Health Insurance After Medicaid: Your Step-by-Step Guide to New Coverage

Losing Medicaid can be a major disruption, especially if you’ve relied on it for your healthcare needs. But you’re not alone. Millions of Americans each year transition from Medicaid to private or subsidized health plans. In 2025, the landscape for health insurance after Medicaid is expanding with more choices, but navigating those options can be overwhelming.

The end of Medicaid doesn’t mean the end of your healthcare coverage—it means it’s time to act quickly and explore your next best option.

Why People Lose Medicaid Eligibility

Medicaid coverage isn’t guaranteed for life. Here are the most common reasons individuals lose eligibility:

• Income changes: If your income exceeds state limits due to a new job or a pay raise.

• Age-out scenarios: Turning 19 (for children) or 65 (transition to Medicare).

• Household size changes: Marriage, divorce, or having children can affect your eligibility.

• Redetermination audits: States are rechecking eligibility annually as part of federal rules.

As of 2025, Medicaid unwinding continues in several states following the end of continuous coverage during the pandemic. That means even small administrative errors can cause someone to lose their benefits—another reason it’s crucial to stay updated and respond promptly to Medicaid notices.

What Happens When Medicaid Ends?

Once your Medicaid coverage ends, here’s what typically happens:

• You receive a termination notice.

• You may be eligible for a Special Enrollment Period in the Health Insurance Marketplace.

• You have 60 days from the date of loss to enroll in a new health insurance plan.

Failure to act within this window could result in being uninsured until the next Open Enrollment period. That could expose you to full medical costs or penalties (depending on your state).

Steps to Take Immediately After Losing Medicaid

If you’ve just lost your Medicaid coverage, take these steps immediately:

1. Confirm your coverage end date.

2. Log in to your state’s Medicaid portal to view your status.

3. Apply for a Marketplace health plan at HealthCare.gov.

4. Gather income documentation to qualify for subsidies.

5. Explore employer-sponsored coverage, if available.

6. Call 1-800-318-2596 (Marketplace call center) for free help.

7. Evaluate all possible options, including short-term and COBRA.

Health Insurance Marketplace Plans

The Affordable Care Act created the Health Insurance Marketplace to help people without coverage get access to affordable plans.

Bronze, Silver, Gold, and Platinum Plans Explained

• Bronze: Lower premiums, higher out-of-pocket costs.

• Silver: Balance between premiums and deductibles; eligible for cost-sharing reductions.

• Gold: Higher premiums, lower out-of-pocket costs.

• Platinum: Highest premiums, but lowest out-of-pocket costs.

Tip: If you had Medicaid, Silver plans may give you the most similar benefits.

Special Enrollment Periods After Medicaid Loss

Losing Medicaid qualifies you for a Special Enrollment Period (SEP). You get 60 days to:

• Apply for a new plan

• Receive federal subsidies (based on income)

• Choose from multiple coverage levels

Failure to act in time will mean waiting until the next Open Enrollment period, typically starting in November.

Affordable Care Act (ACA) Coverage Options

ACA plans offer robust coverage, including:

• Emergency services

• Hospital care

• Preventive services

• Maternity care

• Mental health and substance use services

Subsidies and Premium Tax Credits

Based on your income, you may qualify for:

• Premium Tax Credits to lower monthly costs

• Cost-sharing reductions to reduce deductibles and copayments

In 2025, the Inflation Reduction Act’s enhanced subsidies remain in effect, making ACA plans more affordable than ever before.

Income Requirements for ACA Plans

Income requirements are tied to the Federal Poverty Level (FPL). In 2025:

• 100–400% FPL typically qualifies for assistance

• 138% FPL is the minimum for Medicaid in expanded states

Even if you earn above the Medicaid threshold, ACA plans often remain very affordable.

COBRA Coverage: Temporary Bridge After Medicaid

COBRA allows you to keep your previous health plan temporarily. However:

• COBRA is costly. You pay the full premium plus a 2% administrative fee.

• It only applies if you had employer-sponsored insurance before Medicaid.

• Coverage lasts up to 18–36 months.

Use COBRA as a short-term bridge while researching longer-term solutions.

