If you’re moving off Medicaid, the safest play is to line up your next plan before the old one ends. Losing Medicaid opens a Special Enrollment Period on the ACA Marketplace and on most employer health plans, and knowing how to get off Medicaid and find new coverage without a gap comes down to using those windows: up to 60 days before your Medicaid ends and up to 90 days after to pick a Marketplace plan, and 60 days from the loss date to join an employer’s plan.1HealthCare.gov. Staying Covered if You Lose Medicaid or CHIP2U.S. Department of Labor. Losing Medicaid or CHIP? Waiting until coverage has already ended is the most common mistake, and it turns a comfortable transition into a race.
Why Your Medicaid May Be Ending
The path you take depends on why you’re losing coverage. A raise, more hours, or a new job can push your income past the state’s Medicaid limit. Household changes matter too: marriage, divorce, a birth, or a child aging out shifts the income math because Medicaid limits scale with family size.
For older adults, people with disabilities, and those in long-term care, asset limits also apply. In most states a single applicant for nursing home Medicaid or aged, blind, and disabled coverage can hold no more than $2,000 in countable assets, though a handful of states set the limit higher. An inheritance, a settlement, or a retirement account cash-out can end eligibility overnight.
Other common triggers: moving to a different state (Medicaid doesn’t transfer, so you’d reapply in the new state), gaining access to employer coverage, or turning 65 and becoming eligible for Medicare.
Report the Change to Your State Agency First
If your circumstances have changed, tell your state Medicaid agency before you do anything else. Reporting deadlines vary, typically between 10 and 30 days after the change. Most states accept reports through an online portal, by phone, by mail, or in person. Have documents ready: recent pay stubs for income changes, a marriage or birth certificate for household changes, or a benefits summary from a new employer.
Reporting promptly does two things. It starts the clock on your Special Enrollment Period so you can shop for new coverage, and it stops an overpayment from building up that the state may later try to recover.
Your Main Options for New Coverage
ACA Marketplace Plan
The Marketplace (HealthCare.gov or your state’s exchange) is the most common landing spot. You can enroll as early as 60 days before your Medicaid ends and up to 90 days after. Coverage starts the first day of the month after you complete enrollment.1HealthCare.gov. Staying Covered if You Lose Medicaid or CHIP
When your state finds you ineligible for Medicaid, it’s required to assess whether you might qualify for the Marketplace and transfer your information over so you can enroll without starting from scratch.3CMS. Ensuring Seamless Coverage Transitions Between Medicaid, CHIP, and Other Insurance Affordability Programs If a letter from the Marketplace you weren’t expecting shows up, that transfer is why. You can also go directly to HealthCare.gov and start an application; you’ll need proof your Medicaid ended (usually the termination notice), income information, and household details.
Employer-Sponsored Plan
Losing Medicaid also triggers a Special Enrollment Period at work. You generally have 60 days from the date Medicaid ends to request enrollment.2U.S. Department of Labor. Losing Medicaid or CHIP? Contact HR as soon as you know your Medicaid is ending rather than waiting for the termination date.
Compare the employer plan to Marketplace options before committing. Employer coverage skips the premium tax credit — you can’t claim the credit for months you have access to affordable employer coverage — but many employers subsidize a large share of the premium. Look at the whole picture: monthly premium, deductible, out-of-pocket maximum, and whether your doctors and prescriptions are covered. If the employer plan is expensive and doesn’t meet the ACA’s affordability standard, you may still qualify for Marketplace subsidies instead.
Medicare (If You’re Turning 65 or on SSDI)
If you’re leaving Medicaid because you turned 65, Medicare becomes your primary insurance. You’re automatically enrolled in Part A (hospital) and Part B (medical) at 65 if you’re already receiving Social Security benefits.4Medicare.gov. Getting Social Security Benefits Before 65 If you’re under 65 and on Social Security disability, you become eligible for Medicare after a 24-month waiting period.5SSA. Medicare Information
Some people qualify for both. If your income and assets are low enough, Medicaid can stay in place alongside Medicare, helping pay Medicare premiums, deductibles, and copays, and covering services Medicare doesn’t, like long-term care. Ask your state Medicaid agency explicitly about “dual eligible” programs during the transition; not every agency raises it on its own.
