When life changes, your health coverage and saving options may change too. If you’ve had a change, like you got married or moved to a new address, let the Marketplace know.
Loss of health coverage: Losing job-based coverage (yours or a household member’s) or eligibility for Medicaid, Medicare, or the Children’s Health Insurance Program (CHIP)
Residence changes: Certain household moves, like to a new ZIP code, county, or state
Household changes: New baby, marriage, divorce, or death
Other qualifying life events, like changes in your income that affect the coverage you qualify for or becoming a U.S. citizen
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Having a baby qualifies you for a Special Enrollment Period to enroll in or change 2023 Marketplace coverage for you, your baby, and other household members.
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Enroll in Marketplace coverage after birth/adoption
Access to health care services is important. With Marketplace coverage, you’ll get free preventive benefits, like well-baby visits.
Apply within 60 days after your baby’s birth or adoption/foster care date. Update an existing application, or apply for the first time. Your coverage can start the day of the event, even if you enroll up to 60 days afterward.
If you already have Marketplace coverage, you can keep your current plan and add your baby to your coverage. You may have new coverage options with better savings.
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What are the new Medicaid eligibility guidelines after expansion?
South Dakota’s Medicaid expansion makes coverage available to many low-income adults who weren’t previously eligible and now meet eligibility criteria. This includes adults who:
Previously, non-disabled adults under age 65 were only eligible for South Dakota Medicaid if they had minor children and a household income that didn’t exceed 46% of the poverty level. (For a household of two, that was just over $9,000 in total annual income.)
Who became newly eligible for Medicaid in South Dakota as a result of expansion?
As a result of Medicaid expansion, an estimated 52,000 low-income adults in South Dakota are newly eligible for Medicaid as of July 2023.
Can I apply for expanded Medicaid if I recently lost Medicaid in South Dakota?
Yes, some people who have recently lost Medicaid in South Dakota will find that they’re once again eligible for coverage under the new guidelines.
During the COVID pandemic, states could not disenroll anyone from Medicaid unless they moved out of state, passed away, or requested a disenrollment. But that rule ended April 1, 2023 and South Dakota was among the first states to begin disenrolling people. South Dakota Medicaid enrollment dropped by more than 21,000 people by May, after just two months of disenrollments (enrollment in March was nearly 153,000, and by May it had dropped to under 132,000).
If you’ve recently been disenrolled from South Dakota Medicaid, you may have already received a notification from the state about your potential eligibility for Medicaid expansion and a reminder to submit an application.
Will Medicaid expansion affect South Dakotans who currently have Marketplace plans?
Some people who currently have subsidized private coverage through the South Dakota Marketplace will be newly eligible for expanded Medicaid as of July 1.
In addition to the non-disabled adults without minor children described above, this includes adult parents and caretakers with household income between 100% and 138% of the poverty level. For a single person, that’s between $14,580 and $20,120 in annual income this year. The amount increases if there are more people in the household.
These individuals were eligible for Marketplace subsidies to purchase private plans prior to July 1, 2023. And they will not automatically be transitioned to Medicaid in July. They’ll have the option to keep their Marketplace coverage (and subsidy) through the end of the year.
Or they can choose to apply for Medicaid and then drop their Marketplace plan if and when they’re approved for Medicaid. It’s important to wait until the Medicaid application is approved before dropping a Marketplace plan to prevent a gap in coverage. There would not be an opportunity to re-enroll in the Marketplace plan prior to January 1 unless the person has another qualifying life event.
For people in this income range who have Marketplace coverage and choose to keep it for now, Medicaid eligibility will be redetermined during open enrollment this fall. At that point, if a person is eligible for Medicaid (i.e. income up to 138% of the poverty level), they will be notified that they are no longer eligible for a subsidy in the Marketplace after the end of 2023, and are instead eligible for Medicaid.
People whose projected 2024 income is above 138% of the poverty level will continue to be eligible for subsidies in the Marketplace, as long as they can provide any requested income verification documentation. (There is no set upper income limit for subsidy eligibility. Subsidies are available as long as the benchmark plan would cost more than 8.5% of your household income.)
Which states might implement Medicaid expansion next?
South Dakota was the 39th state to expand Medicaid, leaving 11 others that have not yet done so. North Carolina appears likely to be the next state to expand Medicaid, with coverage expected to become available in late 2023 or early 2024.
North Carolina was the first state in several years to approve Medicaid expansion legislatively, and some of the remaining states might follow suit in the coming years. Other states – including Wyoming and Kansas – have seen multiple failed attempts in the past five years to advance expansion legislation
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org since 2013. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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Friday Health Plans, which offers coverage in five states, is winding down its business operations. And in at least three of those states, thousands of enrollees need to select new plans in the coming weeks to avoid becoming uninsured.
