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. ou may also know it as Healthy Michigan. Since Medicaid eligibility depends on many factors, a change in eligibility often follows a change in your life.

If you lose Medicaid eligibility, you can purchase an Individual & family health plan to avoid gaps in coverage. You can enroll in an Affordable Care Act (ACA) plan on the Health Insurance Marketplace® (unless you have an offer of employer-sponsored insurance). Federal subsidies such as premium tax credits and cost share reductions are available to help make it more affordable.

How can I lose Medicaid eligibility?

  • More income: If you get another job or a raise at your current one, you may exceed the maximum income needed to qualify for Medicaid.
  • Inheritance: Receiving money or property as an inheritance can impact your eligibility.
  • Family changes: A marriage or divorce changes your marital status, which will affect your Medicaid status.
  • Pregnancy ending: Medicaid eligibility for pregnant individuals changes after delivery or loss of pregnancy.
  • Moving out of state: Medicaid eligibility can differ from state to state.

Reasons for losing CHIP eligibility

Child Health Insurance Plan (CHIP), known as MIChild in Michigan, is the division of Medicaid that covers children. To qualify for CHIP, you must be 18 years or younger and meet household income requirements.

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 outside the annual Open Enrollment Period (Nov. 1 through Jan. 15) when you can enroll in Individual & family health coverage. This period is triggered by a qualifying life event.

How to get coverage after losing Medicaid eligibility

Losing Medicaid or CHIP doesn't mean you have to go without health coverage. When you lose Medicaid eligibility, a Special Enrollment Period opens, allowing you to enroll in an Individual & Family plan. However, you need to act quickly.

During your Special Enrollment Period, you can apply and enroll up to 60 days before your Medicaid or CHIP coverage ends to avoid a coverage gap. If you miss this window, you'll have to wait for the next Open Enrollment Period.

When applying for Marketplace coverage, you'll be asked if you have job-based coverage. The Marketplace will determine if it meets basic coverage standards and if the premiums are affordable for you. Here's what you can do to find an Individual & family health plan.

  1. Research plans: Compare different plans to find one that fits your needs and budget.
  2. Check subsidies: See if you qualify for federal subsidies like premium tax credits and cost share reductions to lower your costs.
  3. Enroll promptly: Make sure to enroll within your Special Enrollment Period to avoid any gaps in coverage.

By following these steps, you can ensure continuous health coverage even after losing Medicaid eligibility.

Is the process the same if I've lost CHIP eligibility?

When you age out of MIChild on your 19th birthday, you may still be eligible for Medicaid depending on your income. The state will provide information about transitioning to a Medicaid health plan.

To ensure you receive important updates from the state, make sure 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 assistance 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 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 cover more of your health needs and more of Michigan. Individual plans are available across all of lower Michigan.

Call 844.590.0836 to enroll or learn more.

Check if you qualify for additional savings through a federal subsidy.

See plans & prices

 

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.