What Marketplace Coverage Actually Costs in 2026
Whether a Marketplace plan is affordable depends on the premium tax credit. For 2026, you qualify for the credit with household income between 100% and 400% of the Federal Poverty Level, which is between $15,960 and $63,840 for an individual, or between $33,000 and $132,000 for a family of four.6IRS. Eligibility for the Premium Tax Credit7HHS ASPE. 2026 Poverty Guidelines
This is a meaningful change from recent years. The expanded premium subsidies in place since 2021, which helped people above 400% FPL and lowered premiums across the board, expired at the end of 2025. If you earn more than 400% of the poverty level, you won’t receive a subsidy in 2026, and people below the cap will generally pay more than they would have last year. Budget for that when you compare plans.
If your income sits just above the Medicaid cutoff, the credit can still cover most or all of your premium. In that range, pay particular attention to Silver-tier plans, which carry cost-sharing reductions that lower deductibles and copays on top of the premium discount.
The Marketplace application calculates your subsidy in real time, so you’ll see actual monthly costs before choosing.
Transitional Medical Assistance for Families
If you’re a parent or caretaker relative losing Medicaid specifically because your earnings or work hours went up, you may qualify for Transitional Medical Assistance, which extends Medicaid for up to 12 months after you’d otherwise lose it.8Medicaid.gov. Frequently Asked Questions – Transitional Medical Assistance and Medical Support TMA exists so a better job doesn’t cost your family its health coverage.
The first six months have no income test. Some states offer a second six-month extension that requires you to report earnings and stay below 185% of the Federal Poverty Level, about $50,542 for a family of three in 2026.9Medicaid.gov. Transitional Medical Assistance Other states run a single 12-month period with no income test the whole way through.8Medicaid.gov. Frequently Asked Questions – Transitional Medical Assistance and Medical Support
TMA is for families only, meaning parents and caretaker relatives of dependent children. Single adults without dependents don’t qualify. Your state Medicaid office should flag TMA when your coverage is under review, but not every state does that reliably, so ask.
Short-Term Plans as a Narrow Bridge
If the gap is brief, such as waiting for an employer plan’s effective date, a short-term policy can prevent a total lapse. Under current federal rules, these plans can last up to three months initially, with a maximum total coverage period of four months including renewals.10CMS. Short-Term, Limited-Duration Insurance Final Rules
Short-term plans are not ACA-compliant. They can deny coverage for pre-existing conditions, impose annual or lifetime benefit caps, and exclude categories like mental health or prescription drugs. They’re also not eligible for premium tax credits. If you have ongoing medical needs or take regular medications, a Marketplace plan at full price is almost certainly a better fit.
If You Think the Termination Is Wrong
If you receive a termination notice you disagree with, whether because the state used outdated income data, miscounted your household, or didn’t check other eligibility groups, you can request a fair hearing. Federal regulations give you up to 90 days from the date the notice was mailed to file.11eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries
Timing changes the outcome. If you file your appeal before the effective date on the notice, federal law requires the state to keep your Medicaid running while the appeal is decided; this is called aid paid pending.12eCFR. 42 CFR 431.230 – Maintaining Services File after the effective date and you can still get a hearing, but coverage will already have stopped.
One risk: if the hearing goes against you, the state can seek to recoup the cost of benefits paid during the appeal.12eCFR. 42 CFR 431.230 – Maintaining Services Appeal a genuinely wrong decision, but weigh the risk if the dispute is marginal.
Don’t Keep Benefits You No Longer Qualify For
Holding on to Medicaid you know you’re not entitled to isn’t a gray area. If the state discovers you received benefits while ineligible, likely at the next renewal or through data-matching with tax records, it can require repayment.
Intentionally misrepresenting income or household status to keep Medicaid crosses into fraud. Under the federal False Claims Act, knowingly submitting false information to a government health care program can carry civil penalties for each false claim, plus damages of three times the overpayment. Criminal prosecution is possible, with potential prison time of up to five years for false claims violations or up to ten years under the federal health care fraud statute.13CMS. Laws Against Health Care Fraud
The more common story isn’t fraud. It’s someone who got a raise, meant to report it, and never did. You’ll still owe the money back. Reporting promptly avoids that, and it opens the Special Enrollment Period that lets you move into new coverage without a gap.