Friday Health Plans of Georgia has been placed into receivership, and its health policies will terminate on July 31, 2023. Friday Health Plans of Oklahoma and Friday Health Plans of North Carolina have also been placed into receivership, with coverage ending on August 31, 2023. Enrollees will need to continue paying their Friday Health Plans premiums through those dates to maintain coverage until the plans terminate at the end of July or August, depending on the state.
Policyholders in these states will need to select new health insurance plans if they want to avoid coverage gaps for the remainder of 2023.
What is the deadline for Friday Health Plans policyholders to select new coverage in Georgia?
If you have Friday Health Plans coverage in Georgia, your policy’s coverage will end July 31, 2023. A special enrollment period for current enrollees began June 1 and continues through September 29.
To avoid a gap in coverage, you need to select a new plan by July 31. That will allow your new plan to take effect without a gap in coverage on August 1. If you wait until August or September to enroll, you’ll go a month or two without any insurance.
How will Friday Health Plans coverage termination affect customers in Oklahoma and North Carolina?
If you have Friday Health Plans coverage in Oklahoma or North Carolina, your policy will end August 31, 2023. A special enrollment period began July 2, and continues through October 30. To avoid a gap in coverage, you need to select a new plan by August 31.
Automatic re-enrollment via the federal Marketplace (the exchange used in Georgia, Oklahoma, and North Carolina) is unavailable for mid-year plan terminations. So it’s essential for enrollees to select their own replacement coverage to avoid becoming uninsured.
To be eligible for subsidies, you must obtain your new plan through your state’s Marketplace / exchange. (Subsidized on-exchange enrollment and plan changes can also be made through an enhanced direct enrollment entity.) If you’re certain you aren’t interested in receiving subsidies, you can purchase new coverage directly from an insurer.
Will Friday Health Plans policyholders in Colorado and Nevada have a special enrollment period to buy new coverage?
If you have coverage with Friday Health Plans in Colorado or Nevada, note that no special enrollment period is set at this time. The current expectation is that coverage in Colorado and Nevada will end December 31 for enrollees who continue paying their premiums.
Friday Health Plans policyholders in Colorado and Nevada can select Marketplace plans for 2024 during the usual open enrollment period, which runs from November 1 through January 15 in both states. (A replacement plan will need to be selected by December 31 to take effect January 1.) If that changes, we’ll let you know on the healthinsurance.org website as the story develops. If a policyholder becomes eligible for employer-sponsored coverage, they will need to ask about the employer’s enrollment window.
What will happen to Friday Health Plans customers who have already paid out-of-pocket costs this year?
It is unlikely that your deductible and other out-of-pocket spending will transfer to new policies that take effect mid-year. People who have already paid out-of-pocket costs in 2023 under Friday Health Plans policies in Georgia, Oklahoma, and North Carolina will likely find they are starting over at $0 in out-of-pocket spending under their new policies. In Colorado and Nevada, the Friday Health Plans coverage is expected to continue through December 31. So out-of-pocket costs would reset to $0 on January 1 under a consumer’s replacement policy, just as they would on January 1 with any policy.
Louise Norris is an independent individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org since 2013. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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If you’ve received notification that you’re losing Medicaid eligibility, you’re certainly not alone. Millions of Americans will get similar notices in 2023 and 2024, now that states are once again disenrolling people from Medicaid after not doing so between March 2020 and March 2023.
But that doesn’t make it any easier to find out your health coverage is ending. You’re still left with a big question: What to do now that you’ve been declared ineligible for Medicaid and dropped from the program? Let’s take a look.
Can I reapply for Medicaid after my coverage is terminated?
Yes. Enrollment is open year-round, which means you can reapply for Medicaid anytime. So if your circumstances change and you think you once again meet the eligibility criteria (perhaps you experienced a pay cut or job loss), file a new application.
If you ended up losing Medicaid eligibility because you didn’t complete the renewal process, you have a 90-day window when you can get your coverage reinstated if you complete the renewal and are determined eligible.
What are my coverage options if I’m losing Medicaid?
If you’re losing Medicaid and are eligible for a plan from your employer or your spouse’s employer, you’ll be able to enroll in that plan. You also have the option to enroll in a plan offered through the Marketplace/exchange in your state. Here’s what you need to know about these coverage options:
If you have access to an employer’s plan that’s considered comprehensive and affordable, that may be your best option. (Access to an employer’s plan will vary from one employer to another. Some offer coverage only to full-time workers, while others also offer coverage to part-time employees.) Take the necessary steps to enroll in that plan as soon as you receive notice that your Medicaid is ending. The special enrollment period will continue for 60 days after your Medicaid ends, but it’s best to sign up before the date your Medicaid ends, so that you avoid a gap in coverage.
