Wednesday, November 2, 2016

Important info for families with an ACA plan and a child with Medicaid

Once you get a final determination that you're eligible for Medicaid or the Children’s Health Insurance Program (CHIP) that counts as qualifying health coverage (or "minimum essential coverage"):
  • You’re no longer eligible for a Marketplace plan with advance payments of the premium tax credit and savings on out-of-pocket costs
  • You should IMMEDIATELY end Marketplace coverage with premium tax credits or other cost savings for anyone in your household who is determined eligible for or already enrolled in Medicaid or CHIP that counts as qualifying health coverage
  • If you still want a Marketplace plan after you’re found eligible for Medicaid or CHIP, you will have to pay full price for your share of the Marketplace plan without premium tax credits or other cost savings
Note: Most programs through Medicaid and CHIP count as qualifying health coverage under the health care law. If your Medicaid program doesn't count as qualifying health coverage, you may be eligible for advance payments of the premium tax credit and other savings on a Marketplace health plan, if you qualify based on your income and other factors. Find out if your Medicaid program counts as qualifying health coverage.

You may get a notice from the Marketplace

If our records show you’re enrolled in both a Marketplace plan with premium tax credits or other cost savings and Medicaid or CHIP — something we check a few times a year — you may get a notice in the mail that lists the household members who are enrolled in both kinds of coverage. The notice explains what to do next.
IMPORTANTTake action by the date indicated on your notice (within 30 days). If you’re enrolled in a Marketplace plan and get help paying for coverage, you should end your enrollment. If you choose to stay enrolled in a Marketplace plan, the Marketplace will recalculate your eligibility for this financial help.
If you want more information about Medicaid or CHIP, or if you aren’t sure if you or others in your household are enrolled in Medicaid or CHIP, you can contact the office in your state:
If you still want a Marketplace plan
You can have both Marketplace coverage and Medicaid or CHIP, but you are not eligible to receive advance payments of the premium tax credit or other cost savings to help pay for your share of the Marketplace plan.
  • If you are on an application with other people who are also enrolled in Marketplace coverage: You’ll need to "report a life change"and then select that you are enrolled in Medicaid or CHIP. Continue to confirm enrollment in order to remain enrolled in your plan without premium tax credits or other cost savings.
  • If you are the only person on your application who is enrolled in Marketplace coverage: You’ll need to end your Marketplace plan with premium tax credits and then submit a new application for Marketplace coverage without premium tax credits or other cost savings. You can only enroll in Marketplace coverage during the annual Open Enrollment Period or if you qualify for a Special Enrollment Period.

When and how to end your Marketplace plan

When and how you end your Marketplace plan depends on the following:
  • If you’re currently enrolled in Medicaid or CHIP coverage that counts as qualifying health coverage
  • If you’re ending coverage for the household contact
  • If you’re ending coverage for everyone on your plan or just some members
    • If everyone on your application is found eligible for Medicaid or CHIP, you’ll want to end your Marketplace plan for everybody.
    • If just some people on your Marketplace plan are found eligible for Medicaid or CHIP, you’ll want to end Marketplace coverage only for those who are eligible for Medicaid or CHIP.
IMPORTANT: The household contact is usually the person who created the Marketplace account and may have filled out the application to buy the Marketplace plan for a spouse or dependents. You must contact the Marketplace Call Center to:
  • Change the household contact
  • Remove the household contact from the plan if others in your household are staying on the plan
Don’t try to do this online unless you’re ending coverage for everyone on the plan. It’s important to do this by phone so dependents can stay on the plan.

Steps to end your Marketplace plan

The steps to end your Marketplace plan may be different depending on your situation.

If you’re waiting to hear if you’re eligible for Medicaid or CHIP OR your notice says you “may be eligible” for Medicaid or CHIP

You’ll probably want to wait to end your Marketplace plan if:
  • The eligibility notice you get from the Marketplace when you applied or updated your information says you or others on your application “may be eligible” for Medicaid or CHIP
  • You or others in your household applied for Medicaid or CHIP at your state Medicaid or CHIP agency and you're waiting for your eligibility results
Important: If you end your Marketplace plan before you get a final decision of your Medicaid or CHIP eligibility and are later found ineligible for Medicaid or CHIP, you can’t re-enroll in the Marketplace plan unless you qualify for a Special Enrollment Period. Otherwise, you’d have to wait for the next Open Enrollment Period and may have a gap in coverage. If you can afford health insurance but choose not to buy it, you must have a health coverage exemption or pay a fee.

If your notice says you “are eligible” for Medicaid or CHIP OR you or others in your household are enrolled in Medicaid or CHIP

You’ll want to end your Marketplace plan immediately if:
  • Your eligibility notice from the Marketplace or the state Medicaid or CHIP agency says you or others in your household “are eligible” for Medicaid or CHIP
  • You or others in your household are currently enrolled in Medicaid or CHIP that’s considered qualifying health coverage
  • You received a notice from the Marketplace that says you are enrolled in Medicaid or CHIP

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