Medicaid & CHIP

Canceling a Marketplace plan when you get Medicaid or CHIP

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

Any health insurance that meets the Affordable Care Act requirement for coverage. The fee for not having health insurance no longer applies. This means you no longer pay a tax penalty for not having health coverage.

Refer to glossary for more details.

(or "minimum essential coverage"):

You’re no longer eligible for a Marketplace plan with

advance payments of the premium tax credit

A tax credit you can take in advance to lower your monthly health insurance payment (or “premium”). When you apply for coverage in the Health Insurance Marketplace®, you estimate your expected income for the year. If you qualify for a premium tax credit based on your estimate, you can use any amount of the credit in advance to lower your premium. Refer to glossary for more details.

and savings on out-of-pocket costs

Your expenses for medical care that aren't reimbursed by insurance. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that aren't covered. Refer to glossary for more details.

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.

Important: Make sure you're eligible

Don’t end your Marketplace plan before you get a final decision of your Medicaid or CHIP eligibility. If you’re found ineligible for Medicaid or CHIP, you can’t re-enroll in the Marketplace plan unless you qualify for a

Special Enrollment Period

A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount.

Refer to glossary for more details.

. You’d have to wait for the next Open Enrollment Period and may have a gap in 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.

Take action within 30 days

Update your Marketplace application to show you’re not enrolled in Medicaid or CHIP, or end your Marketplace coverage with premium tax credits or other cost savings by the date indicated on your initial warning notice (within 30 days from the date of the notice).

If you don’t take action:

The Marketplace will end the advance payments of the premium tax credit and any extra savings being paid on your behalf for your share of the Marketplace plan premium and covered services
You’ll still be enrolled in your Marketplace plan without financial assistance and will be responsible for paying the full cost of your share of the Marketplace plan premium and covered services

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

If you decide to pay full price for a Marketplace plan

You can have both a Marketplace plan and Medicaid or CHIP, but you’re 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 premium and covered services. If you or others on your Marketplace application choose to have Medicaid or CHIP and full-price Marketplace coverage:

End your Marketplace plan with premium tax credits if you’re the only one on the application. (If others in your household are on the same Marketplace plan, you’ll need to “report a life change” and then select that you’re enrolled in Medicaid or CHIP. When you get to the “Eligibility Results” page, continue to “Enrollment” and select a Marketplace plan for those who are still eligible for Marketplace coverage. Once you’ve confirmed your selection for the rest of the household, enrollment in a Marketplace plan with financial help will end for those who are eligible for Medicaid or CHIP.)
Submit a new application for Marketplace coverage without premium tax credits or other cost savings. Note: You can only enroll in Marketplace coverage during the annual Open Enrollment Period or if you qualify for a Special Enrollment Period.
Notify your state Medicaid or CHIP agency of your Marketplace enrollment. Note: You may no longer be eligible for CHIP.

Ending your Marketplace plan

Answer a few questions for step-by-step instructions on how and when to end your Marketplace plan with premium tax credits and other cost savings.