If you do not have access to a comprehensive, affordable plan from an employer, you can enroll in a plan through the Marketplace/exchange. Most people qualify for income-based subsidies to offset the cost. (To be clear, Marketplace coverage is an option for nearly anyone, but financial subsidies are only available if you don’t have access to an affordable, comprehensive plan offered by an employer.) Your special enrollment period will continue for at least 60 days after your Medicaid ends (or until July 2024 in many states), but in most states you’ll need to enroll before your Medicaid ends in order to avoid a gap in coverage.
What if I can’t afford health insurance and don’t qualify for Medicaid?
It’s important to understand that the rules have changed in recent years to make health coverage more affordable for more people. This includes larger and more widely available subsidies for Marketplace coverage, and a fix for the “family glitch” that makes some employees’ family members newly eligible for Marketplace subsidies.
So it’s very unusual for a person who isn’t eligible for Medicaid (or Medicare) to also be unable to find health insurance deemed affordable. But there are some exceptions, including very low-income adults in states that haven’t expanded Medicaid, as well as people who are ineligible to use the Marketplace because they’re not lawfully present in the U.S.
To some extent, yes. If you’ve been notified you are ineligible for Medicaid, there are several things to keep in mind in terms of how coverage options vary from state to state:
If you’re in one of the states that use HealthCare.gov as their Marketplace, you’ll have an extended special enrollment period, through July 2024, when you can sign up for a Marketplace plan. But the coverage will not be retroactive, so you’ll still need to enroll before your Medicaid ends if you want to avoid a gap in coverage.
If you’re in California or Rhode Island, you may find that you’re automatically enrolled in a Marketplace health plan. (You’ll still have an option to decline the plan or pick a different plan.)
If you’re in Pennsylvania or New Mexico, you may be able to avoid a gap in coverage even if you sign up for a Marketplace plan after your Medicaid ends. (In most states, you need to enroll in a new plan before your Medicaid termination date if you want to avoid a gap in coverage.)
Some people in New Mexico and Rhode Island will find that their initial premiums for Marketplace coverage are paid by the state.
If you’re in New York or Minnesota, you’ll likely qualify for Basic Health Program (BHP) coverage if your income doesn’t exceed 200% of the poverty level. And in Oregon, Medicaid expansion coverage has been temporarily extended to 200% of the poverty level for people who were already enrolled as of March 2023. This is intended to minimize coverage losses until Oregon’s BHP is up and running in mid-2024.
If you’re in a state that hasn’t expanded Medicaid and your income is below the poverty level, you may find that you’re in the coverage gap and not eligible for any financial assistance with your health coverage. This could be the case for some people who have aged off of Medicaid for children, no longer have minor children, or who no longer qualify for Medicaid due to pregnancy. Depending on their circumstances, low-income people in states with a coverage gap can find that they’re denied Medicaid and also ineligible for premium subsidies in the Marketplace. You’ll want to read this article about avoiding the coverage gap.
If you’re in Georgia, South Dakota, or North Carolina, you may be able to re-enroll in Medicaid under new Medicaid expansion guidelines. Expansion took effect in Georgia and South Dakota on July 1 (with a work requirement in Georgia), but it will be late 2023 or early 2024 before it takes effect in North Carolina.
The rules for transitioning from Medicaid to an employer-sponsored plan are the same in every state. If you’re transitioning from Medicaid to Medicare, the rules are generally the same nationwide, but there’s state-to-state variation in terms of Medigap access if you’re under 65 or eligible for Medicare due to a disability.
If I’m losing Medicaid eligibility, what happens to my child’s coverage?
Even if you’re no longer eligible for Medicaid, your child still may be eligible for Medicaid or the Children’s Health Insurance Program (CHIP). In every state, children can access these programs with higher household income levels than adults. So your ineligibility does not necessarily translate to your entire household.
If your kids are not eligible for Medicaid or CHIP, you may be able to secure coverage for them through an employer or the Marketplace under the same terms discussed above.
I’m not sure if I’ll lose my coverage. How do I check Medicaid eligibility?
The state will process your renewal when it’s due and definitively determine your eligibility. But if you want to get a rough idea of your eligibility ahead of time, this chart shows Medicaid and CHIP income limits (as a percentage of the poverty level) in each state for children, pregnant women, parents of minor children, and adults under age 65.
And this chart shows the dollar amounts that correspond to various percentages of the poverty level in 2023. Note that the amounts vary depending on how many people are in your household.
If you’re 65 or older, or eligible for Medicaid due to a disability or blindness, your eligibility in most states depends on both income and assets.
Louise Norris is an independent individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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As you get ready to move, it’s important to know that your new address may impact your health coverage options and savings. Don’t forget to update your Marketplace application to get the best plan for your household, and the right amount of savings.
