Lost Medicaid? Your Step-by-Step Guide to Marketplace Coverage

If you recently received a letter saying your Medicaid coverage is ending — or worse, you found out at a doctor's office that your coverage was terminated without warning — you're not alone. And you're not without options.

Over 25 million Americans have been disenrolled from Medicaid since the pandemic protections ended. Here's the part that makes this particularly frustrating: 69% of those terminations were procedural — paperwork issues, unreturned mail, administrative backlogs. Not because people actually became ineligible.

If that's you, take a breath. This guide will walk you through exactly what to do next, whether you might still qualify for Medicaid, and how to get marketplace coverage (often with substantial help paying for it) if you don't.

You have options. Let's figure them out.

---

First Things First: Why Did Your Medicaid End?

Before we move forward, it's worth understanding what happened. Medicaid terminations generally fall into a few categories:

1. Income-Related (Your Income Increased)

This is the legitimate reason. Your household income rose above your state's Medicaid eligibility threshold (typically 138% of the Federal Poverty Level in expansion states, or lower in non-expansion states for adults).

If this is you, marketplace coverage with subsidies is your path forward.

2. Procedural (Paperwork Issues)

This is what happened to the majority. You may have: - Not received the renewal paperwork (wrong address on file) - Received it but didn't respond in time - Submitted incomplete information - Had your case caught up in administrative backlog

If this is you, you may still be eligible for Medicaid. Keep reading.

3. You Moved

Different states have different Medicaid rules. If you moved from an expansion state to a non-expansion state, you might lose eligibility even at the same income level.

4. Age-Out or Life Change

Certain categories of Medicaid (like CHIP for children, or pregnancy-related coverage) have specific eligibility periods.

---

Step 1: Check If You Can Get Medicaid Back

If you believe you were terminated due to procedural issues and you're still income-eligible, don't assume it's final. You may be able to:

Appeal the Decision

You have the right to appeal a Medicaid termination. The timeline varies by state, but typically you have 30-90 days to request an appeal.

To appeal: - Contact your state Medicaid agency directly - Ask for the specific reason for termination in writing - Request a "fair hearing" or appeal - Provide any documentation showing you're still eligible - If approved, your coverage can be reinstated retroactively

Update Your Information and Reapply

If your termination was due to outdated contact information: - Update your address and contact info with the Medicaid agency - Submit a new application - Keep copies of everything you submit

Check for Automatic Reinstatement

Some states have implemented "mitigation strategies" that automatically reinstate coverage for people terminated due to procedural issues. Your state may contact you, or you may need to call them.

Find your state Medicaid office: Search "[Your State] Medicaid" or call 1-800-318-2596 (the marketplace line can connect you).

---

Step 2: If Medicaid Isn't an Option, You Have a Special Enrollment Period

Here's the crucial thing to know: Losing Medicaid qualifies you for a Special Enrollment Period (SEP) on the health insurance marketplace.

This means: - You don't have to wait for Open Enrollment - You can enroll in a marketplace plan right now - You have 60 days from your Medicaid end date to enroll - Coverage can start as soon as the 1st of the following month

Don't wait. A gap in coverage leaves you vulnerable, and losing Medicaid is one of the strongest qualifying events for immediate marketplace enrollment.

---

Step 3: Understand What Marketplace Coverage Will Cost

If you were on Medicaid, you're used to free or very low-cost coverage. The marketplace isn't quite the same, but for people at lower incomes, the help is substantial.

Premium Subsidies

Based on your income as a percentage of the Federal Poverty Level (FPL):

Single Person: | Income Level | % of FPL | Approximate Monthly Premium | |--------------|----------|----------------------------| | $18,000 | 118% | $0-50 (highly subsidized) | | $24,000 | 157% | $50-100 | | $30,000 | 196% | $100-175 | | $40,000 | 262% | $200-300 |

Family of 4: | Income Level | % of FPL | Approximate Monthly Premium | |--------------|----------|----------------------------| | $37,000 | 115% | $0-100 (highly subsidized) | | $50,000 | 156% | $100-200 | | $65,000 | 202% | $200-400 | | $80,000 | 249% | $350-550 |

These are estimates. Your actual cost depends on your location and available plans.

