What happens if you have medicaid and private insurance

Medicaid is one of the most famous entitlement programs in America, but there is some confusion on who can apply and how they can do it. Medicaid is available to people who fit into several categories, including those with very low incomes, some who are disabled and the children of people who fit into various categories. If you’re thinking about trying to qualify for Medicaid, you need to know whether you qualify. One of the most common questions has to do with private health insurance. Are you barred from seeking Medicaid if you already have insurance? The short answer is “no,” but there are other questions to answer about your financial situation.

Table of Contents Show

Apply for Medicaid and CHIP 2 ways
1. Through the Health Insurance Marketplace®
2. Through your state Medicaid agency
Medicaid & CHIP basics
More answers: Medicaid & CHIP
What is the highest income to qualify for Medicaid?
Can you have Medicaid and private insurance at the same time in Texas?
What are the disadvantages of Medicaid?
Can you have private and Medicaid in NC?

Medicaid eligibility varies from state to state
The first thing to know about Medicaid eligibility is that there is no singular national standard. The original version of the Affordable Care Act sought to force states to expand Medicaid to include people up to a higher level of income. The Supreme Court struck this down as unconstitutional, though, leaving states to make a choice on expansion. While some states chose to expand the program, others chose to keep it the same. This has let to a hodgepodge of state requirements.

General financial requirement for this means-tested program
Medicaid qualifies as what’s known as a “means-tested” program. This means that if you are going to receive assistance, you’ll need to meet the government’s standard for neediness. In most states, you can receive Medicaid so long as you earn 200% of the federal poverty level or less. In some states, this figure is much lower. People living either in poverty or right at the federal poverty level can generally qualify.

This is true whether you have private insurance or not. Some people are lucky enough to work for employers that provide insurance coverage. In many instances, those people are also earning very little money in their jobs. The test for Medicaid eligibility is not whether you receive insurance from an employer or from the private marketplace. Rather, it has to do with your level of income and other eligibility factors.

Medicaid assistance for qualifying applicants who already have insurance
If you already have insurance coverage but want to apply for Medicaid, you should know that the program will work a bit differently in your case. For the typical person who does not have insurance, applying for Medicaid will mean that they will receive coverage under the program. If you already have insurance coverage, then you are eligibility to receive premium assistance through the Medicaid program. The program will recognize that you are struggling to pay your premiums, so you can keep your current insurance while receiving a helpful check from the government.

Those who want to receive Medicaid should check their state law to see the income cutoff and other eligibility requirements. You aren’t barred just because you have insurance, but the benefits you receive will be somewhat different from the person who seeks Medicaid while having no insurance at all. Your state’s health department can provide information on how to best handle these issues.

Jim Treebold is a North Carolina based writer. He lives by the mantra of “Learn 1 new thing each day”! Jim loves to write, read, pedal around on his electric bike and dream of big things. Drop him a line if you like his writing, he loves hearing from his readers!

Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities.

Some states have expanded their Medicaid programs to cover all people below certain income levels.

See if you qualify for Medicaid based on income alone
Find out if you qualify for Medicaid based on your income. Enter your household size and state in our savings tool, and we'll tell you if you qualify for Medicaid or savings on a Marketplace plan.
FIND OUT NOW

Even if you don't qualify for Medicaid based on income, you should apply. You may qualify for your state's program, especially if you have children, are pregnant, or have a disability. You can apply for Medicaid any time of year — Medicaid and CHIP do not have Open Enrollment Periods.

Note: Medicaid & CHIP program names vary. Learn what they’re called in your state.

Apply for Medicaid and CHIP 2 ways

1. Through the Health Insurance Marketplace®

Fill out an application through the Health Insurance Marketplace®.

If it looks like anyone in your household qualifies for Medicaid or CHIP, we’ll send your information to your state agency. They’ll contact you about enrollment.
When you submit your Marketplace application, you’ll also find out if you qualify for an individual insurance plan with savings based on your income instead. Plans may be more affordable than you think.

Create an account to start a Marketplace application.

2. Through your state Medicaid agency

You can also apply directly to your state Medicaid agency. Select your state below for your Medicaid agency’s contact information.

Pick your state to start your application for health coverage.

Medicaid & CHIP basics

Medicaid basics

In all states, Medicaid provides coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities.
In some states, Medicaid has been expanded to cover all adults below a certain income level. Learn more about Medicaid expansion in your state and what it means for you.
Medicaid programs must follow federal guidelines, but coverage and costs may be different from state to state.
Some Medicaid programs pay for your care directly. Others use private insurance companies to provide Medicaid coverage.

