Switching from Medicaid to ACA Marketplace plans

If you are transitioning from a Medicaid plan to an Affordable Care Aca (ACA) Marketplace plan, the changes and choices may feel overwhelming. Here are 3 big things to know to help you navigate the process.

You have a limited time to enroll in an ACA plan after losing Medicaid eligibility. If you lose Medicaid or Children’s Health Insurance Program (CHIP) coverage, you may qualify for a special enrollment period (SEP). SEPs last for a limited time, so don’t wait.

You can apply and enroll in an ACA Marketplace plan as early as 60 days before your Medicaid or CHIP coverage ends. Applying early helps prevent a gap in coverage, which can help you avoid unexpected health care costs.  

ACA Marketplace plans cover 10 essential health benefits. Depending on the plan, they can offer a wide range of health benefits, including medical, dental and vision coverage, and even mental health and fitness benefits.  

Depending on your income, you may be eligible for subsidies, or savings. These savings come in the form of premium tax credits to lower your monthly premium cost, and cost-sharing reductions to help cover your cost for care. You can see an estimate of your savings and apply for subsidies during the enrollment process.

You can enroll in an ACA Marketplace plan during the annual open enrollment period, which typically runs November 1–January 15, in most states.

If you qualify for a SEP due to the loss of Medicaid coverage, you may be asked to provide documentation to confirm your eligibility for a SEP. Remember, SEPs are time-sensitive, so make sure you apply before your SEP ends.

Looking for coverage after Medicaid doesn’t have to be confusing. UnitedHealthcare provides 1-on-1 guidance from a licensed agent at no cost, to help you find the plan that fits your needs.