Your next steps depend on where you move
When you move to a new state:
You can’t keep the same plan from your old state. Let the Marketplace know if you move to a different state right away, so you don’t have a break in coverage or continue to pay for coverage that doesn’t apply in your new state.
To get coverage in your new state, start a new Marketplace application and enroll in a plan in your new state. How you apply depends on whether your new state uses Healthcare.gov or its own website.
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All private health insurance plans offered in the Health Insurance Marketplace® must cover the same essential health benefits. Care in these 10 categories of services is covered by all Marketplace plans.
10 covered benefits:
Ambulatory patient services (outpatient care you get without being admitted to a hospital)
Emergency services
Hospitalization (like surgery and overnight stays)
Pregnancy and newborn care (both before and after birth)
Mental health and substance use disorder services, including behavioral health treatment, counseling, and psychotherapy
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care (this doesn’t include adult dental or vision coverage)
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For the past few years, states had to continue your coverage in Medicaid (and in some cases the Children’s Health Insurance Program (CHIP)), even if your income or other factors changed that would typically make you ineligible.
States are now returning to normal operations, so they’ll recheck your eligibility for these programs again. If your state finds that your household income is now too high or other changes make you ineligible, you may lose your Medicaid or CHIP coverage.
If this happens, you have other options for health insurance.
Your options to enroll in health coverage:
Apply for Marketplace coverage at HealthCare.gov
Most people qualify for savings on a health plan to lower their monthly premium and what they pay when they get care.
4 in 5 customers are able to find health coverage for $10 or less a month.
All Marketplace plans cover doctor’s visits, prescription drugs, emergency care, mental health, hospitalizations, and more.
You can apply and enroll in a Marketplace plan as early as 60 days before your Medicaid or CHIP coverage ends to avoid a gap in coverage.
From March 31, 2023 – July 31, 2024, you can also apply for a Marketplace plan any time after your Medicaid or CHIP coverage ends. You’ll have 60 days after submitting your application to enroll in a plan that will start at the beginning of the next month after you complete your enrollment.
Enroll now to get coverage that can start the first of next month.
If you’re 65 or older but didn’t sign up for Medicare when you first became eligible, you may be able to sign up without paying a late enrollment penalty.
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Summer is here! With Marketplace coverage, you’re already in a great place to have a healthy summer. Learn more about how you can stay well this summer:
3 ways to stay healthy & make the most of your summer:
Get preventive services. Preventive health check-ups can help detect or even prevent health problems before they start. These services, like shots and cancer screenings, are free when you visit a provider in your plan’s network.
Check your choppers. The health of your mouth impacts your overall health. If you have dental coverage, be sure you’re up-to-date on your dental checkups. If not, put them on your summer schedule.
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Health insurance can protect you at any age. Know your options, whether you’re still covered through a parent’s health insurance plan or searching for your own plan.
4 health insurance options for young adults
Your college or university. If you’re in school, you may be able to enroll in a student health plan.
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The Public Health Emergency for COVID-19 is over. Your Marketplace plan may have some changes to how it covers services for COVID-19.
Coverage changes for COVID‑19
Vaccines continue to be covered without cost sharing when delivered by an in-network provider.
COVID-19 tests (both administered at a doctor’s office and at-home tests from a store or pharmacy) might not be covered. (To find out, check with your plan.)
If you can’t pay your premiums, plans can end your coverage.
Be sure to let us know if your income or household size recently changed – like if you got a raise or had a baby – by updating your Marketplace application. New coverage options and savings may be available to you. You may qualify for more savings than you’re getting now, so don’t miss out.
What changes should I report?
Income changes (like if you got a raise)
Household changes (like if you had a baby or got married)
Status changes (like a change in disability or citizenship status)
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Now that you have Marketplace coverage, take advantage of the many free preventive services to help you stay healthy and get the care you need. Getting these services and making healthy lifestyle choices are key steps to good health and well-being. Check with your doctor to find out what services are right for you.
What are preventive services?
Marketplace insurance plans cover preventive services for free when they’re delivered by a doctor or other provider in your plan’s network.
Preventive services include screenings, check-ups, and patient counseling. These services are used to prevent illnesses, disease, and other health problems, or to detect illness at an early stage when treatment is likely to work best.
Common preventive services
Blood pressure screenings
Cholesterol screenings (for certain ages and people at high risk)
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You’ll use your Form 1095-A to “reconcile” your 2022 premium tax credits when you file your taxes if you or anyone in your household had Marketplace coverage at any point in 2022.
Any difference between the amount of premium tax credit you used in advance during the year and the premium tax credit you actually qualify for based on your final income will affect whether you owe money or get a refund.
If you used premium tax credits you’ll report the excess advance payment of the premium tax credit on your tax return or file Form 8962, Premium Tax Credit (PDF, 110 KB).
