Medicaid coverage will end for millions of Americans in the coming months, which will push many people into unfamiliar territory: the health insurance marketplace.
States will start cutting people from the government-funded plans when they no longer qualify based on income, a process that has been paused since shortly after the COVID-19 pandemic hit.
The timing of these cuts will vary. But all states have insurance markets where people who lose Medicaid can buy new coverage with help from subsidies.
Shopping for affordable insurance that covers regular doctors and prescriptions can be daunting, especially in marketplaces that offer dozens of choices and subsidies to help pay for them.
Here’s what you need to know.
WHAT’S HAPPENING TO MEDICAID?
Nearly 85 million people are covered by government-funded Medicaid, which focuses on people with low incomes.
At the start of the COVID-19 pandemic, the federal government barred states from kicking people off Medicaid if they no longer were eligible. That ban ends this spring, and many people on Medicaid will be introduced to this so-called redetermination process for the first time.
States already are verifying eligibility, with most expected to start ending coverage for ineligible people in May, June and July.
Federal officials estimate that more than 8 million people will lose eligibility and be removed from Medicaid mainly because their incomes have changed.
WHERE TO GET NEW COVERAGE
State health insurance marketplaces created under the federal Affordable Care Act are the only places where people can buy individual insurance with help from an income-based subsidy. They can be found through the federal government’s healthcare.gov website.
You also can find coverage sold outside these marketplaces, but doing so can be risky. For instance, short-term plans can exclude coverage of certain things, such as a medical condition someone had before signing up.
INCOME-BASED SUBSIDIES
The cost of any new plan should be one of the first things to consider.
Shoppers can get income-based subsidies to help pay monthly premiums of plans they buy on the state marketplaces. Those subsidies were enhanced 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.
COVERAGE DIFFERENCES
Individual insurance differs from Medicaid in several ways.
Some marketplace plans come with a big deductible that people have to pay before most coverage starts.
So people shopping for coverage should understand deductibles and other payments they’ll need to make before committing to a plan, Smith noted.
Individual insurance also groups hospitals and doctors in networks. The insurance might cover much less of the bill for care received outside those networks. Shoppers should learn how any regular doctors and medications are covered before enrolling in a new plan.
Individual insurance also can give people more care choices. Many doctors don’t accept Medicaid, and states might pay for only a limited amount of prescriptions.
“It is possible that people will have better access to certain services in the marketplace,” said Jennifer Tolbert, a Medicaid expert with the nonprofit Kaiser Family Foundation.
IMPORTANT STEPS IF YOU’RE ON MEDICAID
Make sure your state program has your current contact information — including a mailing address, email and cellphone. They’ll send notifications if they need more information or if someone no longer qualifies for Medicaid.
“Everyone should do that before April,” said Joshua Brooker, an independent broker in Lancaster, Pennsylvania. “It’s going to make a smoother transition.”
Start shopping for new insurance before Medicaid ends. People should allow plenty of time to sort through options.
The goal should be to have new insurance that starts the day after Medicaid ends. That would cut down on temporary coverage losses for regular doctors or important medicines.
Once people register to shop in the insurance marketplace, they have 60 days to find a plan.
GETTING HELP
Seeking assistance might be a good idea, especially for people who need help figuring out their income for the coming year. That’s 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 also will 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.
Federally qualified health centers also have counselors who can help people apply.
Independent brokers also help people sort through options. They get a fee that usually comes out of the premium you wind up paying.
