are expected to qualify for financial help in the form of premium subsidies, which lower the cost of a health plan in the Marketplace.
Get coverage through your employer
Of those expected to lose Medicaid coverage, an estimated 5 million are expected to gain other coverage – primarily through employer-sponsored plans. If you have access to an employer’s health plan, you will qualify for a special enrollment window to sign up for the plan. This could be through your employer or the employer of a parent or spouse. But don’t delay. Employer enrollment periods are typically limited to 60 days in cases where the applicant has lost Medicaid coverage.
Can't afford employer coverage?
If your employer-sponsored coverage option seems unaffordable, you may qualify for help paying for health insurance through the Marketplace. Use our Employer Health Plan Affordability Calculator to see your potential savings.
If you live in a state that begins disenrollments as soon as allowed, you could lose coverage as soon as April 1, 2023.
The redetermination processes for the entire Medicaid population are being spread out over 12 months. In some states, Medicaid redeterminations may not happen until the anniversary of when you signed up for Medicaid, so the process could take longer. Depending on your state, you may not hear from your state’s Medicaid department until early 2024.
You can learn more about Medicaid redeterminations and renewals by reading this in-depth article.