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Life change? You may qualify for a Special Enrollment Period
Open Enrollment for 2023 ended on January 15, 2023, but you may still be able to enroll in or change Marketplace coverage if you’ve had certain life events or income. Life events that may qualify include getting married, having a baby, moving, or losing health coverage. Get a full list of qualifying life changes.
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The tax filing deadline is April 18, 2023. If anyone in your household had a Marketplace plan in 2022, use Form 1095-A, Health Insurance Marketplace® Statement to file your federal taxes. You’ll get this form from the Marketplace, not the IRS. Check your Form 1095-A to make sure your information is correct. Keep it with your other important tax information.
Check your online account for Form 1095-A
If you didn’t get your Form 1095-A in the mail, or you can’t find it, check your HealthCare.gov account:
You’ll use the 1095-A form to “reconcile” — check if there’s any difference between the premium tax credit you got and the amount you qualify for on your taxes.
Before you start, check the form to make sure the information is right. If you filed your taxes with an incorrect form, you may need to file an amended tax return using the correct information.
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Congratulations on getting covered for 2023! Get answers to some common questions about health insurance, like how to find a doctor and learn what prescriptions are covered.
What prescriptions are covered by my plan?
Your plan will help pay the cost of certain prescriptions.
Your plan’s list of covered drugs is called a “formulary.”
Visit your plan’s website, call their Member Services, or review your Summary of Benefits and Coverage for a list of covered drugs.
How can I find a doctor in my plan?
Most plans give you the best price on services when you go to an “in-network” health care provider who has a contract with the plan.
You may be able to visit doctors who aren’t in your plan’s network, but you may pay more.
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If you had Marketplace coverage at any point in 2022, or got premium tax credits last year, here’s what you need to know about filing your federal taxes.
If there’s a difference between the amount of premium tax credit you used during the year and the amount you actually qualify for, it will impact your refund or the amount of taxes you owe.
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Report life changes to the Marketplace
When life changes, your health coverage and saving options may change too. If you’ve had a change, like you got married or moved to a new address, let the Marketplace know.
What type of changes should I report?
Certain changes are considered qualifying life events. There are 4 basic types:
These changes may affect the coverage or savings you’re eligible for. Also, you may qualify for a Special Enrollment Period to sign up for health insurance outside of Open Enrollment.
Get the full list of changes to report.
3 ways to report changes:
New baby could mean new health coverage options
Having a baby qualifies you for a Special Enrollment Period to enroll in or change 2023 Marketplace coverage for you, your baby, and other household members.
Enroll in Marketplace coverage after birth/adoption
Learn more about Special Enrollment Periods and how to apply.
South Dakota Medicaid expansion is underway
South Dakota is the 39th state to expand Medicaid eligibility to cover low-income adults, with coverage that could take effect as early as July 1. Applications were accepted starting June 1, and enrollment continues year-round.
What are the new Medicaid eligibility guidelines after expansion?
South Dakota’s Medicaid expansion makes coverage available to many low-income adults who weren’t previously eligible and now meet eligibility criteria. This includes adults who:
Previously, non-disabled adults under age 65 were only eligible for South Dakota Medicaid if they had minor children and a household income that didn’t exceed 46% of the poverty level. (For a household of two, that was just over $9,000 in total annual income.)
Who became newly eligible for Medicaid in South Dakota as a result of expansion?
As a result of Medicaid expansion, an estimated 52,000 low-income adults in South Dakota are newly eligible for Medicaid as of July 2023.
This includes parents/caretakers with income above 46% and not more than 138% of the poverty level, as well as childless adults with income up to 138% of the poverty level.
Can I apply for expanded Medicaid if I recently lost Medicaid in South Dakota?
Yes, some people who have recently lost Medicaid in South Dakota will find that they’re once again eligible for coverage under the new guidelines.
During the COVID pandemic, states could not disenroll anyone from Medicaid unless they moved out of state, passed away, or requested a disenrollment. But that rule ended April 1, 2023 and South Dakota was among the first states to begin disenrolling people. South Dakota Medicaid enrollment dropped by more than 21,000 people by May, after just two months of disenrollments (enrollment in March was nearly 153,000, and by May it had dropped to under 132,000).
If you’ve recently been disenrolled from South Dakota Medicaid, you may have already received a notification from the state about your potential eligibility for Medicaid expansion and a reminder to submit an application.
Will Medicaid expansion affect South Dakotans who currently have Marketplace plans?
Some people who currently have subsidized private coverage through the South Dakota Marketplace will be newly eligible for expanded Medicaid as of July 1.
In addition to the non-disabled adults without minor children described above, this includes adult parents and caretakers with household income between 100% and 138% of the poverty level. For a single person, that’s between $14,580 and $20,120 in annual income this year. The amount increases if there are more people in the household.
