What to Do if You No Longer Qualify for Medicaid
If you’ve received notice that you no longer qualify for Medicaid, don’t panic.
There are other options for affordable coverage, including the federal Health Insurance Marketplace. You might also be able to get coverage through your or your spouse’s employer.
How to Get Started
To shop for health insurance, go to the Federal Marketplace (healthcare.gov) or shop for Affordable Care Act (ACA)-regulated plans offered by Avera.
- Enter your ZIP code and answer some basic questions about yourself and your family members. Be as accurate as you can to get the most accurate cost estimates.
- You’ll get a list of Bronze, Silver and Gold plans and your estimated monthly premiums for each of these plans, depending on your household size and income.
- You may qualify for financial assistance in the form of tax credits, reducing your premium.
- You might qualify for extra savings on out-of-pocket costs through Silver plans, again based on your income and household size.
How Do I Know What Marketplace Plans Cover?
All Marketplace plans are compliant with the Affordable Care Act and have 10 essential benefits:
- Outpatient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance abuse services
- Prescription drugs
- Rehabilitative and habilitative services
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
You can click on Plan Details to learn more about the plan.
What’s the Difference Between Plans?
Marketplace plans will differ depending on their deductible, co-insurance and co-pay amounts as well as the family or individual out-of-pocket maximum. It’s important to pay attention to these amounts because these are your responsibility if you have an illness or injury.
Focus on the most affordable premium with the smallest out-of-pocket costs.
Take Health Systems Into Consideration
The plans you look at may be associated with a health system, like Avera. If you choose an Avera plan, your in-network providers will be mostly Avera providers along with many independent providers. If you see an out-of-network provider, you’ll pay more.
Avera’s network is comprehensive with 60 medical specialties and a large network of clinics and hospitals. If you need an area of specialty that is not in-network, you’ll still be covered by an out-of-network referral. If you travel out of network, you’re always covered for urgent or emergency services.
If You’re Ready to Purchase
If you see a plan you like and want to apply for coverage, click Enroll Now.
The website will walk you through the steps to apply for coverage. If you lost your Medicaid coverage, you will qualify for a special enrollment period (SEP). You can apply for new coverage up to 60 days after coverage ends.
Want Help Getting Health Insurance?
To talk to a licensed agent about Avera Health Plans options by calling 605 504-3360.
Or call the Marketplace Call Center at 800-318-2596. TYY users can call 855-889-4325. Visit localhelp.healthcare.gov to find someone in your area.