Children’s Health Insurance Program (CHIP) basics

In all states, CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers pregnant women.
Each state works closely with its state Medicaid program.
In many cases, if you qualify for Medicaid your children will qualify for either Medicaid or CHIP.
Learn more about CHIP.

More answers: Medicaid & CHIP

What’s the income level to qualify for Medicaid?

It depends on the state you live in.

If your state has expanded Medicaid: You can qualify based on income alone. See if you’ll qualify.If your state has not expanded Medicaid: You may qualify based on your state’s existing rules. These vary from state to state and may take into account income, household size, family status (like pregnancy or caring for young children), disability, age, and other factors. Because each state and each family situation is different, there’s no way to find out if you qualify without filling out an application.

If my income’s too high for Medicaid, can I buy insurance through the Health Insurance Marketplace®?

Generally yes, as long as you qualify to use the Marketplace. Most people whose incomes are just above the level to qualify for Medicaid can pay very low premiums and out-of-pocket costs for private health insurance through the Marketplace. Find out if you’ll qualify for savings.

What if I'm eligible for Medicaid, but want to buy an insurance plan in the Marketplace instead?

A Marketplace insurance plan would cost more than Medicaid and usually wouldn’t offer more coverage or benefits. If you qualify for Medicaid, you aren’t eligible for savings on Marketplace insurance. You’d have to pay full price for a plan.

What if I have Medicaid now, but I have only limited benefits?

Some limited types of Medicaid coverage pay only for:

Family planning
Emergency Medicaid
Tuberculosis services
Outpatient hospital services
Coronavirus disease 2019 (COVID-19) testing

If you have limited Medicaid coverage, you can fill out an application through the Health Insurance Marketplace® and find out if you qualify for comprehensive coverage through either Medicaid or a Marketplace insurance plan with savings based on your income.

Important: If you have limited Medicaid coverage, when you fill out a Marketplace application and are asked if you have coverage now, don’t check the box saying you have Medicaid. Check “None of the above” instead.

What rules apply to former foster children and Medicaid?

All states must offer former foster children uninterrupted Medicaid coverage until they turn 26, as long as at least one of the following is true:

They were in the foster care system and received Medicaid benefits on their 18th birthday
They aged out of the foster care system with Medicaid coverage after they were 18 or older

Note: If the foster child moves to a new state, the new state’s Medicaid agency may not provide coverage. Check with your state Medicaid agency to learn more.

What if I’ve been turned down for Medicaid or CHIP coverage?

You may be able to buy a private health plan through the Marketplace instead. You may qualify for savings based on your income through a premium tax credit and savings on out-of-pocket costs. Many people can find plans for $75 or less per month.

If your state Medicaid or CHIP agency said you’re not eligible

If your state agency decides someone in your household isn’t eligible, you’ll get a notice explaining this.
In most cases, the state will send your information to the Marketplace. The Marketplace will send you a notice explaining how to submit an application for a private insurance plan. The application will be pre-filled with information you gave the state agency.

If your state hasn't expanded Medicaid coverage

If your state hasn’t expanded Medicaid and your state agency said you’re not eligible under its current rules, you may have fewer options for coverage. Depending on your income you may not qualify for savings on a private insurance plan.
Learn about your options if you’re in this situation.

What is the highest income to qualify for Medicaid?

Federal Poverty Level thresholds to qualify for Medicaid The Federal Poverty Level is determined by the size of a family for the lower 48 states and the District of Columbia. For example, in 2022 it is $13,590 for a single adult person, $27,750 for a family of four and $46,630 for a family of eight.

Can you have Medicaid and private insurance at the same time in Texas?

If approved, Medicaid may pay the private health insurance costs for the entire family and not just for the family members who get Medicaid. The family will get services through the private health insurance plan.

What are the disadvantages of Medicaid?

Disadvantages of Medicaid They will have a decreased financial ability to opt for elective treatments, and they may not be able to pay for top brand drugs or other medical aids. Another financial concern is that medical practices cannot charge a fee when Medicaid patients miss appointments.

Can you have private and Medicaid in NC?

To be eligible for Medicaid payment of premiums, the beneficiary must be authorized for Medicaid and have access to private health insurance through an employer. NC Medicaid will pay the premiums only on existing employer-based policies, including COBRA, or those known to be available to the beneficiary.