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Loss of Medicaid Coverage

Q. What is Medicaid?
A. Medicaid is a government program that provides health coverage to qualified low-income individuals including 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 requirements. 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 healthcare 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 through our health plans or the Health Insurance Marketplace 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 , you’ll be able to shop for, compare and buy health insurance that fits your medical care needs and budget. You can also see if you qualify for low monthly premiums based on your family’s total income.

Q. What happens if I don’t enroll in health coverage after I’ve lost Medicaid?
A. If you aren’t insured, you may have to pay the fee that some uninsured people pay, which is applied to your tax return that you’ll file in 2015. However, if you don’t have coverage for less than 3 months of the calendar year, you don’t have to pay the fee.

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