It can be expensive to pay for health insurance when you lose your job, but many people don’t realize that they’re eligible for Medicaid coverage. If you live in one of the 36 states that expanded Medicaid coverage for low-income adults, you can qualify for coverage if your monthly income is less than $1,467 for an individual or $3,013 for a family of four — even if you earned a lot more than that during the first few months of the year.
This type of Medicaid has different eligibility requirements than the version that provides nursing home coverage for people over age 65 — there is no asset test for this type of Medicaid. Instead, eligibility is based on your family size and your modified adjusted gross income (sometimes called MAGI Medicaid).
“Many people don’t know that they’re eligible for Medicaid,” says Robin Rudowitz, co-director of the Program on Medicaid and the Uninsured at the Kaiser Family Foundation. “Medicaid is based on monthly income, so people who have significant drops in income could become eligible. There is no open enrollment period for Medicaid, so when people experience a change in their circumstances, they don’t have to wait for a special open enrollment period to enroll.”
If you lose your job and are only receiving unemployment benefits, or your income has dropped substantially, it’s worthwhile to see if you’re eligible for Medicaid before signing up for other coverage. “If you live in an expansion state, you should look at Medicaid first,” says Karen Pollitz, senior fellow at the Kaiser Family Foundation. “Medicaid is comprehensive — it will cover hospitalization, doctor visits, lab tests, immunizations. There’s no premium, except in a handful of states, and there aren’t big deductibles.”
[Read: How to Pay for Coronavirus Medical Expenses.]
Here’s more information about how to qualify for Medicaid, how the coverage works and what you can do if your state hasn’t expanded coverage.
Who Is Eligible for Medicaid?
In the 36 states that expanded coverage to low-income adults after the Affordable Care Act was passed, you can generally qualify for Medicaid if your monthly modified adjusted gross income is less than 138% of the federal poverty level. That’s $1,467 per month for an individual or $3,013 for a family of four. (The income limits are higher in the District of Columbia.)
State unemployment benefits are included in the income calculation, but the extra $600 per week in supplemental federal pandemic unemployment benefits doesn’t count toward the income limits.
See the Kaiser Family Foundation’s Medicaid Income Eligibility Limits table for each state’s requirements.
Use the Medicaid Quick Screening tool at Healthcare.gov (or calculators at your state’s health insurance marketplace) to find out if you are eligible for your state’s Medicaid program and for links to your state’s Medicaid agency, where you can find more information and apply for coverage. Also see the Contact Your State Medicaid Agency list at Medicaid.gov for more resources.
In the 14 states that didn’t expand Medicaid eligibility, the income limits for adults are much lower (and some states don’t provide Medicaid for childless adults at all). If you have children, however, they may qualify for coverage under the Children’s Health Insurance Program, or CHIP. See the Kaiser Family Foundation’s CHIP Income Eligibility Limits table for each state’s requirements.
When and How Can You Sign Up for Medicaid?
You can enroll in Medicaid any time that you’re eligible based on your income — there’s no open enrollment period or time limit to enroll after losing your job. You may even be eligible if you don’t lose your job but your monthly income drops below the cut-off, says Sara Collins, vice president of health care coverage and access at the Commonwealth Fund.
Coverage usually begins on the first day of the month you apply, and you may also be able to get up to 90 days of retroactive coverage if you would have been eligible during that time based on your income, says Joe Weissfeld, director of Medicaid initiatives for Families USA, a national nonpartisan consumer health care advocacy organization. “If you didn’t realize that you were eligible three months earlier, or you had a catastrophic event, you’re able to have retroactive coverage back 90 days based on your eligibility,” he says.
You can usually apply through your state insurance marketplace (find links at Healthcare.gov) or your state Medicaid agency. “The best way to know if you can get Medicaid is to apply,” says Charles Gischlar of the Maryland Department of Health. He says most Marylanders apply for Medicaid through the Maryland Health Connection, the state’s health insurance marketplace. In Minnesota, most people apply for Medical Assistance, the state’s Medicaid program for people with low income, through the MNsure.org state insurance marketplace.
[Read: How Are Unemployment Benefits Taxed?]
You usually need to provide pay stubs, income tax returns or W-2 forms when you apply, but if you lost your job you can also submit an affidavit or notice of employment termination to document the loss of income, says Gischlar. “Individuals who have experienced a job loss can calculate their household income using the ‘calculate income without a tax return’ form,” he says. If your income ends up being too high to qualify for Medicaid, the Maryland Health Connection will let you know if you’re eligible for a premium subsidy to buy health insurance on the state’s marketplace.
If you need extra help figuring out whether you’re eligible for Medicaid or applying for the coverage, you can work with navigator and assistance programs in your state. You can find them through the ” find local help” link at Healthcare.gov or through your state’s marketplace.
How Does the Coverage Work? Are There Premiums and Cost-Sharing?
You usually pay no premiums and little or no cost-sharing, but the specifics depend on the state. Maryland Medicaid, for example, has no premiums and no copay or deductible requirements, except for a $1 copay for preferred drugs and $3 for non-preferred drugs (those copayments may be waived if you sign up for coverage through a Medicaid managed care organization). In Minnesota, there’s no premium for adults on Medicaid, but they generally pay a $3.35 monthly deductible, $3 copay for non-preventive visits (no copay for mental health visits), $3.50 copay for nonemergency ER visits, $3 or $1 copay for prescription drugs (up to $12 per month). Monthly copays and deductibles are limited to 5% of the family income.
“There are a lot of federal and state protections to make sure that the coverage is pretty comprehensive,” says Weissfeld. He says about three-quarters of the states have a Medicaid managed care program with a provider network. “But the networks are also fairly comprehensive, and the states are required to have certain requirements in terms of access,” he says.
In Maryland, for example, more than 85% of those who have Medicaid get their services through HealthChoice, which is Maryland’s Medicaid managed care program, says Gischlar. “Those eligible for HealthChoice pick the Managed Care Organization they want for their care and access services through the MCO’s provider network,” he says. Medicaid beneficiaries who are not enrolled in HealthChoice still get Medicaid services, but on a fee-for-service basis, he says. The cost-sharing may be different in the managed care organizations — for example, some waive the copayments for prescription drugs.
[Read: How to Get Health Insurance When You’re Unemployed.]
What if You Earn Too Much to Qualify for Medicaid or Your State Hasn’t Expanded Coverage?
In states that haven’t expanded Medicaid coverage, the income requirements may be very low, or you may only be able to get coverage for your children (CHIP income requirements are generally higher).
If your income is too high to qualify for Medicaid, then you may be able to get an individual health insurance policy through your state insurance marketplace or Healthcare.gov. You usually need to sign up during open enrollment in the fall, of you may qualify for a 60-day special enrollment period if you lose your job (and some states are offering special coronavirus enrollment periods for people who didn’t have employer coverage).
If your household income is from 100% to 400% of the federal poverty level (which is up to $49,960 if you are single, $67,640 for couples or $103,000 for a family of four), then you can qualify for a subsidy to help pay the premiums. The calculation for the subsidy is different than it is for Medicaid — it’s based on your annual income (you estimate your income for the current year when you apply) and includes any income you receive from state unemployment benefits as well as the $600 per week in supplemental federal pandemic unemployment benefits.
The Kaiser Family Foundation’s subsidy calculator can help you estimate if you are eligible for the premium help, and you can see the specific costs after the subsidy at your state marketplace or Healthcare.gov.
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How to Qualify for Medicaid originally appeared on usnews.com