Medicaid & CHIP

Medicaid & CHIP coverage

When you fill out a Marketplace application, you may learn that you qualify for coverage through Medicaid or the Children’s Health Insurance Program (CHIP).

Medicaid and CHIP provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Both programs are run jointly by federal and state governments, and details vary somewhat between states.

You qualify for these programs based on your household size, income, and other factors, like age and disability. When you fill out your application you’ll find out if you and your family qualify.

You can apply for and enroll in Medicaid or CHIP any time of year. There’s no limited enrollment period for either Medicaid or CHIP. If you qualify, your coverage can begin immediately.

Medicaid

  • In all states, Medicaid provides free or low-cost care for some low-income people, families and children, pregnant women, the elderly, and people with disabilities.
  • In some states the program covers all adults below a certain income level.
  • Medicaid programs must follow federal guidelines, but coverage and costs may be different from state to state. Some Medicaid programs pay for your care directly. Others use private insurance companies to provide Medicaid coverage.

Learn how to apply for Medicaid coverage.

Children’s Health Insurance Program (CHIP)

  • In all states, CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers parents and pregnant women.
  • Each state works closely with its state Medicaid program.
  • In many cases, if you qualify for Medicaid your children will qualify for either Medicaid or CHIP.

Learn how to apply for CHIP coverage.

If you have Medicaid or CHIP coverage, you’re considered covered under the health care law. You don’t have to buy a Marketplace insurance plan. You also don’t have to pay the fee that people without health coverage must pay.

Ending a Marketplace plan when you get Medicaid or CHIP

If you’re enrolled in a Marketplace plan and taking advance payments of the premium tax credit (APTC) and are found eligible for Medicaid or the Children’s Health Insurance Program (CHIP), you should end your Marketplace plan as soon as you know for sure you’re eligible for Medicaid/CHIP coverage.

If you don’t, you (or the person who claims you on their taxes) may need to pay back the advance payments of the tax credit you received for the months you had Medicaid or CHIP coverage.

How do I cancel my Marketplace plan for everyone on my application?

If everyone in your household becomes eligible for coverage from another source, like Medicaid or CHIP, you’ll need to cancel your Marketplace plan. Follow these steps to end coverage for everyone enrolled in a plan you bought through the Marketplace:

  • Log in to your Marketplace account
  • Select My applications & coverage from the menu on the right side of the page
  • Select your application under Your existing applications
  • On the left side of the screen, select My plans & programs
  • Scroll down and select the red button that says End all coverage
  • Select an effective date to end your coverage that’s at least 14 days in the future
  • Select the red End/Terminate Coverage button

A red Terminated status should appear above the plan you ended.

You can also cancel your plan by phone. Contact the Marketplace Call Center.

How do I remove certain household members from a Marketplace plan?

You can end coverage for just some members of your household.

You may want to do this if somebody gets coverage from another source, like Medicaid or CHIP, but the rest of the people on the application want to keep a Marketplace plan.

Important: Cancelling the “subscriber.” The subscriber is usually the person who filled out the application and is buying the plan for a spouse or dependents. If you cancel the subscriber online, you’ll end coverage for everyone on the application. To end the subscriber’s coverage but keep the plan for a spouse or dependents, you must Contact the Call Center. Don’t try to do this online.

To end coverage for anyone other than the subscriber:

In most cases, when you end one person’s coverage, it ends immediately.

When you remove one or more people from your plan, your premium tax credit or other savings may change. If you get new eligibility results, follow the directions and complete all tasks on your new To-do list.

You can also cancel your plan by phone. Contact the Marketplace Call Center.