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Medicaid & CHIP

Changing from Marketplace to Medicaid or CHIP

If you have Marketplace coverage and become eligible for
or the
that counts as 
, consider ending your Marketplace coverage.

What counts as qualifying health insurance?

Most programs through Medicaid and CHIP count as qualifying health coverage. 
If you have qualifying health coverage through Medicaid, you no longer qualify for the premium tax credit or extra savings to lower the cost of your Marketplace plan.
If your Medicaid program doesn't count as qualifying health coverage, you may qualify for lower costs on your Marketplace plan based on your income and other factors. 
Once you're eligible for Medicaid or CHIP, you no longer qualify for savings on your Marketplace plan
or
. You'll have to pay full price for your Marketplace plan. 

1. Make sure you're eligible for Medicaid or CHIP

Your state may send you a letter that says you "may be eligible" or that "you're eligible but they may need more information." If they ask for information, send it right away. 
Wait until you have a final decision from your state agency that says you're eligible before you end your Marketplace coverage.
Warning:
If you end your Marketplace plan before you get a final decision, you may have to wait to re-enroll and have a gap in coverage.
If you're not sure if you or household members have Medicaid, contact your state agency. For CHIP, call 1-877-KIDS-NOW (1-877-543-7669).

2. End Marketplace coverage

End your Marketplace coverage when your Medicaid or CHIP coverage starts. Your
or extra savings won't stop automatically. 
Warning:
Avoid paying back the premium tax credit
If you don't end your Marketplace coverage when Medicaid or CHIP coverage starts, you may have to pay back some or all of the premium tax credit you use when you file your federal taxes.

Keeping both Marketplace and Medicaid and CHIP

If you want to keep both, tell your state agency. Consider these things first:
  • You may no longer qualify for CHIP if you keep your Marketplace plan.
  • If you have qualifying health coverage through Medicaid or CHIP coverage, you’ll pay full price for your Marketplace plan premium and covered services.
  • If you have limited benefits through Medicare, you may qualify for lower costs on your Marketplace plan based on your income and other factors. 
Warning:
If you don't end your Marketplace coverage, you may have to pay back some or all of the premium tax credit you use when you file your federal taxes.  
Occasionally, we re-check our records to make sure people getting savings on their Marketplace plan still qualify for it. If you don’t end your Marketplace coverage when you get Medicaid or CHIP and continue to get the premium tax credit, you may get a letter from us.
This letter tells you to end your Marketplace coverage within 30 days, or we’ll stop your premium tax credit and extra savings. You’ll still have Marketplace coverage, but you’ll pay full price for it.

What if I get limited-benefit Medicaid coverage?

Don’t end your Marketplace coverage. You may be eligible for advance payments of the premium tax credit and other savings on a Marketplace health plan, if you qualify based on your income and other factors.