If you’ve been denied Medicaid due to income, the thought of affording health insurance might seem impossible. But there are options.
This guide is designed to help you learn what might be available to you if you’re denied Medicaid due to income and can’t afford health insurance.
Being denied Medicaid due to income can feel like a dead end, especially when you think you can’t afford any other health insurance options.
But you have more choices than you might think.
This guide will walk you through what to do after a Medicaid denial and introduce you to affordable options, like supplemental and short-term insurance.
You don’t have to navigate your health coverage alone. We can help.
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Denied Medicaid Because You Earn Too Much Money
One of the most common reasons for Medicaid denial is that your household income or assets exceed the state’s established guidelines.
States set specific income levels, known as the Federal Poverty Level (FPL), to determine eligibility for Medicaid and other assistance programs, including savings on Marketplace health insurance and CHIP (Children’s Health Insurance Program).
If your state determines your household income is too high according to these guidelines, you may lose your Medicaid eligibility.
When your income increases, you may lose your eligibility for Medicaid, but that doesn’t mean you’re out of options. Here’s what you need to know.
Health Insurance Marketplace Plans
The Health Insurance Marketplace is an online platform where you can shop for private health plans. If you’ve been denied Medicaid, you may be eligible for significant financial assistance to make a Marketplace plan affordable.
- Premium Tax Credits: These credits can substantially lower your monthly health insurance premium. Depending on your income, you could find a plan with a very low monthly cost.
- Cost-Sharing Reductions: These savings lower your out-of-pocket expenses, such as deductibles, copayments, and coinsurance, making healthcare more accessible.
A Medicaid denial often qualifies you for a Special Enrollment Period, allowing you to enroll in a Marketplace plan outside of the standard open enrollment window.
For some people, even with subsidies, a Marketplace plan is still out of reach. If this is your situation, don’t give up. Consider these alternatives.
Can’t Afford Marketplace Health Insurance
If a traditional health insurance plan is off the table, you can still protect yourself financially.
Supplemental Insurance
While self-pay strategies can help manage costs, a single unexpected medical event can create a financial crisis. This is where supplemental insurance acts as a crucial safety net.
Supplemental insurance plans are not a replacement for major medical insurance.
Most plans provide a cash payout to you, (think reimbursement) when you experience a covered event, like a serious injury or an illness.
For example, a hospital indemnity plan pays you a set amount for each day you are in the hospital.
Yes, you’ll have to pay the bills or make arrangements, but once you file a claim you’ll receive funds.
And that money can be used for anything you need—from paying medical bills to covering household expenses while you are recovering.
This can be a huge help when you’ve been denied Medicaid and lack a comprehensive health plan.
For example, a hospital indemnity plan pays you a set amount for each day you’re in the hospital.
You can use this money for anything you need—from paying your deductible to covering household bills while you’re recovering.
This can be a huge help when you’re denied Medicaid and don’t have a financial safety net.
Available in: FL, GA, MD, NC, NJ, PA, SC, TN, TX, VA (plans & prices will vary)
Short-Term Medical Insurance
Short-term medical plans offer temporary, limited coverage for a specific period, typically a few months to a year. They often have lower premiums than traditional health plans, which can be helpful if you’re denied Medicaid and need a low-cost option.
While they have limitations, short-term plans can offer a few benefits to consider:
- Quick Coverage: You can often enroll in a plan and get coverage within 24 hours.
- Choice of Doctors: Many plans allow you to see any doctor or use any hospital, which can be a valuable benefit if you need to see a specific specialist.
- Customizable Deductibles: You can often choose a plan with a higher deductible to lower your monthly premium, making it a more affordable option.
However, short-term plans are not considered “minimum essential coverage” under the Affordable Care Act.
They often do not cover pre-existing conditions and may have a limited network of doctors. Always read the policy details carefully to ensure you understand what is and isn’t covered.
When in doubt, seek personalized advice from a licensed insurance agent who can help you understand all your choices and find a solution that fits your financial situation.
Example Disclosure
Appeal Your Medicaid Decision
If you’ve been denied Medicaid due to income, double-check the details of your application and the reason for denial.
Errors in reporting income or household size can lead to a denial. File an appeal if you believe there’s been a mistake or your situation has changed (e.g., a recent job loss or reduction in income).
You can often find instructions on how to appeal in your denial letter or by contacting your Medicaid case worker.
Get Help from a Licensed Broker
Even if initial glances at Marketplace plans seem too expensive, you should get a second, expert opinion from a licensed and certified health insurance agent.
In most states, this option is free!
No Cost to You: Their services are typically free to you, as they are compensated by the insurance carriers.