These individuals were eligible for Marketplace subsidies to purchase private plans prior to July 1, 2023. And they will not automatically be transitioned to Medicaid in July. They’ll have the option to keep their Marketplace coverage (and subsidy) through the end of the year.
Or they can choose to apply for Medicaid and then drop their Marketplace plan if and when they’re approved for Medicaid. It’s important to wait until the Medicaid application is approved before dropping a Marketplace plan to prevent a gap in coverage. There would not be an opportunity to re-enroll in the Marketplace plan prior to January 1 unless the person has another qualifying life event.
For people in this income range who have Marketplace coverage and choose to keep it for now, Medicaid eligibility will be redetermined during open enrollment this fall. At that point, if a person is eligible for Medicaid (i.e. income up to 138% of the poverty level), they will be notified that they are no longer eligible for a subsidy in the Marketplace after the end of 2023, and are instead eligible for Medicaid.
People whose projected 2024 income is above 138% of the poverty level will continue to be eligible for subsidies in the Marketplace, as long as they can provide any requested income verification documentation. (There is no set upper income limit for subsidy eligibility. Subsidies are available as long as the benchmark plan would cost more than 8.5% of your household income.)
Which states might implement Medicaid expansion next?
South Dakota was the 39th state to expand Medicaid, leaving 11 others that have not yet done so. North Carolina appears likely to be the next state to expand Medicaid, with coverage expected to become available in late 2023 or early 2024.
Most of the states that have expanded Medicaid in the last few years have done so as a result of voter-approved ballot measures. But those are not an option in most of the 11 remaining states, and are unlikely to be a successful strategy in the states where they are possible.
North Carolina was the first state in several years to approve Medicaid expansion legislatively, and some of the remaining states might follow suit in the coming years. Other states – including Wyoming and Kansas – have seen multiple failed attempts in the past five years to advance expansion legislation
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org since 2013. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
How Friday Health Plans insolvency will affect policyholders in five states
Friday Health Plans, which offers coverage in five states, is winding down its business operations. And in at least three of those states, thousands of enrollees need to select new plans in the coming weeks to avoid becoming uninsured.
Friday Health Plans of Georgia has been placed into receivership, and its health policies will terminate on July 31, 2023. Friday Health Plans of Oklahoma and Friday Health Plans of North Carolina have also been placed into receivership, with coverage ending on August 31, 2023. Enrollees will need to continue paying their Friday Health Plans premiums through those dates to maintain coverage until the plans terminate at the end of July or August, depending on the state.
Policyholders in these states will need to select new health insurance plans if they want to avoid coverage gaps for the remainder of 2023.
Learn more about what to do when your insurer stops offering coverage.
What is the deadline for Friday Health Plans policyholders to select new coverage in Georgia?
If you have Friday Health Plans coverage in Georgia, your policy’s coverage will end July 31, 2023. A special enrollment period for current enrollees began June 1 and continues through September 29.
To avoid a gap in coverage, you need to select a new plan by July 31. That will allow your new plan to take effect without a gap in coverage on August 1. If you wait until August or September to enroll, you’ll go a month or two without any insurance.
How will Friday Health Plans coverage termination affect customers in Oklahoma and North Carolina?
If you have Friday Health Plans coverage in Oklahoma or North Carolina, your policy will end August 31, 2023. A special enrollment period began July 2, and continues through October 30. To avoid a gap in coverage, you need to select a new plan by August 31.
(The special enrollment period runs for 60 days before and after the coverage termination date, which is why the windows don’t align precisely with the start and end of the calendar months.)
Automatic re-enrollment via the federal Marketplace (the exchange used in Georgia, Oklahoma, and North Carolina) is unavailable for mid-year plan terminations. So it’s essential for enrollees to select their own replacement coverage to avoid becoming uninsured.
To be eligible for subsidies, you must obtain your new plan through your state’s Marketplace / exchange. (Subsidized on-exchange enrollment and plan changes can also be made through an enhanced direct enrollment entity.) If you’re certain you aren’t interested in receiving subsidies, you can purchase new coverage directly from an insurer.
Will Friday Health Plans policyholders in Colorado and Nevada have a special enrollment period to buy new coverage?
If you have coverage with Friday Health Plans in Colorado or Nevada, note that no special enrollment period is set at this time. The current expectation is that coverage in Colorado and Nevada will end December 31 for enrollees who continue paying their premiums.
Friday Health Plans policyholders in Colorado and Nevada can select Marketplace plans for 2024 during the usual open enrollment period, which runs from November 1 through January 15 in both states. (A replacement plan will need to be selected by December 31 to take effect January 1.) If that changes, we’ll let you know on the healthinsurance.org website as the story develops. If a policyholder becomes eligible for employer-sponsored coverage, they will need to ask about the employer’s enrollment window.
What will happen to Friday Health Plans customers who have already paid out-of-pocket costs this year?
