If you don’t qualify for Medicaid, your fastest move is a subsidized plan through the ACA Health Insurance Marketplace: a Medicaid or CHIP denial opens a special enrollment period, and you generally have 60 days from the date of the denial to apply.1CMS: Agent and Broker FAQ. When Would Marketplace Coverage Start for Consumers With a Medicaid or CHIP Denial SEP Depending on your situation, employer coverage, CHIP for your kids, Medicare, or a Medicaid spend-down may also be available, and hospital charity care, community health centers, and prescription assistance programs can hold the line on costs while you sort out a plan.
Start With a Marketplace Application
Go to HealthCare.gov or your state’s Marketplace site and start an application.2USA.gov. How to Get Insurance Through the ACA Health Insurance Marketplace Indicate that you were recently denied Medicaid or CHIP. The system confirms your special enrollment period, shows the plans you can pick from, and tells you what financial help you qualify for.3HealthCare.gov. Apply for Marketplace Coverage if You Lost or Were Denied Medicaid or CHIP Miss the 60-day window and you’ll usually have to wait until the next open enrollment period, which can leave you uninsured for months.
Marketplace financial help comes in two forms, both tied to your income relative to the federal poverty level.4U.S. Department of Health and Human Services. 2026 Poverty Guidelines: 48 Contiguous States Premium tax credits lower your monthly premium and can be applied directly to the bill so you never pay full price. Congress previously eliminated the upper income cap for these credits through the Inflation Reduction Act, making them available above 400% of the poverty level; whether that expanded eligibility continues depends on Congressional action, so check the current rules on HealthCare.gov when you apply.5Health Insurance Marketplace. Welcome to the Health Insurance Marketplace
Cost-sharing reductions lower deductibles and copays, but only if you pick a Silver-level plan and your household income is at or below 250% of the poverty level.6HealthCare.gov. Cost-Sharing Reductions The lower your income, the more generous the reduction. People who just missed the Medicaid cutoff often find their most affordable coverage in a Silver plan with these reductions applied.
Check Whether the Denial Was Correct
Before committing to alternatives, look at your denial letter, sometimes called a Notice of Action. It explains the reason for the denial and how to request a fair hearing.7Medicaid.gov. Understanding Medicaid Fair Hearings Denials sometimes come from missing paperwork or administrative errors rather than actual ineligibility, and everyone who applies has the right to a hearing.
The deadline to request a hearing varies by state, running from 30 to 90 days from the date on the notice, so don’t sit on it. An impartial officer who wasn’t involved in your original determination reviews the case, and the state must issue a decision within 90 days of receiving the request. Bring documentation that speaks to the denial reason: proof of income, household composition, or medical expenses. Free help is available through Legal Aid offices in most areas; a local search or a call to 211 will get you a referral.
Employer Coverage and COBRA
If you or a family member can get on a job-based plan, that’s often the simplest route. Employer plans spread risk across a group and usually cost less than an individual plan because the employer covers a share of the premium.
COBRA lets you keep the same employer coverage temporarily after a job loss or a cut in hours.8U.S. Department of Labor. COBRA Continuation Coverage The catch is the price: you pay the full premium your employer used to help with, plus up to a 2% administrative fee.9CMS. COBRA Continuation Coverage Standard COBRA runs up to 18 months, and certain qualifying events like divorce or a dependent aging off a plan can extend it to 36. Before choosing COBRA, price it against a Marketplace plan with subsidies; if your income dropped, a subsidized plan is often much cheaper. COBRA makes the most sense when you’re mid-treatment with an in-network provider on the old plan, or when the coverage itself is meaningfully better than what you’d find on the Marketplace.
CHIP for Your Kids
If your children need coverage but the family earns too much for Medicaid, the Children’s Health Insurance Program covers kids in households with moderate incomes. Each state sets its own CHIP income limits, and many extend well above the Medicaid threshold.10HealthCare.gov. The Children’s Health Insurance Program (CHIP) Some states cover pregnant women through CHIP as well. Premiums are low or nothing, and coverage is comprehensive. Applying through HealthCare.gov automatically checks whether anyone in your household qualifies and forwards your information to the state agency if so.11Medicaid.gov. Children’s Health Insurance Program (CHIP)
Medicare
Medicare covers people 65 and older, along with younger adults who have certain disabilities or specific conditions like end-stage renal disease or ALS.12Medicare.gov. Get Started With Medicare There’s an important trap for people under 65 on Social Security Disability Insurance: Medicare doesn’t start immediately. You have to receive SSDI benefits for 24 months before Medicare kicks in.13Social Security Administration. Medicare Information Plan for interim coverage through the Marketplace or another source during that two-year gap.
