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Frequently Asked Questions

Frequently Asked Questions

Medicaid and CHIP

Is my child eligible for Medicaid or CHIP?

States have different income eligibility rules, but in most states, children up to age 19 with family income up to $48,500 per year (for a family of four) may qualify for Medicaid or the Children’s Health Insurance Program (CHIP). In many states, family income can be even higher and children can still qualify.

Young people up to age 21 may be eligible for Medicaid. Youth who have aged out of foster care can be covered under Medicaid until they reach age 26; there is no income limit for these youth.

Resource: Insure Kids Now

Who can apply for Medicaid and CHIP for a child?

A parent, grandparent, guardian or other authorized representative can apply on behalf of a child. If you are a teenager living on your own, your state may allow you to apply for Medicaid on your own behalf or any adult may apply for you.

Resource: Insure Kids Now

Is there a limit on the amount of time my child or teen can remain enrolled in Medicaid or CHIP?

Children and teens can stay covered as long as they qualify. You will need to renew their coverage once a year.

Resource: Insure Kids Now

How do I know when to renew Medicaid or CHIP coverage for my child or teen?

The program will contact you to let you know that it is time to renew your child’s coverage.

Resource: Insure Kids Now

Is there a limit on the amount of time my child or teen can remain enrolled in Medicaid or CHIP?

Children and teens can stay covered as long as they qualify. You will need to renew their coverage once a year.

Resource: Insure Kids Now

When can I enroll in Medicaid through the Marketplace?

You can enroll in Medicaid or CHIP at any time during the year, not just during Open Enrollment.

Marketplace

What is the health insurance Marketplace?

Health Insurance Marketplaces (also known as Exchanges) are new organizations that will be set up to create more organized and competitive markets for buying health insurance. They will offer a choice of different health plans, certifying plans that participate and providing information to help consumers better understand their options. Through the Marketplace, individuals and families will be able to shop for coverage if they need to buy health insurance on their own. Premium and cost sharing subsidies will be available through the Marketplace to reduce the cost of coverage for individuals and families, based on their income. Individuals and families with very low incomes will also be able to find out at the Marketplace if they are eligible for coverage through Medicaid and CHIP.

Finally, small businesses can also buy coverage for their employees through the Small Business Health Options Program (SHOP) Marketplace. There will be a health insurance Marketplace in every state for individuals and families and for small businesses. Some Marketplaces will be operated by the State and have a special state name (such as CoveredCalifornia or The Maryland Health Connection). In other states where the federal government runs the Marketplace, it will be known as “The Health Insurance Marketplace of [state name]”.

Who can buy coverage in the Marketplace?

Most people can shop for coverage in the Marketplace. To be eligible you must live in the state where your Marketplace is, you must be a citizen of the U.S. or be lawfully present in the U.S., and you must not currently be incarcerated.

Not everybody who is eligible to purchase coverage in the Marketplace will be eligible for subsidies, however. To qualify for subsidies (also called premium tax credits) people will have to meet additional requirements having to do with their income and their eligibility for other coverage.

Health Insurance Marketplace Calculator 

When can I enroll in Medicaid through the Marketplace?

You can enroll in Medicaid or CHIP at any time during the year, not just during Open Enrollment.

Can I buy or change private health plan coverage outside of Open Enrollment?

If you have a qualifying life event, like the ones listed below, you can sign up for private coverage. You can enroll at any time, even outside the Open Enrollment period. 

Events that trigger a special enrollment opportunity are:

  • Loss of eligibility for other coverage. (For example, if you quit or lost your job, or if your hours were reduced.) If you didn't pay premiums and lost other coverage, that does not trigger a special enrollment opportunity.
  • Gaining a dependent (for example, if you get married or give birth to or adopt a child). Note that pregnancy does NOT trigger a special enrollment opportunity.
  • Loss of coverage due to divorce or legal separation
  • Loss of dependent status (For example, “aging off” a parent's plan when you turn 26)
  • Moving to another state or moving outside of your health plan service area
  • Exhaustion of COBRA coverage
  • Loss of eligibility for Medicaid or the Children’s Health Insurance Program
  • If you are enrolled in a Marketplace plan, changes in income may affect your eligibility for subsidies
  • Change in immigration status
  • Enrollment or eligibility error made by the Marketplace or a government agency or somebody acting on their behalf made an error.

Some events will only qualify you for enrollment in the health insurance Marketplace. They do not apply outside the market. For example, if you gain citizenship, the Marketplace must provide you with a special enrollment opportunity.

When you experience a qualifying event, your enrollment opportunity will last 60 days from the date of that event. If you predict a qualifying event, you can ask the Marketplace for a special enrollment opportunity. For example, you know the date when you will graduate and lose student health coverage. You must notify the Marketplace up to 60 days in advance so new coverage will take effect after your old coverage runs out. 

States have the flexibility to expand special enrollment opportunities for consumers. Check with your State Marketplace for more information.

I like my Marketplace plan just the way it is. Will it stay the same every year?

Insurers are allowed to make changes to policies each year. Most likely, the premium for your policy will change. There may be other changes in the deductible or copays for some services. In some cases an insurer may stop offering a particular policy and offer you new choices, instead. Shortly before Open Enrollment begins, you should receive a notice from your insurance company describing any changes to your policy and the new monthly premium. If you want to continue the policy you can renew coverage for another year. If you prefer to shop for other coverage, you can do that during Open Enrollment.

Learn more about How ACA Marketplace Premiums are Changing by County in 2021.