Lost Medicaid? Your Marketplace Options Explained

Why did this happen?

During COVID, states were not allowed to remove anyone from Medicaid. Enrollment grew to over 94 million people. When those protections ended in April 2023, states had to re-check everyone's eligibility. This process, called "unwinding," took about 18 months in most states.

The numbers are striking: 25 million people lost coverage. About 69% of those were dropped for procedural reasons, meaning they didn't return paperwork on time, their address was wrong, or the state couldn't verify their information. Many of them were still eligible but got caught up in the bureaucracy.

Starting in 2026, states are also required to conduct eligibility redeterminations every six months (previously once a year), which means more frequent opportunities to lose coverage if paperwork falls through the cracks.

First: try to get your Medicaid back

If you were dropped for a procedural reason and you think you still qualify, you may be able to get reinstated. Contact your state Medicaid office and ask about the appeals or reinstatement process. Some states have extended deadlines for people who were improperly terminated.

Income thresholds for Medicaid vary by state. In states that expanded Medicaid, adults generally qualify with income up to about 138% FPL ($21,597 for one person in 2026). In non-expansion states, eligibility is much more limited, often restricted to pregnant women, children, and people with disabilities.

Marketplace coverage: your main alternative

Losing Medicaid triggers a Special Enrollment Period. In most states, you get 90 days (not 60) to enroll in a marketplace plan. This extended window was created specifically because of the volume of Medicaid redeterminations.

If your income is now between 100% and 400% FPL ($15,650 to $62,600 for a single person), you qualify for a premium tax credit. If it's below 250% FPL and you choose Silver, you also get cost-sharing reductions.

Many people transitioning from Medicaid have incomes in the 138%-200% FPL range. At that level, a Silver CSR plan can have deductibles under $1,500 and copays of $5-$15, which is much closer to what Medicaid covered. The premium after subsidy might be $20-$80/month.

Check what you might pay

Transitioning from Medicaid can feel overwhelming. Nora can find marketplace plans that match what Medicaid covered — low copays, low deductibles — in your area.

Find affordable plans

The coverage gap problem

If you live in a state that did not expand Medicaid and your income is below 100% FPL, you fall into what's called the coverage gap. You earn too little for marketplace subsidies (which start at 100% FPL) and too much for your state's limited Medicaid program.

This affects residents of Texas, Florida, Tennessee, Mississippi, and several other non-expansion states. Options are limited in this situation:

• Community health centers provide care on a sliding fee scale regardless of insurance status
• Some hospitals offer charity care or financial assistance programs
• You can buy a marketplace plan at full price, but without a subsidy this is expensive
• Check if your state has any limited coverage programs for adults

CHIP for children

If your children lost Medicaid or CHIP coverage, they may still be eligible. CHIP income limits are higher than adult Medicaid limits in most states, often up to 200-300% FPL. You can apply for CHIP year-round at HealthCare.gov or by contacting your state directly.

Even if your children don't qualify for CHIP, they can be included on your marketplace plan and covered by your premium tax credit.

How to enroll

1. Gather your Medicaid termination notice. This is your proof of the qualifying event. If you don't have a letter, your state Medicaid office can provide one, or the marketplace may be able to verify your status electronically.
2. Ask Nora to find marketplace plans for you, or go directly to HealthCare.gov (or your state's exchange) to start an application.
3. Estimate your annual income for 2026. Include all sources: wages, self-employment, unemployment, Social Security, etc.
4. Compare plans carefully. If you qualify for CSR, Silver will almost certainly be the best value. The deductibles and copays are much lower than what the sticker price suggests.
5. Pay your first premium. Coverage starts the 1st of the month after you enroll (or the month after next if you enroll after the 15th).

Don't let it lapse

Going uninsured after Medicaid is risky, especially if you have ongoing prescriptions or health conditions that Medicaid was covering. A single ER visit without insurance can result in bills of $5,000 or more. The 90-day enrollment window is generous, but don't wait until the last week. Processing delays happen, and a missed deadline means waiting until the next Open Enrollment in November.