Medicaid, CHIP & Medicare Medicaid & CHIP

Cancelling a Marketplace plan when you get Medicaid or CHIP

Once you’re found to be eligible for Medicaid or the Children’s Health Insurance Program (CHIP), you’re considered to have minimum essential coverage. This means if you have a Marketplace plan, you’re no longer eligible for a premium tax credit and savings on out-of-pocket costs.

IMPORTANT If you kept your Marketplace plan after you were found eligible for Medicaid or CHIP, you have to pay full price for the Marketplace plan, without a tax credit or other savings.

In most cases, you’ll want to end your Marketplace plan as soon as you get a final determination that you’re eligible for Medicaid or CHIP. This determination could come from the Marketplace or your state Medicaid or CHIP agency.

You may get a notice from the Marketplace

The Marketplace checks a few times during the year to make sure you’re not enrolled in both a Marketplace plan with advance payments of the premium tax credit and Medicaid or CHIP coverage at the same time.

If our records show you’re enrolled in both a Marketplace plan with savings and Medicaid or CHIP, 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.

IMPORTANT If you or someone in your household is enrolled in Medicaid or CHIP and a Marketplace plan with savings, you should end your Marketplace plan immediately.

If you don’t end your Marketplace coverage, you may have to pay back any advance payments of the premium tax credit you take for the months you have both kinds of coverage.

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:

  • For CHIP, visit www.insurekidsnow.gov, or call 1-877-543-7669
  • For Medicaid, choose your state below

When and how to end your Marketplace plan

When and how you end your Marketplace plan depends on the following:

  • What your eligibility determination notice says
  • If you’re currently enrolled in Medicaid or CHIP coverage that counts as minimum essential coverage
  • If you’re ending coverage for everyone on your plan or just some members
    • If everyone on your application qualifies 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: Changing the household contact. 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. If you end coverage for the household contact, the household contact will remain the contact for everyone staying on the plan. For help updating the household contact, you must contact the Marketplace Call Center. Don’t try to do this online.

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

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 determination of your Medicaid or CHIP eligibility and are later found ineligible, 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

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 minimum essential coverage

Ending a Marketplace plan for everyone on your application

Follow these steps to end Marketplace coverage for everyone on your Marketplace plan:

  1. Log into your Marketplace account
  2. Click “Visit The Marketplace for Individuals And Families”
  3. Select your application under “Your existing applications.”
  4. On the left side of the screen, select “My plans & programs.”
  5. Scroll down and select the red button that says “End (Terminate) All Coverage.”
  6. Select the date you want to end your coverage (as soon as 14 days from the current date).
  7. Check the attestation box.
  8. Click the red “Terminate Coverage” button.

A red “Terminated” or “Cancelled” status should appear above the plan you ended.

You can also end your plan by phone.

Removing a spouse or dependents from your Marketplace plan

Follow these steps to end Marketplace coverage only for some people:

  1. Log into your Marketplace account
  2. Click “Visit The Marketplace For Individuals And Families”
  3. Select your application under “Your existing applications”
  4. Click “Report a life change” on the menu to the left
  5. Click “Report A Life Change” near the bottom of the page
  6. Select “Report a change in my household’s income, size, or other information”
  7. Check the attestation box, then click “Save & Continue”
  8. Continue through the application, updating information as necessary
  9. On the “Who Needs Coverage” page, select all household members who want to keep Marketplace coverage
  10. Click “Save & Continue”
  11. Click "Remove" people who are eligible for or currently enrolled in Medicaid or CHIP
  12. Confirm the removals and answer any following questions
  13. Click “Save”
  14. Note: You must complete steps 10, 11 and 12 for each household member you want to remove from Marketplace coverage. After removing these people from the list of people who need insurance, you need to add them back in as people in your household who don’t need insurance if they’re still members of your tax household (like your spouse or tax dependents on your federal income tax return). This is because your savings are based on income for everyone in your household -- including people who don’t need coverage. Review the list of people who’ll continue with Marketplace coverage, then click “Save & Continue.”
  15. Continue clicking through the application, updating information as necessary
  16. When you get to the screen that asks about your household information, answer the questions appropriately and list members of the tax household. This may include listing people you just removed as an applicant, if they’re still a member of the tax household
    • Click “Save & Continue”
    • Continue clicking through the application, adding or updating information as needed
  17. Click “View Eligibility Results.” After you’ve read them, click “Continue to Enrollment”
  18. Important: Complete all items on the “To-Do List,” including selecting and confirming a plan
    • The plan selection will show only people who applied and were found eligible to enroll in a Marketplace plan. Anyone who is or may be eligible for Medicaid or CHIP OR who are no longer applying for Marketplace coverage won’t appear in the plan selection.
    • Anyone continuing Marketplace coverage must select and confirm enrollment in a Marketplace plan for the coverage changes to take effect. Anyone eligible for a Special Enrollment Period can select a new plan if they want to.
  19. Once enrollment in a Marketplace plan is confirmed, coverage will be ended for the people you’ve removed.

Note: Anyone who has been or may be found eligible for Medicaid or CHIP coverage will not appear in the plan selection.

You can also end coverage for just some members of your household members by phone. Contact the Marketplace Call Center.

Common questions

Some limited types of Medicaid coverage pay only for:

  • Family planning
  • Emergency Medicaid
  • Tuberculosis services
  • Outpatient hospital services

If you have limited Medicaid coverage, you can apply for coverage through the Marketplace to get comprehensive coverage.

You could get this coverage in addition to your Medicaid coverage.

Depending on your household size and income, you may qualify for lower costs on your monthly premiums and out-of-pocket costs for a private insurance plan.

Important: If you have limited Medicaid coverage, when you fill out a Marketplace application and are asked whether you have coverage now, don’t check the box saying you have Medicaid. Check “None of the above” instead.

 
 

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