It is unlikely that your deductible and other out-of-pocket spending will transfer to new policies that take effect mid-year. People who have already paid out-of-pocket costs in 2023 under Friday Health Plans policies in Georgia, Oklahoma, and North Carolina will likely find they are starting over at $0 in out-of-pocket spending under their new policies. In Colorado and Nevada, the Friday Health Plans coverage is expected to continue through December 31. So out-of-pocket costs would reset to $0 on January 1 under a consumer’s replacement policy, just as they would on January 1 with any policy.
Louise Norris is an independent individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org since 2013. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
Are you losing Medicaid eligibility? Here’s what to do next.
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If you’ve received notification that you’re losing Medicaid eligibility, you’re certainly not alone. Millions of Americans will get similar notices in 2023 and 2024, now that states are once again disenrolling people from Medicaid after not doing so between March 2020 and March 2023.
(If you need help to understand why you lost Medicaid, how to avoid loss of coverage or appeal lost coverage, please visit our article explaining Medicaid redeterminations.)
But that doesn’t make it any easier to find out your health coverage is ending. You’re still left with a big question: What to do now that you’ve been declared ineligible for Medicaid and dropped from the program? Let’s take a look.
Can I reapply for Medicaid after my coverage is terminated?
Yes. Enrollment is open year-round, which means you can reapply for Medicaid anytime. So if your circumstances change and you think you once again meet the eligibility criteria (perhaps you experienced a pay cut or job loss), file a new application.
If you ended up losing Medicaid eligibility because you didn’t complete the renewal process, you have a 90-day window when you can get your coverage reinstated if you complete the renewal and are determined eligible.
What are my coverage options if I’m losing Medicaid?
If you’re losing Medicaid and are eligible for a plan from your employer or your spouse’s employer, you’ll be able to enroll in that plan. You also have the option to enroll in a plan offered through the Marketplace/exchange in your state. Here’s what you need to know about these coverage options:
If you became eligible for Medicare during the pandemic but didn’t enroll because your Medicaid didn’t end due to the continuous coverage rule, you’ll have a six-month window when you can transition to Medicare without a late-enrollment penalty. Here’s more about transitioning from expanded Medicaid to Medicare.
What if I can’t afford health insurance and don’t qualify for Medicaid?
It’s important to understand that the rules have changed in recent years to make health coverage more affordable for more people. This includes larger and more widely available subsidies for Marketplace coverage, and a fix for the “family glitch” that makes some employees’ family members newly eligible for Marketplace subsidies.
So it’s very unusual for a person who isn’t eligible for Medicaid (or Medicare) to also be unable to find health insurance deemed affordable. But there are some exceptions, including very low-income adults in states that haven’t expanded Medicaid, as well as people who are ineligible to use the Marketplace because they’re not lawfully present in the U.S.
There are also various medical providers throughout the U.S. that can be used by people who don’t have health insurance, including federally qualified health centers, safety net hospitals, and free or sliding-scale clinics.
Does it matter what state I’m in?
To some extent, yes. If you’ve been notified you are ineligible for Medicaid, there are several things to keep in mind in terms of how coverage options vary from state to state:
The rules for transitioning from Medicaid to an employer-sponsored plan are the same in every state. If you’re transitioning from Medicaid to Medicare, the rules are generally the same nationwide, but there’s state-to-state variation in terms of Medigap access if you’re under 65 or eligible for Medicare due to a disability.
If I’m losing Medicaid eligibility, what happens to my child’s coverage?
Even if you’re no longer eligible for Medicaid, your child still may be eligible for Medicaid or the Children’s Health Insurance Program (CHIP). In every state, children can access these programs with higher household income levels than adults. So your ineligibility does not necessarily translate to your entire household.
If your kids are not eligible for Medicaid or CHIP, you may be able to secure coverage for them through an employer or the Marketplace under the same terms discussed above.
I’m not sure if I’ll lose my coverage. How do I check Medicaid eligibility?
The state will process your renewal when it’s due and definitively determine your eligibility. But if you want to get a rough idea of your eligibility ahead of time, this chart shows Medicaid and CHIP income limits (as a percentage of the poverty level) in each state for children, pregnant women, parents of minor children, and adults under age 65.
And this chart shows the dollar amounts that correspond to various percentages of the poverty level in 2023. Note that the amounts vary depending on how many people are in your household.
If you’re 65 or older, or eligible for Medicaid due to a disability or blindness, your eligibility in most states depends on both income and assets.
Louise Norris is an independent individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
Moving can impact your health coverage
As you get ready to move, it’s important to know that your new address may impact your health coverage options and savings. Don’t forget to update your Marketplace application to get the best plan for your household, and the right amount of savings.
Your next steps depend on where you move
When you move to a new state:
If you move within the same state:
Learn more about making updates to your Marketplace application when your income or household changes.
