Aura Insure
Don’t Wait Until Your Medicaid Coverage Ends
If you know that your Medicaid or CHIP coverage will end soon, you may be able to select a Marketplace plan before the termination date.
Depending on your circumstances, you may qualify to enroll:
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During the 60 days before your Medicaid or CHIP coverage ends
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During the 90 days after losing Medicaid or CHIP
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After a recent Medicaid or CHIP denial in certain circumstances
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During annual Open Enrollment
Starting the process early can reduce the risk of a gap between your Medicaid coverage and your new plan.
A state Medicaid agency may end coverage after reviewing updated information about your household. Common reasons include:
Your Household Income Changed
A raise, new job, additional work hours, marriage or another income change may cause your household to exceed the Medicaid eligibility requirements that apply to you.
Your Household Changed
Marriage, divorce, a child leaving the household or another change in household composition can affect eligibility.
A Child Aged Out of CHIP
Children can lose CHIP eligibility because of age or changes in household circumstances.
Your Eligibility Category Changed
Eligibility can change following pregnancy, a change in disability status or another life event.
Information or Documents Were Missing
Coverage may be terminated if the state could not complete a renewal because requested information was not received.
If you believe your Medicaid coverage ended incorrectly, contact your state Medicaid agency promptly. You may have appeal, reconsideration or renewal options. Applying for Marketplace coverage does not replace your right to question the state’s decision.
Why did my Medicaid Coverage End?
What Are Your Health Insurance Options?
Losing Medicaid does not automatically mean you must remain uninsured. Depending on your household, you may have several options.
ACA Marketplace Coverage
Marketplace plans provide comprehensive individual or family coverage and include the Affordable Care Act’s essential health benefits. They cannot deny coverage or charge a higher premium because of a pre-existing condition.
Eligible households may receive a premium tax credit to reduce the monthly premium. Some applicants may also qualify for cost-sharing reductions that lower deductibles, copayments and other costs when an eligible Silver plan is selected.
Employer-Sponsored Coverage
If coverage is available through your employer or a spouse’s employer, losing Medicaid may allow you to request enrollment outside the employer plan’s normal enrollment period.
Ask the employer about its deadline, premium contribution, provider network and dependent cost before deciding.
Medicaid or CHIP Reconsideration
If your circumstances changed or you believe the decision was incorrect, update your information with your state. Medicaid and CHIP applications are accepted throughout the year.
Medicare
If you are eligible for Medicare because of age, disability or another qualifying condition, Marketplace coverage and financial-assistance rules may apply differently. Review your Medicare eligibility before selecting a Marketplace plan.
What Documents Should You Keep?
Save every notice you receive from your state Medicaid agency. If the Marketplace asks you to confirm your Special Enrollment Period, you may need documentation showing:
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The name of each person losing Medicaid or CHIP
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The type of coverage that ended
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The date coverage ended or will end
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The state agency’s eligibility decision
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The reason for the termination, when stated
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Current household and income information
Potential documents may include:
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A Medicaid or CHIP termination notice
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A denial or eligibility letter
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A renewal determination
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A benefits statement showing the coverage-end date
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Other correspondence from the state Medicaid agency
After selecting a plan, applicants who are asked to verify their Special Enrollment Period generally have 30 days to provide the requested documents. Follow the deadline stated in your Marketplace Eligibility Notice.
When Can New Coverage Begin?
If you already lost Medicaid or CHIP and qualify for a Special Enrollment Period, Marketplace coverage generally starts on the first day of the month after you select a plan.
If your Medicaid will end in the future, selecting a plan before that date may allow your new coverage to begin on the first day of the month after Medicaid ends.
Your coverage cannot be used until any required eligibility documents are approved and the insurance company receives your first-premium payment.
Example
If Medicaid ends on September 30 and an eligible consumer completes enrollment in September, the new Marketplace plan may begin October 1.
Exact effective dates depend on eligibility, application timing and Marketplace rules.
