Losing Medicaid/Medi-Cal coverage

If you’re losing your Medicaid coverage, there are several ways to stay covered, including:

• An individual plan through Kaiser Permanente for Individuals and Families (KPIF), which can be bought directly through Kaiser Permanente or your state’s Health Benefit Exchange. If you qualify for financial assistance, you’ll need to purchase your plan through your state’s Health Benefit Exchange. To see if you qualify, and view plan rates and benefits, visit buykp.org.
• Employer sponsored coverage is health coverage provided by an employer or organization of someone in your household such as a spouse, domestic partner, or parent (for children up to age 26). Each employer or organization has their own enrollment rules, so check for eligibility information.
• Medicare plans that are highly-rated and provide affordable coverage if you’re 65 or older. Some individuals with disabilities under age 65 are eligible for both Medicare and Medicaid or Medi-Cal. If you are enrolled in a Dual Eligible Special Needs Plan (D-SNP) and no longer qualify for Medicaid, you’ll need to choose a different Medicare plan. To learn about your Medicare plan options, visit kp.org/medicare. Or call 1-855-832-0353, TTY: 711 (7 days a week, 8 a.m. to 8 p.m.) to speak with a Kaiser Permanente Medicare Specialist.

• If you buy a Kaiser Permanente Individual or Family plan through Kaiser Permanente or the Health Benefit Exchange, coverage can start the first day of the month after you lose your coverage, depending on when you apply.
• If employer-sponsored coverage is an option, you will have 60 days to enroll after the termination of your Medicaid plan. Enrollment rules vary among employers and organizations. Check directly with your employer or HR representative for coverage details.
• Medicare coverage can start as early as the first day of the following month, depending on when your application is received.

Depending on your family size and income level, you may qualify for federal financial assistance to help pay your monthly membership fees or reduced out-of-pocket costs for care. If you choose an individual plan through Kaiser Permanente for Individuals and Families (KPIF), you can buy your plan directly through Kaiser Permanente or through your state’s Health Benefit Exchange. To find our if you qualify for financial assistance, visit healthcare.gov, or your state’s Health Benefit Exchange.

You may also be eligible for affordable, employer sponsored coverage. Check with your employer or HR representative for eligibility details.

To find out if you qualify:

• Check healthcare.gov or your state’s Health Benefit Exchange to see if you qualify for Medicaid, CHIP, or other government-funded programs.
• To learn about Kaiser Permanente’s Medical Financial Assistance and Charitable Health Coverage programs, visit kp.org/mfa and kp.org/chc.

Depending on your circumstances, the deadline to enroll varies. If you have a major life event — known as a qualifying life event — like losing coverage because you no longer qualify for Medicaid/Medi-Cal, you can apply for coverage for a limited time outside the yearly open enrollment period. This is called a special enrollment period.

• If you’re applying for an individual plan, you have a special enrollment period that typically lasts 60 days from the date of your life event, but in some cases extends from 60 days before to 60 days after the event.
• If you’re applying for employer-based coverage, you also have a special enrollment period, but in this case, it lasts at least 30 days from the date of your life event — duration varies by employer.

You’ll want to act quickly: If you don’t apply by your deadline, you’ll usually need to wait until the following year’s open enrollment period to apply for new coverage.