Employer-Sponsored Health Insurance

If you’ve gained employment, check for health benefits:

How to Enroll in Group Plans Through Work

• Contact your HR department

• Enroll within 30 days of losing Medicaid

• Compare the cost to Marketplace options

In many cases, employer plans offer competitive coverage but may have higher premiums than subsidized ACA plans.

Short-Term Health Insurance Plans

Short-term plans can offer fast, affordable protection:

• Designed for temporary coverage

• Typically, do not include essential benefits

• Often exclude pre-existing conditions

These plans are best used as a backup—not a long-term solution. Use caution and read the fine print.

Medicaid Expansion and Redetermination in 2025

In 2025, more states are reconsidering Medicaid expansion. If your state expands eligibility, you may requalify:

• Monitor your state’s Medicaid website

• Reapply if your income or household changes

• Appeal any denials promptly

Redetermination audits can disqualify you even if you still qualify, so be proactive in submitting documentation.

Health Insurance Through State Programs

Some states offer their own coverage options for those who don’t qualify for Medicaid:

• Basic Health Programs (BHP)

• State-funded plans for low-income residents

• Subsidy enhancements beyond federal programs

These are often managed through state exchanges like Covered California or NY State of Health.

Children’s Health Insurance Program (CHIP)

If you lost Medicaid but have children:

• Your kids may qualify for CHIP, even if you don’t qualify for adult Medicaid.

• CHIP offers low-cost or free care for doctor visits, immunizations, dental, and vision.

Always check CHIP eligibility separately.

Coverage for Seniors: Transitioning to Medicare

If you’re approaching 65, Medicare is your next step:

• Initial Enrollment Period begins 3 months before your 65th birthday

• You may qualify for Extra Help with drug costs

• Medicaid loss doesn’t affect your Medicare eligibility

Coverage for Disabled Individuals

If you’re under 65 and disabled:

• You may qualify for Medicare after 24 months on SSDI

• Medicaid may still apply for long-term care or dual eligibility

Explore both federal and state disability insurance options.

Common Mistakes to Avoid After Medicaid Loss

1. Missing the 60-day enrollment window

2. Assuming you don’t qualify for ACA subsidies

3. Not comparing all available plans

4. Ignoring employer-based options

5. Failing to check for CHIP or local programs

Avoiding these pitfalls can save you time, money, and stress.

How to Compare Health Insurance Plans

Use these criteria:

• Premiums vs. out-of-pocket costs

• Network coverage (doctors/hospitals)

• Prescription drug formularies

• Specialty care needs

Use HealthCare.gov or your state exchange to compare plans easily.

Frequently Asked Questions (FAQs)

How to get health insurance after losing Medicaid?

Apply for a plan at HealthCare.gov within 60 days using the Special Enrollment Period. You may qualify for subsidies.

Can I still get health insurance for 2025?

Yes, through the Marketplace or employer-sponsored plans. Open Enrollment and SEPs make coverage accessible in 2025.

What would happen if Medicaid ended?

You would lose access to Medicaid services but can transition to ACA plans, employer plans, or COBRA coverage.

Can I get insurance if I have Medicaid?

You usually don’t need both, but dual coverage can apply for Medicare recipients. ACA plans and Medicaid don’t typically overlap.

What is the income limit for ACA subsidies in 2025?

Subsidies are available for households earning between 100%–400% of the Federal Poverty Level. Many will pay low or no premiums.

Is CHIP still available if I lose Medicaid?

Yes. CHIP offers coverage for children even if the parent doesn’t qualify for Medicaid.

Final Thoughts

Losing Medicaid doesn’t mean losing health coverage. The key is to act quickly, understand your options, and make an informed decision. Whether it’s through the Marketplace, an employer, short-term plans, or state alternatives, there’s a path forward.

In 2025, enhanced subsidies, extended enrollment periods, and evolving state policies mean more Americans can afford quality care even after Medicaid ends.

Stay proactive. Use official resources. And never delay in seeking coverage—your health depends on it.

The right plan is just a click or call away! Visit NewHealthInsurance.com or call us at 📞 (833) 877-9927.