Losing Medicaid eligibility doesn't have to mean losing health coverage
Medicaid is a state and federally-funded program that provides health coverage to eligible low-income adults (including pregnant women), children, and people with disabilities. You may also know it as Healthy Michigan. Since Medicaid eligibility depends on many things, a change in eligibility will likely come after a change in your life.
A change in Medicaid eligibility means you can purchase an Individual & family health plan so that you don't have any gaps in your coverage. You can enroll in an Affordable Care Act (ACA) plan on the Marketplace (unless you have an offer of employer-sponsored insurance), and federal subsidies are available to help make it more affordable through premium tax credits and cost share reductions.
How can I lose Medicaid eligibility?
- More income: If you get another job, or a raise at your existing one, you may make more than the maximum income needed to qualify for Medicaid.
- Inheritance: Whether you are left money or property, getting an inheritance gift can impact your eligibility.
- Family changes: A marriage or divorce changes your marital status, and your Medicaid status will change, too.
- Pregnancy ending: Medicaid eligibility for pregnant people changes after delivery or loss of pregnancy.
- Moving out of state: Medicaid eligibility can differ from state to state.
Reasons for losing CHIP eligibility
CHIP is the division of Medicaid that covers children. It stands for Child Health Insurance Plan and is known as MIChild in Michigan. To qualify for CHIP, you must be 18 years or younger and qualify based on household income.
Reasons children can lose eligibility:
- Aging out
Once a child turns 19 years old, they need to qualify for Medicaid eligibility as adults
- Household income
If your household income is more than the maximum for Medicaid eligibility, a child can lose CHIP eligibility
- Non-payment of MIChild premium
If you don't pay the $10 monthly premium payment, you must reapply for MIChild benefits
What is a Special Enrollment Period?
A Special Enrollment Period (SEP) is a time during or outside the annual Open Enrollment Period (Nov. 1 through Jan. 15). If you've gone through a qualifying life event, you can enroll for Individual & family health coverage during your Special Enrollment Period.
How to get coverage after losing Medicaid eligibility
Losing Medicaid or MIChild doesn't mean you have to go without health coverage. A Special Enrollment Period opens when you lose Medicaid eligibility so you can enroll in an Individual & family plan, but you have to act quickly.
During your Special Enrollment Period, you have 60 days after losing your Medicaid eligibility to sign up for an Individual plan, or you'll have to wait for the next Open Enrollment Period.
If not offered employer-sponsored insurance, here's what you can do to find an Individual & family plan.
- Collect any documents that show you lost Medicaid coverage
- You should get a letter from Medicaid or CHIP proving loss of eligibility before your Medicaid coverage ends
- You can request a copy from Medicaid if you've misplaced your letter
- Coverage starts as soon as you make your first premium payment
- Federal subsidies may help lower the cost of Individual & family plans based on your income
Is the process the same if I've lost CHIP eligibility?
You age out of MIChild on your 19th birthday, however, you may still be eligible for Medicaid, depending on your income. You will receive information from the state about moving to a Medicaid health plan.
To make sure you receive important information from the state, check that your contact information is correct in MI Bridges.
MyPriority plans through Priority Health
Priority Health understands that life circumstances can change and you may need some help choosing the best plan for you and your family. Our Michigan-based enrollment specialists can guide you through the enrollment process and answer any questions you have about Individual health plans.
All MyPriority plans include important things like:
- Preventive care, including well-child exams and adult cancer screenings
- Chronic condition coverage for diabetes, high blood pressure, asthma and heart disease
- Low prescription copays
- On-demand mental health support
- Virtual care options
- Maternity care
Priority Health plans don't just cover more of your health needs, they cover more of Michigan; Individual plans are offered across all of lower Michigan.
Call 833.532.0372 to enroll or learn more.
You can also check if you qualify for additional savings through a federal subsidy.
Frequently asked questions
Medicaid is a state and federally-funded program providing health coverage to eligible low-income adults.
CHIP is the Medicaid program for eligible children who are 18 years of age or younger and qualify based on household income.
If you apply for Medicaid benefits and are denied, you qualify for a Special Enrollment Period. Within 60 days of denial, you can look into a MyPriority Individual & family plan.
The process for enrolling in an Individual & family health plan is the same whether you lose Medicaid eligibility or are denied Medicaid eligibility.
A qualifying life event is a major change that opens a Special Enrollment Period, letting you enroll in a plan outside of the annual Open Enrollment Period.
Qualifying life events include marriage, divorce, adding to your family, moving, becoming a U.S citizen, the death of a policy holder, leaving prison, or losing qualifying health coverage, like from a job or Medicaid.
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