The Medicaid Spend-Down Pathway
If your income is above the Medicaid limit but you have high medical costs, a spend-down may still get you in. Roughly two-thirds of states offer a “medically needy” pathway that lets you subtract qualifying medical expenses from your countable income, and once your income after those expenses drops to the state’s medically needy income limit, you become eligible.14Office of the Law Revision Counsel. 42 U.S. Code 1396a – State Plans for Medical Assistance
Health insurance premiums, copayments, prescription costs, unpaid medical bills, and other medically necessary services all count toward the spend-down.15eCFR. 42 CFR Part 435 Subpart I – Specific Eligibility and Post-Eligibility Requirements Keep every receipt and bill. States calculate this over a set budget period, and once you meet the spend-down amount for that period, Medicaid covers eligible services for the rest of it. This works best for people with ongoing costs like prescriptions, dialysis, or nursing care. Not every state offers it, so contact your state Medicaid agency to ask whether the program exists and what the income limits and budget period are.
If You Live in a Non-Expansion State
Roughly ten states have not expanded Medicaid under the ACA.16MACPAC. Medicaid Expansion to the New Adult Group In those states, adult Medicaid eligibility is often restricted to very low incomes, sometimes well below the poverty level, while Marketplace subsidies generally start at 100% of the poverty level. If your income falls between the state’s Medicaid limit and 100% of the poverty level, you can land in the “coverage gap” where neither program is available.
Your options here are narrower but not empty. Community health centers charge on a sliding scale. Hospital charity care programs may cover emergency and medically necessary treatment. Some non-expansion states run limited Medicaid programs for specific circumstances like pregnancy or disability. Call your state Medicaid agency or a local healthcare navigator to work through every program you might qualify for.
Getting Care While You’re Uninsured
Hospital Charity Care
Every nonprofit hospital is required by federal law to have a written financial assistance policy covering emergency and other medically necessary care. The policy has to spell out who qualifies for free or reduced-cost treatment, how to apply, and how charges are calculated.17eCFR. 26 CFR 1.501(r)-4 – Financial Assistance Policy and Emergency Medical Care Policy Income thresholds vary by hospital, with many offering free care below 200% of the poverty level and discounted care at higher incomes. If you get a big hospital bill and you’re uninsured or underinsured, ask the billing department for a financial assistance application before you pay anything or agree to a payment plan. The programs exist, but hospitals don’t always tell patients about them up front.
Community Health Centers
Federally qualified health centers provide primary care, dental care, and mental health services on a sliding fee scale based on your income and family size. At or below the federal poverty level, you pay a nominal fee or nothing at all; partial discounts apply up to 200% of the poverty level.18Bureau of Primary Health Care. Chapter 9: Sliding Fee Discount Program Above that, you pay the center’s standard rates. These centers serve everyone regardless of insurance status. Bring proof of household income to qualify for the discount.
Prescription Assistance
If medication cost is the problem, pharmaceutical manufacturers and nonprofits run assistance programs that provide free or discounted drugs to people who are uninsured, underinsured, or meet income guidelines. Searchable databases at RxAssist (rxassist.org) and NeedyMeds (needymeds.org) let you look up programs by drug or manufacturer, which is the fastest way in. Many drug makers also run their own patient assistance programs directly; check the manufacturer’s website or the number on the packaging for a brand-name prescription. These often cover the full cost for qualifying patients.
Short-Term Plans as a Stopgap
Short-term, limited-duration insurance is meant to bridge a gap, not to serve as long-term coverage. Under current federal rules, these plans last no more than three months, with a maximum coverage period of four months including any renewal.19CMS. Short-Term, Limited-Duration Insurance Final Rules Premiums tend to be lower than comprehensive plans.
The trade-offs are real. Short-term plans aren’t required to cover pre-existing conditions, can impose annual or lifetime benefit caps, and don’t have to include the essential health benefits that ACA-compliant plans do.19CMS. Short-Term, Limited-Duration Insurance Final Rules If you have any ongoing medical condition, they can leave you with large uncovered bills. They also don’t count as qualifying coverage for Marketplace subsidies. Use them as a stopgap while you arrange something more permanent.
Reapply If Your Situation Changes
Medicaid eligibility isn’t fixed. A drop in household income is the most direct path back, since most eligibility is income-based.20Medicaid.gov. Eligibility Policy A change in household size, such as a new baby or taking in a dependent, shifts the thresholds in your favor because the poverty level rises with each additional household member.4U.S. Department of Health and Human Services. 2026 Poverty Guidelines: 48 Contiguous States Developing a disability can open separate Medicaid categories that use different income and asset rules, and turning 65 changes which category applies to you. Poverty guidelines and state policies also change annually, so a fresh application is worth doing even if little has changed on your end.