Loss of Medicaid Coverage

Q. What is Medicaid?
A. Medicaid is a government program that provides health coverage to qualified low-income individuals. This includes families and children, pregnant women, the elderly, as well as people with disabilities. In some states, the program is available to all adults below a certain income level.

Q. What does Medicaid cover?
A. All Medicaid programs cover basic medical care, such as:

  • Inpatient hospital care
  • Doctors services
  • Outpatient hospital or clinic care
  • Lab and X-ray services
  • Short-term skilled nursing, rehab and home health care
  • Ambulance service
  • Pediatric care

Some Medicaid programs may also cover other medical care such as prescriptions, vision and dental care.

Q. How could I lose Medicaid?
A. Medicaid eligibility is based on many different factors. Some reasons you could lose Medicaid coverage are:

  • You earn too much
  • You are no longer pregnant
  • You are no longer under a certain age
  • You inherit, win or are given assets that change your financial status
  • You fail to report a household change like getting married or adopting/having a child

Q. What are my health care options if I lose Medicaid?
A. If you lose Medicaid, your child or children may be eligible for the Children’s Health Insurance Program (CHIP). You can also buy your own coverage. Choose one of our health plans or the Health Insurance Marketplace leaving site icon during the special enrollment period. Most special enrollment periods last 60 days from the date you lose coverage.

Q. Why should I shop through BCBSTX or on the Health Insurance Marketplace?
A. By using our site or the Health Insurance Marketplace, leaving site icon you’ll be able to shop for, compare and buy health insurance that fits your medical needs and budget. You can also see if you qualify for low monthly premiums based on your family’s total income.

Need more information? Read about these topics.

Originally published 10/2/2014; Revised 2018, 2022, 2023, 2024

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