Medicaid coverage will end for millions of Americans in the coming months, pushing many into uncharted territory: the health insurance market.
States will start cutting people from the state-funded plans if they no longer qualify based on their income, a process that was 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. Some states will even link buyers to a potential new plan.
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. Experts say it helps to start this quest with a plan. Here’s a deeper look at the process.
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 pandemic, the federal government prohibited states from throwing people out of 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. Some, like Arizona, Arkansas and Idaho, are expected to begin ending coverage to ineligible individuals in April. Most states will do so in May, June and July.
Federal officials estimate that more than 8 million people will become ineligible and exit Medicaid, primarily because their income has changed.
WHERE CAN I GET NEW COVER
Government health insurance marketplaces, created by the 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 Healthcare.gov Website.
Buyers can also find cover sold outside of these marketplaces, but it can be risky. For example, short-term plans may exclude certain things from being covered, such as: B. An illness that someone had before registering.
INCOME-BASED SUBSIDIES
The cost of any new plan should be one of the first things people 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.
People often don’t know 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,” he 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.
Buyers 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 has your current contact information, including a 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 based in Lancaster, Pennsylvania. “There will be a smoother transition.”
Start looking for new insurance before Medicaid ends. Buyers 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 buyers register to shop on the insurance marketplace, they have 60 days to find a plan.
GET HELP
Seeking help can be a good idea, especially for people who need help figuring out 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 telling them how to connect to the marketplace, said Kate McEvoy, executive director of the nonprofit National Association of Medicaid Directors.
Some states will go even further. The California marketplace Covered California will enroll people in a qualifying health plan and mail them the information. These individuals must then confirm enrollment and pay the first premium to remain insured.
State marketplaces have navigators like Smith who can help people sort through options and understand potential plans. The government-funded navigators are free to use, but cannot recommend any particular selection.
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.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
