Losing Medicaid? You Have Options
Nevada Medicaid provides comprehensive health insurance coverage for qualified individuals in the state. Like many states, Nevada has an expanded Medicaid program, meaning that the eligibility requirements are based on income, not just age or disability.
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Every year, Medicaid enrollees have to go through a redetermination process. This process is used by the state to evaluate members and determine whether they are eligible for Medicaid for another year. To renew Medicaid coverage, individuals can complete the redetermination form the State mailed to them. They can also call the Nevada Division of Welfare and Supportive Services at (800) 992-0900 or visit their local district DWSS office.
At the height of the COVID-19 pandemic, Congress barred states from kicking people off Medicaid, and the DWSS temporarily stopped member eligibility redeterminations. Those who were already enrolled did not have to go through the annual verification process. This means that even if they had an increase in their income or a change in their living situation that caused them to become ineligible for coverage, they would not be at risk of losing their Medicaid health insurance coverage.
Despite the fact that there is not yet a date declaring the end of the COVID-19 Public Health Emergency, the DWSS is preparing to resume member eligibility redeterminations. According to an analysis from Urban Institute, resuming redeterminations may lead to as many as 15 million people nationwide, including about 6 million children, losing their Medicaid coverage. In some cases, beneficiaries may not even know that they are no longer covered until they are faced with a bill from their doctor’s office or hospital.
If you are currently on Medicaid, there are some scenarios in which you may soon be at risk of losing your coverage. Knowing your options can help ensure that you do not have a gap in health insurance coverage.
Who Is at Risk of Losing Medicaid Coverage?
There are several reasons that you may lose your Medicaid coverage. By understanding why you are losing your coverage, you can determine what to do next.
You Did Not Complete the Annual Redetermination Form
You are required to go through the redetermination process every 12 months to ensure you are still eligible for Medicaid. Your redetermination month depends on when you first enrolled in Medicaid, and to let you know when you need to update your information, the State sends you a redetermination reminder in the mail.
Soon, your Medicaid coverage will no longer be automatically renewed, so if you did not mail in the redetermination form, call the DWSS or visit your local office, the coverage may be canceled. If that happens and you are certain that you still meet the program’s eligibility guidelines, you can contact the DWSS to get re-enrolled.
Your Income Changed
Medicaid is open to those whose household income is up to 138% of the federal poverty level. In 2022, one-person households can have an annual pre-tax income of up to $18,075. In a four-person household, the income limit is about double that at $36,908.
If your job pays by the hour, even a slight increase in your hourly wage can have a notable impact on your annual income, potentially pushing it over the edge of Medicaid eligibility. While raises may not have impacted your Medicaid eligibility in the past two years, this year may be different.
Your Household Size Changed
A lot can happen in a household in two years. Perhaps you had a child graduate and move out, or perhaps an elderly parent moved in. Medicaid’s eligibility is based on household size, so if your household changed, you may no longer be eligible for coverage.
This rule can be difficult to remember because changes in household size do not necessarily affect household income. Your child that moved out may not have contributed financially, but their leaving brought down your household income limit by over $6,000. Similarly, elderly family members who moved in may have increased the size of your household, but if they receive government or VA benefits such as Social Security or veterans’ pensions, the increase in household income may put you beyond the threshold.
What to Do If You Lose Coverage
Losing health insurance coverage, particularly free health insurance coverage, can be scary. After all, medical debt can be life-changing, potentially causing you to lose your financial security or even your home. Whether you are managing chronic health issues or you just want to make sure annual care is covered, it is important to take immediate action to obtain coverage.
Verify That You Are No Longer Eligible for Medicaid
In some cases, Medicaid coverage is canceled because the individual simply forgot to verify their eligibility. After two years of not having to think about the redetermination process, it can be easy to overlook this requirement.
If you think this may be why you lost coverage, get in touch with the DWSS, and submit an application with your correct information through Nevada Health Link.
Prepare to Enroll in a New Health Insurance Plan
In most cases, you can only enroll in or switch to a new health insurance plan during the annual Open Enrollment Period, which runs from November 1 through January 15. However, if you have lost your health insurance coverage, a Special Enrollment Period opens up.
During this 60-day period, you can enroll in an ACA-compliant plan. If you know that you are getting ready to lose Medicaid coverage, you can sign up in advance. Generally speaking, health insurance plans take effect the first day of the month after you submit an application, but sometimes, processing times are longer.
If you do not enroll in a health insurance plan during that 60-day window, you will have to wait until the next Open Enrollment Period to sign up for coverage.
Look Before You Leap into Short-Term Health Insurance
Short-term health insurance is an attractive option for those seeking affordable coverage. However, it is important to recognize what these plans cover, and just as importantly, what they do not. Short-term plans are meant to be temporary stop-gap coverage. While they have low monthly premiums, the trade-off comes in the form of high out-of-pocket deductibles and copays. These plans do not meet the minimum requirements ACA-compliant plans do, which could leave you with hefty medical bills. In most cases, short-term health insurance plans do not cover preexisting conditions.
Determine Whether you Qualify for Health Insurance Subsidies
Quality health insurance is available through Nevada Health Link, and depending on your household income, coverage may not cost you anything thanks to government subsidies.
Subsidies are tax credits that can cover between 0% and 100% of your monthly health insurance premium. They are calculated automatically by the exchange based on what the benchmark plan in your area costs versus your expected contribution.
How Nevada Insurance Enrollment Can Help
Shopping for new health insurance can be stressful, but fortunately, you do not have to go it alone. At Nevada Insurance Enrollment, our licensed health insurance agents can help you determine whether you qualify for a subsidy and research available health insurance plans that fit your needs and budget.
Read More: Health Insurance in Las Vegas, Nevada
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