The Arizona Republic

Entering the health marketplac­e

Experts say it helps to start search with a plan

- Tom Murphy The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educationa­l Media Group. The AP is solely responsibl­e for all content.

Medicaid coverage will end for millions of Americans in the coming months, and it will push many into unfamiliar territory: the health insurance marketplac­e.

States will start cutting people from the government-funded plans when they no longer qualify based on income, a process that has been paused since shortly after the COVID-19 pandemic hit.

The timing of these cuts will vary. But all states have insurance markets where people who lose Medicaid can buy new coverage with help from subsidies. Some states will even connect shoppers with a potential new plan.

Shopping for affordable insurance that covers regular doctors and prescripti­ons can be daunting, especially in marketplac­es that offer dozens of choices and subsidies to help pay for them.

Experts say it helps to start this search with a plan. Here’s a deeper look at the process.

What’s happening to Medicaid?

Nearly 85 million people are covered by government-funded Medicaid, which focuses on people with low incomes.

At the start of the pandemic, the federal government prohibited states from kicking people off Medicaid if they were no longer eligible. That ban ends this spring, and many people on Medicaid will be introduced to this so-called redetermin­ation process for the first time.

States are already verifying eligibilit­y. Some, like Arizona, Arkansas and Idaho are expected to start ending coverage for ineligible people in April. Most states will be doing that in May, June and July.

Federal officials estimate that more than 8 million people will lose eligibilit­y and leave Medicaid mainly because their incomes have changed.

Where to get new coverage

State-based health insurance marketplac­es created by the Affordable Care Act are the only places where people can buy individual insurance with help from an income-based subsidy. They can be found through the federal government’s website.

Shoppers also can find coverage sold outside these marketplac­es, but it may be risky. For instance, short-term plans can exclude coverage of certain things like a medical condition someone had before signing up.

Income-based subsidies

The cost of any new plan should be one of the first things people consider. Shoppers can get income-based subsidies to help pay monthly premiums of plans they buy on the state-based marketplac­es. Those subsidies were enhanced during the pandemic.

People often don’t realize they can get this help, said Jeremy Smith, director of West Virginia’s health insurance navigator program, which helps shoppers find coverage.

Coverage difference­s

Individual insurance differs from Medicaid in several ways. Some marketplac­e plans come with a big deductible that people must pay before most coverage starts. Shoppers should understand deductible­s and other payments they will need to make before committing to a plan, Smith noted.

Individual insurance also groups hospitals and doctors in networks. The insurance may cover much less of the bill for care received outside those networks. Individual insurance also can give people more care choices. Many doctors don’t accept Medicaid, and states may pay for only a limited amount of prescripti­ons.

Important steps if you’re on Medicaid

Make sure your state program has your current contact informatio­n, including a mailing address plus email and cellphone. They will send notificati­ons if they need more informatio­n or if someone no longer qualifies for Medicaid.

“Everyone should do that before April,” said Joshua Brooker, an independen­t broker based in Lancaster, Pennsylvan­ia.

Start shopping for new insurance before Medicaid ends. Shoppers should allow plenty of time to sort through options. The goal should be to have new insurance that starts the day after Medicaid ends. That would cut down on temporary coverage losses for regular doctors or important medicines.

Once shoppers register to shop in the insurance marketplac­e, they have 60 days to find a plan.

Getting help

Seeking assistance may be a good idea, especially for people who need help figuring out their income for the coming year. That’s needed to calculate subsidies.

States will transfer the names and contact informatio­n of those who no longer qualify for Medicaid to their marketplac­es. They also will send a letter to Medicaid beneficiar­ies telling them how to connect to the marketplac­e, said Kate McEvoy, executive director of the nonprofit National Associatio­n of Medicaid Directors. Some states will go further. California’s marketplac­e, Covered California, will enroll people in a qualified health plan and send them the informatio­n. Those people then must confirm enrollment and pay the first premium to remain covered.

State marketplac­es have navigators like Smith who can help people sort through options and understand potential plans. The government-funded navigators are free to use, but they cannot recommend any specific choices.

Federally qualified health centers also have counselors who can help people apply.

Independen­t brokers also help people sort through options. They will get a fee that usually comes out of the premium you wind up paying.

 ?? DAVID GOLDMAN/AP, FILE ?? States will start cutting people from Medicaid plans when they no longer qualify based on income, a process that has been paused since shortly after the COVID-19 pandemic hit.
DAVID GOLDMAN/AP, FILE States will start cutting people from Medicaid plans when they no longer qualify based on income, a process that has been paused since shortly after the COVID-19 pandemic hit.

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