FAQs

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

Medicaid

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.

Resource: The Kaiser Family Foundation

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

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 know as “The Health Insurance Marketplace of [state name]”.

Resource: The Kaiser Family Foundation 

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.

Resource: The Kaiser Family Foundation

What health benefits are covered under Marketplace plans?

All qualified health plans offered in the Marketplace will cover essential health benefits. Categories of essential health benefits include:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization
  • Maternity and newborn care (care before and after your baby is born)
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including dental and vision care

The precise details of what is covered within these categories may vary somewhat from plan to plan.

Resource: The Kaiser Family Foundation

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.

Resource: The Kaiser Family Foundation

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

In general, you can have a special enrollment opportunity to sign up for private, non-group coverage during the year, other than during Open Enrollment period, if you have a qualifying life event. Events that trigger a special enrollment opportunity are:

  • Loss of eligibility for other coverage (for example if you quit your job or were laid off or if your hours were reduced, or if you lose student health coverage when you graduate) Note that loss of eligibility for other coverage because you didn’t pay premiums 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 parents’ plan when you turn 26)
  • Moving to another state or within a state if you move outside of your health plan service area
  • Exhaustion of COBRA coverage
  • Losing eligibility for Medicaid or the Children’s Health Insurance Program
  • For people enrolled in a Marketplace plan, income increases or decreases enough to change your eligibility for subsidies
  • Change in immigration status
  • Enrollment or eligibility error made by the Marketplace or another government agency or somebody, such as an assister, acting on their behalf.

Note that some triggering events will only qualify you for a special enrollment opportunity in the health insurance Marketplace; they do not apply in the outside market. For example, if you gain citizenship or lawfully present status, the Marketplace must provide you with a special enrollment opportunity.

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

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

Resource: The Kaiser Family Foundation

I like my Marketplace plan just the way it is. Will it stay the same in 2016?

It depends.  Insurers are allowed to make changes to policies each year.  Most likely, the premium for your 2015 policy will change in 2016.  There may be other changes as well, for example, 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.

Resource: The Kaiser Family Foundation

What is the Cadillac tax?

The so-called Cadillac tax is an excise tax on high cost health plans offered by employers. Beginning in 2018, health plans that cost more than $10,200 for an individual or $27,500 for a family plan will be subject to the tax, which is 40% of the amount that exceeds those thresholds. For example, if a family plan costs $30,000, the employer that offers the plan would owe 40% of $2,500 ($30,000 minus $27,500), or $1,000 for each family it covers under that plan.

The tax was intended to be a disincentive for employers to provide overly rich health benefits, and the cost of the health plan is one measure of the level of benefits. However, some plans may cost more because they cover people with higher-than-average health care costs, including retirees, older workers and workers in high-risk occupations. The cost thresholds for plans that cover a significant number of individuals in any of those categories are higher.

Resource: The Kaiser Family Foundation 

Medicare

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