Cost-Sharing Reductions (The Hidden Benefit)

If your income is below 250% of FPL, you also qualify for Cost-Sharing Reductions on Silver plans. This means:

Income	What You Get
100-150% FPL	Deductibles often under $500, very low copays
150-200% FPL	Deductibles often under $1,000, low copays
200-250% FPL	Modest improvements to cost-sharing

This is important: If you're coming from Medicaid, you're probably used to minimal out-of-pocket costs. Choosing a Silver plan with CSR (if you qualify) will give you the closest experience to what you had on Medicaid.

A Bronze plan might look cheaper monthly, but the high deductible ($7,000+) could devastate you if you need care.

---

Step 4: Gather What You Need to Enroll

To complete a marketplace application, you'll need:

For everyone in your household: - Full legal names - Dates of birth - Social Security numbers (or document numbers for legal immigrants) - Citizenship or immigration status

Income verification: - Recent pay stubs - Last year's tax return (helpful for estimate) - Expected annual income for the coverage year - Information about any tax credits/deductions you expect

Coverage information: - Date your Medicaid coverage ended (check your termination letter) - Any current coverage for household members

Pro tip: If you're not sure about your exact income, estimate conservatively. You can update your estimate throughout the year if things change. It's better to slightly underestimate your subsidy than face a big tax-time bill.

---

Step 5: Apply for Marketplace Coverage

You have two main options:

Option A: HealthCare.gov (or your state marketplace)

This is the safest, most direct route.

1. Go to HealthCare.gov (or your state's marketplace if you live in a state-run exchange like California, New York, or Colorado)

2. Click "Get Coverage" or "Apply Now"

3. Create an account (you'll need an email address)

4. Complete the application — this takes about 30-45 minutes

5. When asked about your current coverage situation, indicate that you recently lost Medicaid/CHIP coverage

6. Enter your Medicaid termination date

7. Complete income and household information

8. Review available plans and estimated costs

9. Choose a plan and complete enrollment

Option B: Get Free Help from a Navigator

If the online process feels overwhelming, Navigators are trained counselors who help people enroll for free. They're unbiased (they don't earn commissions) and can walk you through every step.

Find a Navigator: - Go to LocalHelp.HealthCare.gov - Enter your zip code - You'll see local Navigators and their contact info - Services are free

Why consider a Navigator: - They can help you understand your options - They can ensure you report your Medicaid loss correctly - They're especially helpful if you have complicated circumstances (immigration status, variable income, etc.) - No cost to you

---

Watch Out for Scams

Losing Medicaid makes you a target for scammers. In 2024, there were over 275,000 fraud complaints related to health insurance. Here's how to protect yourself:

Red Flags:

• Unsolicited phone calls claiming to be from "the healthcare marketplace"
• Pressure to enroll immediately over the phone
• Requests for payment information before you've chosen a plan
• Promises of "free" or "special" plans not available elsewhere
• Callers who already seem to know your Medicaid status

Safe Practices:

• Go directly to HealthCare.gov — type it yourself, don't click links
• Never give Social Security or payment info to unsolicited callers
• Legitimate marketplace enrollment is free — you should never pay anyone to enroll you
• If someone contacts you claiming to be from the marketplace, hang up and call 1-800-318-2596 directly

If Something Seems Off:

• Check your HealthCare.gov account to see if any applications were started
• If you've been enrolled in a plan without your consent, report it to CMS
• You can file complaints at CMS.gov/Medicare/Fraud

---

What If You're in the Coverage Gap?

If you live in a state that hasn't expanded Medicaid and your income is below 100% of the Federal Poverty Level (roughly $15,000 for a single person), you're in what's called the "coverage gap."

This is a genuinely difficult situation — you earn too little to qualify for marketplace subsidies but too much (or wrong category) for traditional Medicaid. About 1.4 million Americans are stuck here.

Your options are limited but not zero:

Community Health Centers: These federally-funded facilities must serve everyone regardless of ability to pay. Fees are based on a sliding scale.

Free Clinics: Many areas have free clinics staffed by volunteer medical professionals.

