What’s best for me: Medicaid, CHIP or the Marketplace?

Whats-best-for-me

With the Affordable Care Act came new and expanded options for more Americans to have access to essential health insurance benefits, either through Medicaid or the Health Insurance Marketplace.

  • According to figures released by the Centers for Medicare & Medicaid Services, at the end of 2015, nearly 72 million people were enrolled in either Medicaid or the Children’s Health Insurance Program (CHIP). Slightly more than half were children.
  • As of February 2016, about 16 million people were determined to be eligible to enroll in one of the Marketplace plans, and nearly 13 million people had signed up for a Marketplace plan. A little more than 5 million people were determined or assessed by the Marketplace as eligible for either Medicaid or CHIP.

Medicaid provides no- or low-cost coverage to people below certain income limits, and the Marketplace offers affordable plan options, which are made even more cost-effective thanks to tax credits.

What Do All These Figures Mean?

You have choices when selecting health insurance for you and your family, though your choices change according to your income and whether the Marketplace finds you to be eligible for Medicaid. If you qualify for Medicaid or CHIP enrollment, you do not qualify for a Marketplace plan with advance payments of the premium tax credit or out-of-pocket cost savings. But you still may choose to enroll in one of the Marketplace plans instead.

Pros and Cons of Medicaid vs. Marketplace Plan

Reasons to choose Medicaid:

  • Your costs will be significantly lower. If you qualify for Medicaid but opt for a Marketplace insurance plan, you must pay the full price for premiums and out-of-pocket costs.
  • Your benefits will be comparable to most Marketplace plans.

Reasons to choose a Marketplace plan:

  • Different plans connect you to different networks of providers, and not all providers choose to participate in Medicaid.
  • Some family members do not qualify for Medicaid, and you prefer to keep the entire family on the same plan.

How to Get the Coverage You Want

The steps necessary for ending or switching coverage depend on which household members are found eligible for Medicaid or CHIP and whether you want to keep Marketplace coverage for some, all or none of your family. For anyone eligible or enrolled in Medicaid or CHIP, you should immediately end Marketplace plan coverage if that plan provides advanced payments of the tax credit.

If you received a notice from the Marketplace about your eligibility for Medicaid and have questions about your current coverage or future enrollment options, contact one of our Consumer Advocates, available year-round, to answer your enrollment and coverage questions.

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