What To Do If You Have Medicare & Lose Medicaid Eligibility

Medicaid programs are administered by each state to ensure low-income individuals and families have the health coverage they need. Some beneficiaries qualify to be enrolled in both Medicare and Medicaid. While seniors 65 and older will always remain eligible for Medicare, it is possible to lose Medicaid eligibility.

Many seniors do not know what happens when they lose Medicaid eligibility. Understanding what happens if you lose eligibility ensures you are prepared for any future changes in your dual-eligible status.

What is dual-eligible status?

Dual-eligible simply means that you are enrolled in both Medicare and Medicaid. 

Medicaid and Medicare work together to ensure that you are not paying out-of-pocket for health coverage bills. If this applies to you, your local Medicare advisor can share more specific information regarding your policies and how they are aligned currently. 

Why did I lose Medicaid eligibility? 

There are a variety of reasons why you may lose Medicaid coverage. Loss of coverage can result from: 

What happens if I am a Medicare Advantage beneficiary and lose Medicaid?

Medicare Advantage members might be affected by the loss of Medicaid, but there is an opportunity to avoid the adverse effects. 

As it pertains to Medicare Advantage clients, losing Medicaid coverage triggers a Special Election Period. You have one opportunity to make an election within three months of the loss, or notification of the loss, whichever is later. 

The effective date for enrollments under this SEP is the first day of the month following receipt of the enrollment application. For this reason, it’s important to stay on top of any Medicare-related correspondences you might receive.

What about Medicare Supplement? 

If you are new to Medicaid and formerly had a Medicare Supplement plan, you have a 24-month suspension period during which you can reinstate your Medigap policy if you were to lose Medicaid benefits.

The key to this grace period is that you must request suspension of the Medigap policy within 90 days of the notification date of Medicaid eligibility.

Recipients are often notified of Medicaid eligibility more than 90 days after the effective date. Therefore, it is the notification date that is recognized as the starting point for the 90-day window.

Have more in-depth questions regarding Medicare Supplement and your Medicaid benefits? Read the full Program Memorandum.

Which states offer a guaranteed issue Medigap policy after the loss of Medicaid eligibility?

There are several states that allow beneficiaries a guaranteed issue Medigap policy after the loss of Medicaid eligibility. You can find more information below about these states’ specific policies and how those can best aid you.

Also, be sure to refer to each state’s Medicaid office for specific guarantee issue time frames.

Steps to Take After Losing Medicaid Eligibility

  1. Review your letter informing you of your eligibility change – it should state the reason your Medicaid eligibility was terminated
  2. Schedule a time to talk with a local Medicare/Medicaid advisor – they can help you determine your appeal options or help you get the new coverage you need in a timely manner
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