Medicaid coverage will end for millions of Americans in the coming months, pushing many into unfamiliar territory: the health insurance market.
States will begin removing people from state-funded plans if they no longer qualify based on income, a process halted shortly after the outbreak of the COVID-19 pandemic.
The timing of these cuts will vary. But all states have insurance markets where people who lose Medicaid can use subsidies to buy new coverage.
Buying affordable insurance that covers regular doctors and prescriptions can be daunting, especially in marketplaces that offer dozens of choices and subsidies to pay for them.
Here’s what you need to know.
WHAT HAPPENS TO MEDICAID?
Nearly 85 million people are covered by federally funded Medicaid, which focuses on low-income people.
At the start of the COVID-19 pandemic, the federal government prohibited states from throwing people off Medicaid if they were no longer eligible. That ban ends this spring, and many people who receive Medicaid will be introduced to this so-called reassessment process for the first time.
States are already reviewing eligibility, with most expected to begin ending coverage to ineligible individuals in May, June and July.
Federal officials estimate that more than 8 million people will become ineligible and excluded from Medicaid, primarily because their income has changed.
WHERE CAN I GET NEW COVER
State health insurance marketplaces, created under the federal Affordable Care Act, are the only places people can get individual insurance with the help of an income-based subsidy. They can be found through the federal government’s website healthcare.gov.
You can also find cover sold outside of these marketplaces, but this can be risky. For example, short-term plans may exclude certain things from being covered, e.g. B. An illness that someone had before registering.
INCOME-BASED SUBSIDIES
The cost of a new plan should be one of the first things to consider.
Buyers can get income-based subsidies to pay the monthly premiums for plans they buy on state marketplaces. These subsidies have been increased during the pandemic.
Many people don’t realize they can get this help, said Jeremy Smith, director of West Virginia’s Health Insurance Navigator program, which helps shoppers find coverage.
“A very large percentage of people can qualify for a plan starting at $0 per month,” Smith said.
COVER DIFFERENCES
Individual insurance differs from Medicaid in several ways.
Some marketplace plans come with a high deductible that people have to pay before most coverage begins.
Therefore, people choosing coverage should understand deductibles and other payments they must make before committing to a plan, Smith noted.
Individual insurance also combines hospitals and doctors in associations. Insurance may cover a much smaller portion of the bill for care received outside of these networks. Buyers should find out how all regular doctors and medications are covered before signing up for a new plan.
Individual insurance can also provide people with more care options. Many doctors don’t accept Medicaid, and states may only pay for a limited number of prescriptions.
“People may have better access to certain services in the marketplace,” said Jennifer Tolbert, Medicaid expert at the nonprofit Kaiser Family Foundation.
IMPORTANT STEPS WHEN YOU ARE ON MEDICAID
Make sure your state program includes your current contact information — including postal address, email, and cell phone. They send out notifications when they need more information or when someone no longer qualifies for Medicaid.
“Everyone should do this before April,” said Joshua Brooker, an independent broker in Lancaster, Pennsylvania. “There will be a smoother transition.”
Start looking for new insurance before Medicaid ends. People should allow plenty of time to sort through the options.
The goal should be to have new insurance starting the day after Medicaid ends. This would reduce temporary coverage shortfalls with family doctors or important medicines.
Once people register to shop on the insurance marketplace, they have 60 days to find a plan.
GET HELP
Seeking support can be a good idea, especially for people who need help calculating their income for the year ahead. This is needed to calculate subsidies.
There are several ways people can get help.
States will transfer the names and contact information of those who no longer qualify for Medicaid to their marketplaces. They will also send a letter to Medicaid beneficiaries explaining how to connect to the marketplace, said Kate McEvoy, executive director of the nonprofit National Association of Medicaid Directors.
Nationwide qualified health centers also have counselors who can help people apply.
Independent brokers also help people sort through options. You receive a fee, which is usually derived from the premium you pay at the end.
