Even if you’ve already been on a Medicaid plan for healthcare coverage, you might find that you no longer qualify if your household income increased or if you turned 65. Here’s where you can find coverage instead.
Over the pandemic, the American government helped U.S. citizens on Medicaid maintain access to healthcare by setting in place a short-term continuous enrollment provision for Medicaid. Essentially, this allowed people who were already on Medicaid to remain covered without the need to reapply. However, now it’s ending.
The Medicaid continuous enrollment provision ends on March 31, 2023, meaning that if you’re on Medicaid, you’ll need to reapply to regain your health coverage.
An estimated 5–14 million Americans will lose Medicaid coverage this year as continuous enrollment provisions end.
However, you can consider these options for health insurance coverage — without Medicaid.
If you turned 65 and you’re an American citizen, you now qualify for Medicare. Younger people may also qualify, including those with certain disabilities or end-stage renal disease (ESRD).
The different “parts” of Medicare cover different aspects of healthcare and are billed differently:
- Medicare Part A: This covers inpatient care in hospitals and other facilities and home care.
- Medicare Part B: This covers doctor visits, outpatient care, preventive medicine, and medical supplies.
- Medicare Part C: Also called Medicare Advantage, this is a combo of Parts A and B plus additional services and other offerings.
- Medicare Part D: This covers prescription drugs, including some vaccines.
Various coverage options are available depending on your situation and preferences.
Your employer may offer health insurance as part of your employment benefits. About
It’s a good idea to understand the coverage and costs involved, including the premium, copayments, deductibles, and coinsurance, to help you decide whether this is right for you.
Costs to consider
- Premium: The upfront payment you or your family makes to keep your health insurance policy active. Premiums are often paid through payroll deductions when you get health insurance coverage through your employer. They’re billed monthly when purchased on the Marketplace.
- Deductible: The deductible is the amount usually paid yearly for healthcare services before the insurer begins paying.
- Copayment: A copayment or copay is paid to the healthcare professional each time you need a service. Not all plans require copays.
- Coinsurance: This is the portion of costs employees are responsible for after their deductible. For example, in a plan with a 30% coinsurance, the insurance company will pay 70% of each covered bill while you pay 30%.
Small businesses with 1–50 employees are not legally obligated to offer any welfare or health insurance benefits. However, in some cases, if you work for a small business, they may offer you Small Business Health Options Program (SHOP) coverage.
Large businesses aren’t legally obligated to offer health insurance to their employees, either. However, following the Affordable Care Act (ACA), they must pay a fine to the Internal Revenue Service (IRS) if they don’t provide coverage to at least 95% of their full-time employees.
The fines that businesses can incur are quite hefty — $3,860 per employee per year in 2020. This motivates large businesses to provide health insurance to their staff.
To comply with ACA, health insurance must meet minimum requirements for coverage and affordability. They also cover your adopted and biological children under the age of 26 years. But spouses, stepchildren, and foster children are not covered.
Although employees typically can’t demand health insurance, you may demand coverage if:
- Your contract stipulates it: If your employment contract says your employer will provide health insurance, they’re legally required to do so.
- Similarly situated employees are offered health insurance: The Health Insurance Portability and Accountability Act (HIPAA) states that employers must offer the same health insurance coverage to employees with a similar job position, employment status, or geographical location. If you find that co-workers with a profile similar to yours get health insurance coverage, you can demand similar benefits.
- Your employer offers discriminatory health insurance coverage: Following the Civil Rights Act, employers can’t discriminate while offering employees benefits and compensation. It would be illegal for your employer to deny you coverage based on age, race, gender, disability, religion, national origin, pregnancy, or color.
If you don’t qualify for Medicaid, you may still qualify for discounted health insurance coverage in your state.
Each state offers a Health Insurance Marketplace — also called a Marketplace or Exchange. These are enrollment services for medical insurance that were created by the ACA in 2010.
You can buy discounted health insurance through your state’s Marketplace if your income is 100%–400% of the federal poverty level (FPL).
Plans are available for less than $10 per month for 4 out of 5 enrollees. All plans include coverage for:
- prescription drugs
- doctor visits
- urgent care
- hospital visits
There’s no need to worry about missing the Open Enrollment Period. You can enroll in a Marketplace plan outside of the Open Enrollment Period because losing Medicaid or Children’s Health Insurance Program (CHIP) coverage is a Qualifying Life Event (QLE), according to Medicaid.gov.
States offer a Marketplace to their citizens in one of three ways:
Federal Marketplace
Your state may require you to find insurance using the federal Marketplace. You can find more information about this online at HealthCare.gov.
On the federal Marketplace platform, you can:
- Fill out a Marketplace application to determine whether you qualify for lower monthly premiums or out-of-pocket savings based on your income.
- Find out whether you qualify for other programs, such as the Children’s Health Insurance Program (CHIP).
State-based Marketplace-federal platform
In this model, the states have a state-based Marketplace but rely on the federal Healthcare.gov website for eligibility and enrollment functions. Here, you apply on the federal platform but receive services from your state.
State-based Marketplace
States with a state-based Marketplace perform all Marketplace functions for that state. You can apply for and enroll in coverage through the Marketplace website created by your state.
Marketplace links by state
You can find the Marketplace for your state in the table below.
Another option for getting health insurance coverage is through group health insurance plans. Other names for this type of insurance include:
- Association health plans
- Group membership-sponsored health plans
- Membership health plans
- Group medical plans
Unions, alumni, organizations, and professional and religious groups can offer these health plans to their members. This type of insurance usually costs less than individual plans because the risk for the insurance provider is spread out among the group members.
You may be able to benefit from this type of insurance if you belong to or join a group that offers this. Here are just a few examples of groups with health insurance for their members:
If you no longer qualify for Medicaid, you can get health insurance coverage through employers, state and federal Marketplaces, and organizations.
Understanding the coverage and costs is a good idea. And looking at resources available in your state can help you make an informed choice.