My medicaid eligibility ended 4/1/15 w/only 4 days notice due to making 257 more a month above poverty limit. If I sign up now through the marketplace when would my coverage begin based on this? Thank you in advance.


You qualify for special enrollment on the day you lose coverage. The new coverage can start as early as the day you lose coverage, but you can apply early.

To make this happen you'll typically have to enroll before you lose the old coverage. The rule of thumb with health insurance is that if you buy coverage before the 15th it starts on the 1st of the following month, if you enroll after the 15th it starts on the 1st of the next. So it's generally a wise move to enroll in special enrollment coverage 30 days before your special enrollment period starts.

Because you didn't get a solid 30 days to enroll before you lose coverage you have a few options. A) Simply enroll ASAP and see how early you can get coverage to start and B) appeal to Medicaid via your state Medicaid department and let them know the situation they put you in. You may be able to get some leeway.

The above is all rule of thumb, you'll always want to double check exact start and end dates. Also you'll need to make the first months payment before your coverage starts. It's also worth noting that Medicaid is unique as  it can start up to two months retroactively (if a person would have qualified for coverage in those months but didn't enroll). So if you switch back to Medicaid keep this in mind, it can help avoid gaps in coverage.

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Diane on

Answer Rating:

Neither of your suggestions worked. There is nothing medicaid could do. They stood by their decision to terminate my eligibility decision and could not extend it until my marketplace purchased insurance kicked in. I spoke to supervisors, directors and my state representative’s (Ken Horn) office and none of them could do a thing. As far as the insurance company (Priority Health), they could not begin my coverage any sooner than they did which is a month after I purchased it. I bought it on the first week of April but it will not go into effect until May 1st. I have mass quantities of gall stones which could burst at any time and have been without emergency room or hospital stay coverage since April 1st. This does not seem right. You have a flaw in your system and someone should really address it. on

Answer Rating:

You are 100% right. Medicaid should have rules about when they can and can’t cancel coverage. If they don’t give a consumer at least 30 days they are essentially forcing a gap in coverage. This means that they risk people needing uncompensated care, going bankrupt due to medical bills, paying less tax dollars, hospital writing off debt and paying less tax dollars, and then just having the person inevitably end back up on Medicaid. Will have to look into this more to see if there is something we are missing, seems short sighted for revenue and harmful to people. on

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Also so it’s clear we are an independent facts site. So you should try going up the food chain at Medicaid or the insurer, appealing, or filing a compliant to HHS or CMS for further action.