If I have Medicaid or CHIP, am I considered “covered” by the health care law?

Yes. If you have Medicaid or CHIP you don’t have to buy a Marketplace insurance plan. You don’t have to pay the fee that people without health coverage must pay. (Certain limited coverage Medicaid plans, like those that cover only family planning or outpatient hospital services, don’t qualify as coverage under the health care law.)

What services does Medicaid cover?

Medicaid benefits are different in each state. But all states provide comprehensive coverage.

What’s the income level to qualify for Medicaid?

It depends on the state you live in.

If your state

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has expanded Medicaid: You can qualify based on income alone. See if you’ll qualify in healthcare.gov.

If your state has

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not expanded Medicaid: You may qualify based on your state’s existing rules. These vary from state to state and may take into account income, household size, family status (like pregnancy or caring for young children), disability, age, and other factors. Because each state and each family situation is different, there’s no way to find out if you qualify without filling out an application.

If my income’s too high for Medicaid, can I buy insurance through the Health Insurance Marketplace?

Generally yes, as long as you qualify to use the Marketplace. Most people whose incomes are just above the level to qualify for Medicaid can pay very low premiums and out-of-pocket costs for private health insurance through the Marketplace. Find out if you’ll qualify for savings.

What if I’m eligible for Medicaid, but want to buy an insurance plan in the Marketplace instead?

A Marketplace insurance plan would cost more than Medicaid and usually wouldn’t offer more coverage or benefits. If you qualify for Medicaid, you aren’t eligible for savings on Marketplace insurance. You’d have to pay full price for a plan.

What if I have Medicaid now, but I have only limited benefits?

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 fill out an application through the Health Insurance Marketplace and find out if you qualify for comprehensive coverage through either Medicaid or a Marketplace insurance plan with savings based on your income.

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Important: If you have limited Medicaid coverage, when you fill out a Marketplace application and are asked if you have coverage now,

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don’t check the box saying you have Medicaid. Check “None of the above” instead.

What rules apply to former foster children and Medicaid?

All states must offer former foster children uninterrupted Medicaid coverage until they turn 26, as long as at least

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one of the following is true:

• They were in the foster care system and received Medicaid benefits on their 18th birthday
• They aged out of the foster care system with Medicaid coverage after they were 18 or older

These rules apply after January 1, 2014.

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Note: If the foster child moves to a new state, the new state’s Medicaid agency may not provide coverage. Check with your state Medicaid agency to learn more.

What if I’ve been turned down for Medicaid or CHIP coverage?

You may be able to buy a private health plan through the Marketplace instead. You may qualify for savings based on your income through a premium tax credit and savings on out-of-pocket costs. Many people can find plans for $75 or less per month.

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If your state Medicaid or CHIP agency said you’re not eligible

• If your state agency decides someone in your household isn’t eligible, you’ll get a notice explaining this.
• In most cases, the state will send your information to the Marketplace. The Marketplace will send you a notice explaining how to submit an application for a private insurance plan. The application will be pre-filled with information you gave the state agency.

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If your state hasn’t expanded Medicaid coverage

• If your state

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  hasn’t expanded Medicaid and your state agency said you’re not eligible under its current rules, you may have fewer options for coverage. Depending on your income you may not qualify for savings on a private insurance plan.

Some states have expanded their Medicaid programs to cover all people with household incomes below a certain level. Others haven’t.

Whether you qualify for Medicaid coverage depends partly on whether your state has expanded its program.

• In all states: You can qualify for Medicaid based on income, household size, disability, family status, and other factors. Eligibility rules differ between states.
• In states that have expanded Medicaid coverage: You can qualify based on your income alone. If your household income is below 133% of the federal poverty level, you qualify. (Because of the way this is calculated, it turns out to be 138% of the federal poverty level. A few states use a different income limit.)

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See if you qualify for Medicaid in your state based on income alone

Find out if your state is expanding Medicaid and if you qualify based only on your household income. We’ll also tell you if you qualify for savings on a health insurance plan instead.

If your income is low and your state hasn’t expanded Medicaid

If your state hasn’t expanded Medicaid, your income is below the federal poverty level, and you don’t qualify for Medicaid under your state’s current rules, you won’t qualify for either health insurance savings program: Medicaid coverage or savings on a private health plan bought through the Marketplace.

Apply for Medicaid coverage, even if your state hasn’t expanded

Even if your state hasn’t expanded Medicaid and it looks like your income is below the level to qualify for financial help with a Marketplace plan, you should fill out a Marketplace application.

Each state has coverage options that could work for you – particularly if you have children, are pregnant, or have a disability. And when you provide more detailed income information you may fall into the range to save.

If you don’t qualify for either Medicaid or Marketplace savings

• You can get care at a nearby community health center. The health care law has expanded funding to community health centers, which provide primary care for millions of Americans. These centers provide services on a sliding scale based on your income.

• If you don’t have any coverage, you don’t have to pay the fee. Under the law, most people must have health coverage or pay a fee. But you won’t have to pay this fee if you live in a state that hasn’t expanded Medicaid and you would have qualified if it had. This is called having an exemption from the fee. You can get an exemption when you apply for coverage in the Marketplace. Or you can apply for the exemption without having to fill out a healthcare.gov Marketplace application.
• If your expected yearly income increases so it’s between 100% and 400% of the federal poverty level, you become eligible for a Marketplace plan with with advance payments of the premium tax credit (APTC). In this case, you may qualify for a Special Enrollment Period (SEP) that allows you to enroll in a Marketplace plan any time of year. You must contact the Marketplace Call Center

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  within 60 days from the date your income changed to request this SEP. When you call, you’ll need to attest that you:
  • Weren’t eligible for Medicaid when you first applied because you live in a state that hasn’t expanded Medicaid
  • Weren’t eligible for a Marketplace plan with tax credits when you first applied because your income was too low
  • Had an increase in expected yearly income that now qualifies you for a Marketplace plan with tax credits