When shopping for health insurance, it's important to understand the difference between Medicaid and the Marketplace to determine which one is right for you. In this section, we will explore Florida Medicaid, how it is different from the Marketplace, what is available to children, and eligibility for each.
What is Medicaid?
Medicaid is a combined state health insurance program that provides free or low-cost health insurance for eligible low-income adults, children, pregnant women, the elderly, and people with disabilities. In 2014, Medicaid was drastically expanded due to the Affordable Care Act, and individual states decided to enroll for the expansion or opt out. Currently, more than 30 states and the District of Columbia have expanded their Medicaid programs
Before the Affordable Care Act, many uninsured and low-income people did not qualify for Medicaid. At the time, Medicaid only covered low-income parents with dependent children, children in rehabilitation, and pregnant women, people with specific disabilities, and eligible individuals age 65 and older.
Once the Affordable Care Act is enacted, anyone with a household income below 138 percent of the federal poverty level qualifies for Medicaid. This expanded the program so that you no longer had to fall into one of the eligible categories; You can now qualify for Medicaid based on your income.
Optional services may vary from state to state, but each program must cover the costs of mandatory benefits, such as medical services, family planning services, inpatient and outpatient hospital services, labs, diagnostic x-ray services, and care home health.
Medicaid vs. the Marketplace
If you qualify for Medicaid, you can still enroll in health insurance through the Marketplace. However, you will not qualify for one or both of the benefits provided under the Affordable Care Act: cost-sharing reductions and premium tax credits. Therefore, Medicaid would be the least expensive option.
If you are enrolled in Medicaid and later ineligible due to increased household income, it is time to enroll in a Marketplace health insurance plan. Plus, you most likely qualify for one or both of the ACA benefits. Find out how much you can save.
What is the Medicaid gap?
Medicaid refers to the coverage gap for a group of uninsured people in countries that have not expanded medical assistance programs. They do not qualify for Medicaid, but at the same time they do not qualify for the benefits provided by the Affordable Care Act. Therefore, both forms of health insurance made affordable health insurance unaffordable. There are approximately 2.4 million Americans in this coverage gap, according to the Kaiser Family Foundation.
If you live in a state without Medicaid, you can fall into this gap. The exact factors depend on your condition, but for Medicaid, the median income for parents in these states is just 44% poverty, or an annual income of $ 8,985 per year for a family of three. Medicaid is generally not available to childless adults in states that have not expanded Medicaid. ACA premium benefits are only available to individuals with a household income of at least 100% of the FPL, up to 400% of the FPL.
If you don't qualify for Medicaid or ACA, you are in the Medicaid gap. To get health insurance, you can pay the full price of the ACA Marketplace plan or buy a private health insurance plan. Both of these options can be expensive and lack the protections that come with ACA plans. Often the cheapest option is to get low-cost care through a community health center. These health centers generally offer health care services on a sliding scale based on your income.
What is CHIP and how it relates to Medicaid, ACA and your family
CHIP (Children's Health Insurance Program) was created to help fund children's health coverage across the state. Each state has implemented its own program, primarily for low-income families. Most of the time, these families do not qualify for Medicaid or may have employer-sponsored health insurance that does not cover their children. CHIP helps fill these gaps, helping more children get insurance.
Eligibility for CHIP varies by state, with most states covering children with a family income of at least 200% of the Federal Poverty Level (FPL). In California, more than 1.2 million children under the age of 19 enjoy health insurance through the Children's Health Insurance Program.
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