10 covered Marketplace health benefits
All private health insurance plans offered in the Health Insurance Marketplace® must cover the same essential health benefits. Care in these 10 categories of services is covered by all Marketplace plans.
10 covered benefits:
In addition, plans must also include birth control and breastfeeding coverage. Some plans may offer dental and vision coverage.
Specific services may vary based on your state’s requirements. Get more information on what Marketplace health insurance plans cover.
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Understand your options if you lose Medicaid or CHIP
For the past few years, states had to continue your coverage in Medicaid (and in some cases the Children’s Health Insurance Program (CHIP)), even if your income or other factors changed that would typically make you ineligible.
States are now returning to normal operations, so they’ll recheck your eligibility for these programs again. If your state finds that your household income is now too high or other changes make you ineligible, you may lose your Medicaid or CHIP coverage.
If this happens, you have other options for health insurance.
Your options to enroll in health coverage:
Apply for Marketplace coverage at HealthCare.gov
Enroll now to get coverage that can start the first of next month.
Create an account (or log into an existing one) to start an application.
Explore your eligibility for Medicaid, CHIP, & Medicare
Learn more about staying covered if you lose Medicaid or CHIP.
3 ways to make the most of your health coverage this summer
Summer is here! With Marketplace coverage, you’re already in a great place to have a healthy summer. Learn more about how you can stay well this summer:
3 ways to stay healthy & make the most of your summer:
Health coverage for young adults
Health insurance can protect you at any age. Know your options, whether you’re still covered through a parent’s health insurance plan or searching for your own plan.
4 health insurance options for young adults
Learn more about getting covered if you’re under 30.
New Marketplace coverage changes for COVID-19
The Public Health Emergency for COVID-19 is over. Your Marketplace plan may have some changes to how it covers services for COVID-19.
Coverage changes for COVID‑19
The Special Enrollment Period for the COVID-19 Public Health Emergency ends June 9, 2023.
Learn more about these changes and your coverage options.
Did your income or household recently change?
Be sure to let us know if your income or household size recently changed – like if you got a raise or had a baby – by updating your Marketplace application. New coverage options and savings may be available to you. You may qualify for more savings than you’re getting now, so don’t miss out.
What changes should I report?
Get the full list of changes.
How to report changes
Report changes to the Marketplace by updating your application. You can update your application online, by phone, or in person.
To update your application online, you’ll need to open your existing application and make changes.
Log in to update
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Preventive services you don’t want to skip
Now that you have Marketplace coverage, take advantage of the many free preventive services to help you stay healthy and get the care you need. Getting these services and making healthy lifestyle choices are key steps to good health and well-being. Check with your doctor to find out what services are right for you.
What are preventive services?
Common preventive services
Get more information on preventive and wellness services for your whole household, and learn more about preventive care from the CDC.
The time to file taxes is almost over. Here’s what to know
The last day to file your 2022 federal income taxes is April 18, 2023. If anyone in your household had Marketplace health coverage in 2022, you’ll use Form 1095-A, Health Insurance Marketplace® Statement to file. (If you didn’t get Form 1095-A online or by mail, or if the information on it’s wrong, contact the Marketplace Call Center.)
How to “reconcile” on your tax return
Questions? Free help is available
Life change? You may qualify for a Special Enrollment Period
Life change? You may qualify for a Special Enrollment Period
Open Enrollment for 2023 ended on January 15, 2023, but you may still be able to enroll in or change Marketplace coverage if you’ve had certain life events or income. Life events that may qualify include getting married, having a baby, moving, or losing health coverage. Get a full list of qualifying life changes.
Do I qualify for a Special Enrollment Period?
My income changed. Am I eligible for Medicaid or CHIP?
Learn more about 2023 coverage options.
File your taxes using Form 1095-A, Health Insurance Marketplace® Statement
The tax filing deadline is April 18, 2023. If anyone in your household had a Marketplace plan in 2022, use Form 1095-A, Health Insurance Marketplace® Statement to file your federal taxes. You’ll get this form from the Marketplace, not the IRS. Check your Form 1095-A to make sure your information is correct. Keep it with your other important tax information.
Check your online account for Form 1095-A
If you didn’t get your Form 1095-A in the mail, or you can’t find it, check your HealthCare.gov account:
If you still can’t find your form, contact the Marketplace Call Center.
How to “reconcile” using Form 1095-A
Get to know your Marketplace health plan
Congratulations on getting covered for 2023! Get answers to some common questions about health insurance, like how to find a doctor and learn what prescriptions are covered.
What prescriptions are covered by my plan?
How can I find a doctor in my plan?
How do I use my coverage?
Health insurance and taxes
If you had Marketplace coverage at any point in 2022, or got premium tax credits last year, here’s what you need to know about filing your federal taxes.