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 you can buy directly through Kaiser Permanente or your state’s Health Benefit Exchange

• Employer sponsored coverage – 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). Enrollment rules vary among employers and organization. Check with the employer or organization for eligibility information.

• Medicare – Highly-rated health plans with affordable coverage if you’re 65 or older, or for certain people with disabilities who are under age 65.

• 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.

• 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 you elect COBRA continuation coverage, your employer-sponsored coverage will continue without a break in that coverage.

• If you apply for Medicaid and are eligible for coverage, coverage may start either on the date you apply for Medicaid or the first day of the month you apply, depending on your state’s Medicaid rules.

Depending on your family size and income level, you may be able to get help in a number of ways. You may qualify for:

• Federal financial assistance to help pay your monthly membership bill, or reduced out-of-pocket costs for care

• Coverage through Medicaid, the Children’s Health Insurance Program (CHIP), or other government-funded programs

• Financial assistance through Kaiser Permanente’s Medical Financial Assistance and Charitable Health Coverage programs (not available in all Kaiser Permanente regions)

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 lost your job, getting married or divorced, or having a baby, 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.

• If you opt for COBRA continuation coverage, you can sign up within 60 days of the date you lose coverage or the date you get your COBRA election notice — whichever is later. For state COBRA continuation coverage, sign up by the date specified in your COBRA election notice. Check your election notice to confirm your deadline.

• If you qualify for Medicaid, you can apply anytime — with no time restrictions.

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.