Hospital Charity Care: If you need hospital care, ask about charity care programs. Most hospitals are required to have them.

Medicaid for Specific Conditions: Even non-expansion states cover pregnant women, children, and people with certain disabilities. If your circumstances change, you might qualify.

Consider Your Options: If you're in a coverage gap state and have mobility, expansion states offer dramatically better healthcare access.

---

A Quick Action Plan

Here's your checklist:

Within the first week of losing Medicaid: - [ ] Read your termination letter carefully — note the end date and reason - [ ] If it seems like an error, call your state Medicaid office to appeal or reapply - [ ] If you're definitely not Medicaid eligible, start your marketplace application

Before 60 days from your Medicaid end date: - [ ] Complete your marketplace application at HealthCare.gov - [ ] Indicate your Medicaid termination as your qualifying event - [ ] Choose a plan (Silver with CSR if you qualify) - [ ] Complete enrollment

After enrolling: - [ ] Pay your first premium (coverage won't start until you do) - [ ] Get your new insurance cards - [ ] Find in-network providers - [ ] Update any doctor's offices with your new coverage

---

Your Coverage Doesn't Have to Lapse

The gap between Medicaid and marketplace coverage doesn't have to mean weeks or months without insurance. Here's how the timing can work:

Example: Maria's Medicaid ended March 31

• March 31: Medicaid coverage ends
• April 5: Maria completes marketplace application
• April 7: Maria chooses a Silver plan, pays first premium
• May 1: Marketplace coverage begins

Maria has one month without coverage — not ideal, but manageable. If she had applied earlier:

• March 15: Maria knows Medicaid is ending March 31
• March 20: Maria completes marketplace application
• March 22: Maria chooses a plan, pays first premium
• April 1: Marketplace coverage begins

No gap at all.

The takeaway: Apply as soon as you know your Medicaid is ending, not after it's already gone.

---

Frequently Asked Questions

"Can I choose any plan during my Special Enrollment Period?"

Yes. You have access to all plans available in your area, just like during Open Enrollment.

"What if I get a job with health insurance soon?"

If you gain access to employer coverage, that's another qualifying event. You can switch from marketplace to employer coverage without penalty. In the meantime, having marketplace coverage ensures you're not uncovered.

"Will my doctors accept marketplace insurance?"

Marketplace plans use the same insurers that offer employer coverage (Blue Cross, Aetna, Cigna, etc.). Whether your specific doctors are in-network depends on the plan you choose. Check provider directories before enrolling.

"What if I think I was wrongly terminated but also need coverage now?"

You can do both — appeal your Medicaid termination AND enroll in marketplace coverage. If Medicaid reinstates your coverage, you can cancel the marketplace plan. If Medicaid doesn't reinstate it, you're already covered.

"I'm undocumented. What are my options?"

Undocumented immigrants are not eligible for Medicaid (with very limited exceptions) or marketplace coverage. However, community health centers serve everyone, and some states have separate programs. DACA recipients may qualify for marketplace coverage in some states.

"I'm terrified of owing money back at tax time."

This is a common fear, and it's manageable: - Estimate your income honestly (even conservatively) - Update your estimate on HealthCare.gov if your income changes - Repayment caps exist — you won't suddenly owe thousands - The risk of being uninsured is greater than the risk of small tax adjustments

---

The Bottom Line

Losing Medicaid is stressful, especially when it happens for reasons outside your control. But you have a 60-day window to get marketplace coverage — often with substantial subsidies and cost-sharing reductions that make it far more affordable than you might expect.

Don't let that window close.

• If you might still qualify for Medicaid: Contact your state Medicaid office to appeal or reapply.
• If you need marketplace coverage: Go to HealthCare.gov now and start your application.
• If you're overwhelmed: Find a free Navigator at LocalHelp.HealthCare.gov.

You deserve healthcare coverage. The system exists to help people like you access it. Take the next step today.

---

Ready to Get Started?

Not sure which direction to go? Take our quick quiz to understand your options based on your specific situation.

[Find My Options →]

---

Updated December 2025. If you've lost Medicaid coverage, your 60-day Special Enrollment Period is time-sensitive. Don't wait to explore your options.