If I get Medicaid but am offered private insurance with work but cost too much can I stay with Medicaid?

[coolann902]

I currently have Medicaid and just  recently got offered health insurance at work. I was excited until I started looking at my options and realized that it would take at least half my paycheck each time to get the minimum I need and I just can't afford that. I have done a lot of research on this topic and can't find an answer. I woul like to know before I have to sign up on February 14th. I don't want to get penalized if I can't stay with Medicaid and then have no insurance because I didn't sign up with the work provided health insurance since it is a high cost.

[JillianG]

There is no easy answer to this question because there are several different things that could happen....you could keep the Medicaid and not take the insurance through your job however if for some reason you lose the Medicaid you may have missed the open enrollment period with your employer.  If that happens you will still be able to get health insurance but based on your income you may not qualify for any tax credits.

Hope this helps clarify everything!!

[Olivia522]

Most likely you cannot stay on Medicaid. Medicaid as well as plans through the Marketplace are for people who do not have access to health insurance. If your employer offers health insurance you technically have access —  unless the plans are unaffordable. But that’s subjective therefore there’s a specific formula to determine if it’s unaffordable. And even if you qualify based on that formula - you’d have to make sure you don’t exceed Medicaid’s income requirements. Can you just keep it (Medicaid) and not report your new income? Sure. However the state can find out. 

[Critter]

May I suggest you seek options with the ACA if your income is that low and you will make too much to be on Medicare  ...   https://www.healthcare.gov/subscribe/?gclid=Cj0KCQiA_rfvBRCPARIsANlV66NGqdazLzlccvws2cSUUpa0m2owADQT...

[amaxwell1]

All of these answers are incorrect. I will take them pint by point

1. Medicaid is income-based, not access -based. You can qualify for Medicaid even if your employer offers health insurance.
2. If you lose your Medicaid coverage for some reason, that would be considered a qualifying event, and you would be able to add coverage with your employer outside of the open enrollment period. Examples of these are things like having a baby, getting married, or losing other coverage.
3. Medicaid is not Medicare. Medicare coverage is based on age, or having certain medical conditions. The ACA Marketplace will determine your eligibility for Medicaid, and if you qualify (based on income) that is the option that you will be offered. It will be then be administered through your state. Again it doesn't matter if your employer makes insurance available. McDonald's probably has employee insurance plans available. But many of their employees are likely still receiving Medicaid, because their wages are low enough for them to qualify.

Hope this helps!

[az148]

Another question is, why do you need premium assistance for Medicaid when you are eligible for Medicaid? Trying to understand who qualifies for premium assistance and why not stick to Medicaid if you are given the option of Medicaid and ESI. Thank you!

[Opus 17]

Medicaid eligibility is governed by state law. You will have to ask the administrative agency within your state about the rules for Medicaid, and the rules for keeping Medicaid if you are eligible for other coverage.

[aaskemp]

Hi @amaxwell1 

I know you wrote this reply several years ago but, I am looking for an answer to this question too. You seem to have the answer but I just wanted to double check. Would you be able to provide where you got that information from?

My husband has insurance through his employer and we were having medicaid as secondary insurance. However, the primary insurance (through my husband's work) is taking a lot out of his paycheck and not really doing anything because medicaid just picks everything up. (we got medicaid because we couldn't afford the healthcare costs. - I started not going to the doctor to try and save money 😕   ). 

Anyway, 

I'm trying to find information as to whether Medicaid will penalize us for going off of my husband's insurance. (our gross income - which qualified us for Medicaid - will not change. but we will be getting a bit more from his actual pay check without having $ taken out for the employer-offered insurance. )

If you have a moment, could you please help me find the pertinent rules/regulations/information?

Thanks