Compare More Than the Monthly Premium
A Marketplace plan with the lowest premium is not necessarily the plan with the lowest overall cost.
Before selecting coverage, compare:
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Monthly premium before and after any applicable tax credit
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Annual deductible
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Primary-care and specialist copayments
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Coinsurance
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Maximum out-of-pocket limit
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Doctor and hospital network
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Prescription formulary and drug tiers
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Prior-authorization requirements
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Referral requirements
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Coverage outside the service area
If you receive regular care, take ongoing medications or have an upcoming procedure, checking these details can be especially important.
Check Your Doctors and Prescriptions
Your Medicaid doctors, hospitals and medications will not automatically be covered by every Marketplace plan.
Before enrolling:
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Search for each doctor using the exact plan’s provider directory.
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Confirm the doctor’s location and medical group.
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Check your preferred hospitals and health systems.
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Review the plan’s prescription formulary.
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Confirm each medication’s tier and restrictions.
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Ask whether referrals or prior authorization will be required.
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Contact the provider or insurance company when coverage information is unclear.
Provider networks and formularies can change. A doctor accepting one plan from an insurance company does not necessarily mean the doctor accepts every plan offered by that company.
Frequently Asked Questions
Does losing Medicaid qualify me for a Special Enrollment Period?
It may. Consumers who recently lost Medicaid or CHIP—or expect to lose it soon—may qualify for a Special Enrollment Period. Your Marketplace application and eligibility results will determine whether you qualify.
How long do I have to enroll after losing Medicaid?
You may qualify to select a Marketplace plan during the 90 days after your Medicaid or CHIP coverage ends. You may also be able to enroll during the 60 days before an upcoming loss of coverage. Apply promptly because deadlines depend on your circumstances.
Can I apply before my Medicaid ends?
Yes. If you know your Medicaid or CHIP coverage will end within the next 60 days, you may be able to apply and select a Marketplace plan before the termination date.
Can I receive financial assistance after losing Medicaid?
Potentially. Eligibility for premium tax credits and cost-sharing reductions depends on current federal rules and information including household size, projected annual income and access to other qualifying coverage.
What if only one person in my household lost Medicaid?
Marketplace eligibility is determined for each household member. Some family members may remain enrolled in Medicaid or CHIP while another person enrolls in a Marketplace plan.
What if my child lost CHIP but I still have Medicaid?
Your child may qualify for a Special Enrollment Period even if other household members remain eligible for Medicaid. Include accurate information for everyone in the household when completing the application.
What if Medicaid ended because I missed a renewal notice?
Contact your state Medicaid agency immediately to determine whether you can complete the renewal or request reconsideration. You can also submit a Marketplace application, but eligibility for a Special Enrollment Period is not guaranteed merely because paperwork was missed.
Will my Medicaid doctor accept my new plan?
Not necessarily. Provider participation varies by insurance company and exact plan. Check the plan directory and confirm participation directly with the provider before enrolling.
When will my Marketplace coverage start?
Coverage generally starts on the first day of the month after plan selection. If Medicaid will end in the future, coverage may begin on the first day of the month after Medicaid ends. Eligibility verification and payment requirements can affect when coverage becomes usable.
Do I have to submit my Medicaid termination letter?
The Marketplace may ask for documents confirming the loss of coverage and its termination date. Your Marketplace Eligibility Notice will explain what is required and provide a deadline.
Where do I pay my first premium?
Pay the first premium directly to the insurance company—not Aura Insure or the Marketplace. Coverage will not become active until the insurance company receives any required payment.
Can I complete the entire process online?
Eligible consumers can use Aura Insure to compare available plans and complete Marketplace enrollment online without a mandatory sales call. Additional verification may be required in some cases.
Ready to Compare Coverage After Medicaid?
You do not have to wait for the Marketplace to contact you. Enter your information to review your eligibility, compare available plans and begin enrollment online.
No mandatory sales call. No high-pressure conversation. Optional assistance is available when you need it.