Once you get a final determination that you're eligible for Medicaid or the Children’s Health Insurance Program (CHIP) that counts as qualifying health coverage (or "minimum essential coverage"):
Note: Most programs through Medicaid and CHIP count as qualifying health coverage under the health care law. If your Medicaid program doesn't count as qualifying health 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. Find out if your Medicaid program counts as qualifying health coverage.
If our records show you’re enrolled in both a Marketplace plan with premium tax credits or other cost savings and Medicaid or CHIP — something we check a few times a year — you may get a notice in the mail that lists the household members who are enrolled in both kinds of coverage. The notice explains what to do next.
IMPORTANT Take action by the date indicated on your notice (within 30 days). If you’re enrolled in a Marketplace plan and get help paying for coverage, you should end your enrollment. If you choose to stay enrolled in a Marketplace plan, the Marketplace will recalculate your eligibility for this financial help.
If you want more information about Medicaid or CHIP, or if you aren’t sure if you or others in your household are enrolled in Medicaid or CHIP, you can contact the office in your state:
If you still want a Marketplace plan
You can have both Marketplace coverage and Medicaid or CHIP, but you are not eligible to receive advance payments of the premium tax credit or other cost savings to help pay for your share of the Marketplace plan.
If you are on an application with other people who are also enrolled in Marketplace coverage: You’ll need to "report a life change" and then select that you are enrolled in Medicaid or CHIP. Continue to confirm enrollment in order to remain enrolled in your plan without premium tax credits or other cost savings.
If you are the only person on your application who is enrolled in Marketplace coverage: You’ll need to end your Marketplace plan with premium tax credits and then submit a new application for Marketplace coverage without premium tax credits or other cost savings. You can only enroll in Marketplace coverage during the annual Open Enrollment Period or if you qualify for a Special Enrollment Period.
When and how you end your Marketplace plan depends on the following:
IMPORTANT: The household contact is usually the person who created the Marketplace account and may have filled out the application to buy the Marketplace plan for a spouse or dependents. You must contact the Marketplace Call Center to:
- Change the household contact
- Remove the household contact from the plan if others in your household are staying on the plan
Don’t try to do this online unless you’re ending coverage for everyone on the plan. It’s important to do this by phone so dependents can stay on the plan.
The steps to end your Marketplace plan may be different depending on your situation.
You’ll probably want to wait to end your Marketplace plan if:
Important: If you end your Marketplace plan before you get a final decision of your Medicaid or CHIP eligibility and are later found ineligible for Medicaid or CHIP, you can’t re-enroll in the Marketplace plan unless you qualify for a Special Enrollment Period. Otherwise, you’d have to wait for the next Open Enrollment Period and may have a gap in coverage. For plan years through 2018, if you can afford health insurance but choose not to buy it, you must have a health coverage exemption or pay a fee. Starting with the 2019 plan year, the fee no longer applies.
You’ll want to end your Marketplace plan immediately if:
Follow these steps to end Marketplace coverage for everyone on your Marketplace plan:
A red “Terminated” or “Cancelled” status should appear above the plan you ended.
You can also end your plan by phone. Contact the Marketplace Call Center.
You can end coverage for just some people on your Marketplace plan, such as a spouse or dependents.
You may want to do this if someone in your household gets coverage from another source, but the rest of the people on the application want to keep their Marketplace coverage.
Follow these steps to end Marketplace coverage only for some people:
In most cases, when you end coverage for only some people on your application, their coverage ends immediately.
If Marketplace coverage doesn’t end immediately for the person being removed from the plan:
This could be the case if the people staying on the Marketplace plan qualify for a Special Enrollment Period. For example, if you update your household income after ending coverage for one or more people and the amount of premium tax credits or other cost savings changes, the remaining enrollees may qualify for a Special Enrollment Period. The coverage end date for the person being removed from coverage will align with the coverage effective dates of the Special Enrollment Period.
You can also end coverage for just some members of your household members by phone. Contact the Marketplace Call Center.
Some limited types of Medicaid coverage pay only for:
If you have limited-benefit Medicaid coverage, you can apply for coverage through the Marketplace to get comprehensive coverage in addition to your limited-benefit Medicaid coverage. Because this type of Medicaid is not considered qualifying health coverage, you may qualify for lower costs on your monthly premiums and extra savings on out-of-pocket costs for a Marketplace plan, depending on your household size and income.
Important: If you have limited-benefit Medicaid coverage, when you fill out a Marketplace application and are asked whether you have coverage now, don’t check the box saying you have Medicaid. Check “None of the above” instead.
Note for current Marketplace enrollees: If you are enrolled in Marketplace coverage with premium tax credits or other cost savings, you don’t have to end your Marketplace plan to enroll in limited-benefit Medicaid. That’s because limited-benefit Medicaid isn’t considered qualifying health coverage. You can apply for this coverage directly to your state Medicaid agency.
If you’re not enrolled in Medicaid or the Children's Health Insurance Program (CHIP), and got a notice that you may lose financial help for your Marketplace coverage because of enrollment in one of these programs, you need to tell the Marketplace you’re not enrolled in Medicaid or CHIP by updating your application. If you don’t, you’ll pay more for your monthly premiums because your advance payments of the premium tax credit and cost-sharing reductions (if applicable) will end.
To update your application: