Losing Medicaid or CHIP? How to Move to Marketplace Coverage

If Medicaid or CHIP is ending, check whether the state decision can be corrected and begin comparing replacement coverage now. You do not need to wait for a Marketplace transfer letter. Preserve the state's response or appeal deadline while applying for a new plan, then confirm the new insurance start date.

Medicaid and CHIP, the Children's Health Insurance Program, provide health coverage under state eligibility rules. The Marketplace sells private insurance and determines whether you qualify for help with its costs. Losing one program can open an enrollment window for another, but it does not automatically enroll you or guarantee a low premium.

Decide what the state notice requires

Find whose coverage is ending, the reason, the final covered day, and any response or appeal deadline. Keep the whole notice, including its date and instructions. A parent's loss of Medicaid does not automatically end a child's coverage.

• Missing renewal information: Contact the state about sending the missing form or proof and having the case reconsidered. Ask whether submitting it restores coverage and from what date.
• Income or household change: Check the people, amounts, and income period used in the decision. If the state used an old situation or the calculation is wrong, follow the correction or hearing instructions.
• Another eligibility rule: Ask which rule changed and whether the state assessed every applicable coverage category. If an immigration rule caused the loss, ask specifically about state-funded coverage and any separate route for lawfully residing children or pregnant people.

If you challenge the decision, ask whether coverage can continue while the appeal is pending and the deadline for requesting that continuation. It can be earlier than the general appeal deadline. An informal call or an unfinished appeal does not establish that coverage remains active.

For a child under 19, check the child's continuous-eligibility period with the state before assuming a parent's new income ends the child's benefits immediately. The children's coverage guide explains that protection and its limits.

Protect the Marketplace enrollment window

Loss of Medicaid or CHIP generally allows Marketplace enrollment during the 60 days before coverage ends or 90 days after it ends. This Special Enrollment Period lets you enroll outside annual Open Enrollment. Use the Marketplace for your state and confirm the enrollment deadline in your eligibility result.

The later deadline is not a promise of uninterrupted coverage. A plan chosen after Medicaid ends generally starts on the first day of the following month. Begin before the old coverage ends when possible, and ask which plan-selection date produces the start date you need.

A denial of a first Medicaid application differs from losing Medicaid you already had. If you never had coverage, answer the application that way. A denial after an earlier Marketplace or state application during an enrollment window can create a separate opportunity when the state decides after that window closes. Not every denial does so.

Submit current information rather than waiting for a transfer

Start or update the application through the Marketplace route after a Medicaid or CHIP decision. States can send your information to the Marketplace, but receiving a transfer letter is not a prerequisite to applying.

Include the state's recent decision, household members, current income, and expected income for the full coverage year. Report whether household size or income changed again after the state acted. The application may identify someone who still needs a Medicaid or CHIP review.

Follow questions about the denial reason carefully. Missing paperwork, an asset-based denial, and an income-based denial are different circumstances. Do not mark someone as having lost existing coverage merely to get past a question.

Save the submitted application and eligibility result. Read that result for the people eligible to enroll, approved savings, enrollment deadline, and any proof required. If the Marketplace needs the loss notice, submit the full document through its secure route by the stated deadline.

Compare the monthly price with the cost of care

The premium is your monthly insurance payment. The deductible is what you pay for services subject to it before the plan starts sharing costs. A copayment is a fixed charge for care; coinsurance is a percentage of the covered charge. The out-of-pocket limit caps covered in-network care costs for the plan year, but excludes premiums and other specified charges.

For the same covered people and months, compare premiums after approved savings with what you would pay for regular visits, medicines, and upcoming treatment. A plan with a lower premium can still cost more for a household using care often. If the application awards income-based reductions in care costs, choose a Silver plan to receive those extra savings.

Check the exact plan with your doctors, hospital, and pharmacy. A familiar insurer's name does not establish that your former Medicaid providers are in its new plan. Ask about specialist referrals and prior authorization, approval the insurer requires before certain care.

Use a current quote for the coverage year. Expanded federal premium subsidies ended after 2025. For tax year 2026, excess advance premium tax credits must be repaid in full, so update income and other coverage promptly. If immigration rules affect eligibility, ask about both the remaining 2026 coverage and the separate Marketplace savings rules beginning January 1, 2027.

Complete enrollment and confirm coverage

Select a plan by your enrollment deadline, complete required verification, and pay any first premium directly to the insurer by its payment deadline. An application result or selected plan alone does not confirm active insurance. Ask the insurer to confirm payment receipt, covered household members, and the effective date.

Compare that start date with the last Medicaid or CHIP day. If they leave a gap, ask the Marketplace which options or start-date rules apply in your case. Do not assume the new insurer pays for care received before its policy began.

If enrollment fails, identify whether the problem is a missing document, payment, or eligibility decision. Use free Marketplace enrollment help to resolve the specific step. If you disagree with an enrollment decision, follow its appeal instructions and deadline.

If Medicaid is later restored or a new employer offers coverage, update the Marketplace and coordinate the end date of any plan you no longer need. A changed eligibility result can also change premium assistance.

Handle uncovered care and older bills separately

For care during a gap, ask a community health center about its available services and income-based charges. For an earlier hospital bill, apply for hospital financial assistance. Neither process completes Marketplace enrollment or pays every bill automatically.

If income has fallen again, a new Medicaid review after an income change may be appropriate. Keep the state and Marketplace notices together so each agency can act on the actual decision and dates.