Pros of Consulting a Licensed Agent:
Maximized Subsidies: Agents are experts in navigating the complex subsidy calculations for Premium Tax Credits and Cost-Sharing Reductions. They can ensure you’re getting every dollar of financial assistance you’re eligible for, which can dramatically lower your actual costs.
Understanding Plan Nuances: They can explain the differences between metal levels (Bronze, Silver, Gold), including how deductibles, copayments, and coinsurance truly impact your out-of-pocket costs, helping you find the best value beyond just the premium.
Access to CSRs: They will emphasize how Silver plans, specifically, can offer significantly lower out-of-pocket costs if you qualify for Cost-Sharing Reductions – a critical point many people miss.
Knowledge of State Programs: They are aware of any state-specific premium assistance or other support programs that might exist in your area.
Licensed: FL, GA, MD, NC, NJ, PA, SC, TN, TX, VA
How to Transition from Medicaid to Marketplace
If you lose Medicaid coverage, your information is typically shared with the federal or state health insurance marketplace.
Next, you’ll typically receive a letter with details about your options.
You can enroll in Marketplace coverage once you no long qualify for Medicaid.
Types of Plans Available in The Marketplace
Marketplace plans are categorized by metal level — Bronze, Silver & Gold. Platinum plans are also available in certain areas.
Bronze plans offer the lowest premiums, but they have higher out-of-pocket costs.
Silver plans, on the other hand, are ideal for individuals who qualify for cost-sharing reductions, as they lower expenses for services like doctor visits and prescriptions.
Gold plans typically have higher monthly premiums, but lower out-of-pocket costs.
If you’ve lost Medicaid due to an increase in income, our licensed experts can help you compare your options.
How Much Does Marketplace Health Insurance Cost?
One of the biggest adjustments when transitioning from Medicaid to a Marketplace plan is understanding the costs.
With Medicaid, most services, including medical, dental, and vision care, are typically covered with little to no out-of-pocket expenses.
Marketplace plans, however, come with costs such as monthly premiums, deductibles, copayments, and coinsurance.
While many individuals are eligible for substantial financial assistance through tax credits and subsidies, these additional expenses can still be a significant change.
Your broker can help you understand how these costs work and explore options to minimize them. For example:
- Premium Tax Credits: Reduce your monthly premium based on your income.
- Cost-Sharing Reductions: Lower out-of-pocket expenses for Silver-level plans if you qualify.
- Plan Comparisons: Evaluate Bronze, Silver, Gold, and Platinum plans to find the balance between premiums and out-of-pocket costs that fits your budget.
By working with a licensed agent, you’ll gain clarity on these expenses and ensure you choose a plan that aligns with your healthcare and financial needs.
Available in: FL, GA, MD, NC, NJ, PA, SC, TN, TX, VA (plans & prices will vary)
Federal Marketplace vs. State Marketplace
The Affordable Care Act (ACA) established health insurance marketplaces, also known as exchanges, to provide individuals, families, and small businesses with organized platforms to shop for and enroll in health insurance plans.
These marketplaces officially launched on October 1, 2013, with a primary goal of increasing access to affordable health coverage.
In states that chose not to establish their own, Healthcare.gov serves as the Federal Health Insurance Marketplace, offering a centralized online portal to compare plans, determine eligibility for financial assistance like premium tax credits, and enroll in coverage.
State-Based Marketplace
Many states now operate their own marketplaces, providing residents with local resources, additional subsidies, and a wide range of carrier options.
If you live in Georgia, Maryland, New Jersey, Pennsylvania or Virginia we can help you sign up through your state-based marketplace at no additional cost:
- Georgia Access
- Maryland Health Connection
- Get Covered New Jersey
- Pennie
- Virginia’s Insurance Marketplace
How to Find a Licensed Agent
Navigating the Marketplace can be confusing, but you don’t have to go it alone.
Free assistance is available from licensed Marketplace agents who can:
- Help you compare plans based on your needs and budget.
- Explain financial assistance options, including APTCs and CSRs.
- Ensure you select a plan that includes your preferred doctors and hospitals.
- Never ask for your credit card or payment ensuring a safe transaction.
Contact us to speak with a licensed agent today!
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Ted McNeil
Owner, Broker
BenZen Insurance
An Independent Agency
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Information is meant to be accurate and educational and not intended to be legal, medical or financial advice. Do your own research and contact a professional for help. We earn revenue from partners & advertisers. Read our disclosure for more.
Owner, BenZen Insurance. Licensed insurance broker making it easy for individuals, families and business owners to get affordable health benefits.
His background in marketing, research, insurance, and financial services gives him a unique perspective to help others plan for a secure future and improve their physical, mental, and overall well-being.