Why did this happen?
During COVID, states were not allowed to remove anyone from Medicaid. Enrollment grew to over 94 million people. When those protections ended in April 2023, states had to re-check everyone's eligibility. This process, called "unwinding," took about 18 months in most states.
The numbers are striking: 25 million people lost coverage. About 69% of those were dropped for procedural reasons, meaning they didn't return paperwork on time, their address was wrong, or the state couldn't verify their information. Many of them were still eligible but got caught up in the bureaucracy.
More changes start in 2027. States that expanded Medicaid must begin checking eligibility for expansion adults every six months instead of once a year, which means more chances to lose coverage if paperwork falls through the cracks. Those states must also start applying new work and community engagement requirements to many adults ages 19 to 64 by January 1, 2027, though some states may get more time.
One rule to know before you shop: if you are denied or lose Medicaid because you didn't meet the work requirements, you can't get a premium tax credit for a marketplace plan instead. If you lost Medicaid for another reason, such as higher income, the marketplace options below apply.
First: try to get your Medicaid back
If you were dropped for a procedural reason and you think you still qualify, you may be able to get reinstated. Contact your state Medicaid office and ask about the appeals or reinstatement process. Some states have extended deadlines for people who were improperly terminated.
Income thresholds for Medicaid vary by state. In states that expanded Medicaid, adults generally qualify with income up to about 138% FPL ($22,025 for one person). In non-expansion states, eligibility is much more limited, often restricted to pregnant women, children, and people with disabilities.
Marketplace coverage: your main alternative
Losing Medicaid triggers a Special Enrollment Period. In most states, you get 90 days (not 60) to enroll in a marketplace plan. This extended window was created specifically because of the volume of Medicaid redeterminations.
If your income is now between 100% and 400% FPL ($15,960 to $63,840 for a single person for 2027 coverage), you qualify for a premium tax credit. If it's below 250% FPL and you choose Silver, you also get cost-sharing reductions.
Many people transitioning from Medicaid have incomes in the 138%-200% FPL range. At that level, a Silver CSR plan has much lower deductibles and copays than a standard plan, and out-of-pocket costs are capped at $4,000 for one person in 2027 instead of $12,000. That is closer to what Medicaid covered. For a single person, the expected payment for the benchmark Silver plan in 2027 ranges from about $65 a month at 138% FPL to about $180 a month at 200% FPL. Bronze plans can cost less.
Check what you might pay
Subsidy Estimator
Enter your info below to get a rough estimate of your monthly premium tax credit for a 2027 marketplace plan.
Transitioning from Medicaid can feel overwhelming. Nora can find marketplace plans that match what Medicaid covered — low copays, low deductibles — in your area.
The coverage gap problem
If you live in a state that did not expand Medicaid and your income is below 100% FPL, you fall into what's called the coverage gap. You earn too little for marketplace subsidies (which start at 100% FPL) and too much for your state's limited Medicaid program.
This affects residents of Texas, Florida, Tennessee, Mississippi, and several other non-expansion states. Options are limited in this situation:
- Community health centers provide care on a sliding fee scale regardless of insurance status
- Some hospitals offer charity care or financial assistance programs
- You can buy a marketplace plan at full price, but without a subsidy this is expensive
- Check if your state has any limited coverage programs for adults
CHIP for children
If your children lost Medicaid or CHIP coverage, they may still be eligible. CHIP income limits are higher than adult Medicaid limits in most states, often up to 200-300% FPL. You can apply for CHIP year-round at HealthCare.gov or by contacting your state directly.
Even if your children don't qualify for CHIP, they can be included on your marketplace plan and covered by your premium tax credit.
How to enroll
- Gather your Medicaid termination notice. This is your proof of the qualifying event. If you don't have a letter, your state Medicaid office can provide one, or the marketplace may be able to verify your status electronically.
- Ask Nora to find marketplace plans for you, or go directly to HealthCare.gov(or your state's exchange) to start an application.
- Estimate your annual income for the coverage year. Include all sources: wages, self-employment, unemployment, Social Security, etc.
- Compare plans carefully. If you qualify for CSR, Silver will almost certainly be the best value. The deductibles and copays are much lower than what the sticker price suggests.
- Pay your first premium. If you pick a plan before Medicaid ends, coverage starts the 1st of the month after Medicaid ends. If you pick it later, coverage starts the 1st of the month after you enroll.
Don't let it lapse
Going uninsured after Medicaid is risky, especially if you have ongoing prescriptions or health conditions that Medicaid was covering. A single ER visit without insurance can result in bills of $5,000 or more. The 90-day enrollment window is generous, but don't wait until the last week. Processing delays happen, and a missed deadline means waiting until the next Open Enrollment (November 1 through January 15 on HealthCare.gov).