Medicaid & CHIP

Canceling a Marketplace plan when you get Medicaid or CHIP

Once you get a final determination that you're eligible for Medicaid or the Children’s Health Insurance Program (CHIP) that counts as qualifying health coverage (or "minimum essential coverage"):

  • You’re no longer eligible for a Marketplace plan with advance payments of the premium tax credit and savings on out-of-pocket costs
  • You should immediately end Marketplace coverage with premium tax credits or other cost savings for anyone in your household who is determined eligible for or already enrolled in Medicaid or CHIP that counts as qualifying health coverage
  • If you still want a Marketplace plan after you’re found eligible for Medicaid or CHIP, you will have to pay full price for your share of the Marketplace plan without premium tax credits or other cost savings

Note: Most programs through Medicaid and CHIP count as qualifying health coverage under the health care law. If your Medicaid program doesn't count as qualifying health coverage, you may be eligible for advance payments of the premium tax credit and other savings on a Marketplace health plan, if you qualify based on your income and other factors. Find out if your Medicaid program counts as qualifying health coverage.

You may get a notice from the Marketplace

If our records show you’re enrolled in both a Marketplace plan with premium tax credits or other cost savings and Medicaid or CHIP — something we check a few times a year — you may get a notice in the mail that lists the household members who are enrolled in both kinds of coverage. The notice explains what to do next.

If you want more information about Medicaid or CHIP, or if you aren’t sure if you or others in your household are enrolled in Medicaid or CHIP, you can contact the office in your state:

If you decide to pay full price for a Marketplace plan

You can have both a Marketplace plan and Medicaid or CHIP, but you’re not eligible to receive advance payments of the premium tax credit or other cost savings to help pay for your share of the Marketplace plan premium and covered services. If you or others on your Marketplace application choose to have Medicaid or CHIP and full-price Marketplace coverage:

  • End your Marketplace plan with premium tax credits if you’re the only one on the application. (If others in your household are on the same Marketplace plan, you’ll need to “report a life change” and then select that you’re enrolled in Medicaid or CHIP. When you get to the “Eligibility Results” page, continue to “Enrollment” and select a Marketplace plan for those who are still eligible for Marketplace coverage. Once you’ve confirmed your selection for the rest of the household, enrollment in a Marketplace plan with financial help will end for those who are eligible for Medicaid or CHIP.)
  • Submit a new application for Marketplace coverage without premium tax credits or other cost savings. Note: You can only enroll in Marketplace coverage during the annual Open Enrollment Period or if you qualify for a Special Enrollment Period.
  • Notify your state Medicaid or CHIP agency of your Marketplace enrollment. Note: You may no longer be eligible for CHIP.

Ending your Marketplace plan

Answer a few questions for step-by-step instructions on how and when to end your Marketplace plan with premium tax credits and other cost savings.

More Answers

What if I have Medicaid now, but I only have limited benefits?

Some limited types of Medicaid coverage pay only for:

  • Family planning
  • Emergency Medicaid
  • Tuberculosis services
  • Outpatient hospital services

If you have limited-benefit Medicaid coverage, you can apply for coverage through the Marketplace to get comprehensive coverage in addition to your limited-benefit Medicaid coverage. Because this type of Medicaid is not considered qualifying health coverage, you may qualify for lower costs on your monthly premiums and extra savings on out-of-pocket costs for a Marketplace plan, depending on your household size and income.

Important: If you have limited-benefit Medicaid coverage, when you fill out a Marketplace application and are asked whether you have coverage now, don’t check the box saying you have Medicaid. Check “None of the above” instead.

Note for current Marketplace enrollees: If you are enrolled in Marketplace coverage with premium tax credits or other cost savings, you don’t have to end your Marketplace plan to enroll in limited-benefit Medicaid. That’s because limited-benefit Medicaid isn’t considered qualifying health coverage. You can apply for this coverage directly to your state Medicaid agency.

What if I’m not enrolled in or eligible for Medicaid or CHIP, but I got a notice?

If you’re not enrolled in Medicaid or the Children's Health Insurance Program (CHIP), and got a notice that you may lose financial help for your Marketplace coverage because of enrollment in one of these programs, you need to tell the Marketplace you’re not enrolled in Medicaid or CHIP by updating your application. If you don’t, you’ll pay more for your monthly premiums because your advance payments of the premium tax credit and cost-sharing reductions (if applicable) will end.

To update your application:

  1. Check out this guide (PDF) for help. It’s a good idea to keep it open, so you can follow the steps to correctly update your information.
  2. Report a life change by the date indicated on your notice — within 30 days.