Wednesday, November 2, 2016

Determining if your Medicaid is Minimal Essential Coverage (MEC)

Most Medicaid programs are considered "minimum essential coverage" (also known as qualifying health coverage). This means they meet the requirement for having health coverage under the health care law.
  • If your Medicaid program counts as minimum essential coverage: You are not eligible for a premium tax credit or other savings to enroll in a Marketplace insurance plan. You should immediately end Marketplace insurance for anyone in your household who is enrolled in these Medicaid programs and is also using premium tax credits with a Marketplace plan.
  • If your Medicaid program DOESN’T count as minimum essential coverage: You are eligible for premium tax credits and other savings on a Marketplace insurance plan, if you qualify based on your income and other criteria.

Indiana

Medicaid that COUNTS as “minimum essential coverage” in Indiana

If anyone in your household is covered by the following programs, they do have minimum essential coverage. This means they are not eligible for premium tax credits and other savings with a Marketplace plan.
  • Full Medicaid coverage
  • Medicaid for low-income pregnant women Programs that cover the costs of maternity and childbirth services for women who aren’t eligible for Medicaid otherwise.
  • Healthy Indiana Plan 1.0
  • Healthy Indiana Plan 2.0
What to do: If anyone in your household is covered by the programs above, IMMEDIATELY end their Marketplace coverage with premium tax credits. See how to end a Marketplace insurance plan.
They can enroll in a Marketplace plan, but only at full price.

Medicaid that DOESN’T count as “minimum essential coverage” in Indiana

If anyone in your household is covered by only the following programs, they do not have minimum essential coverage. This means they are eligible for premium tax credits and other savings on a Marketplace insurance plan, if they qualify based on their income and other criteria.
  • Limited coverage that pays only for:
    • Family planning
    • Emergency Medicaid
    • Tuberculosis services
    • Outpatient hospital services
What to do: You don’t have to end Marketplace coverage for anyone whose only additional health coverage is provided by the plans above. They can keep their Marketplace plan with tax credits and other savings too. You don’t have to take any action on the notice from the Marketplace.

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