Why am I being directed to Medicaid?

Why am I being redirected to Medicaid?

When you apply for health insurance through Stride, we ask about your household size and expected income to determine what types of coverage and financial assistance you may qualify for.

Based on the information you entered, you or someone in your household may qualify for Medicaid or CHIP, rather than financial assistance for a Marketplace plan. That's why we're directing you to Medicaid instead of showing you plans with premium tax credits.

Why would I qualify for Medicaid?

Medicaid and CHIP are government programs that provide free or low-cost health coverage to eligible individuals and families. Eligibility depends on your state, household size, income, and other factors.

The income limits are different depending on where you live:

• In states that have expanded Medicaid, adults with household income up to around 138% of the federal poverty level (FPL) may qualify for Medicaid. California is one example of a state that has expanded Medicaid.
• In states that haven't expanded Medicaid, such as Texas and Florida, Medicaid eligibility for adults is more limited. If your income is at or above 100% of FPL, you may instead qualify for financial assistance to purchase a Marketplace plan.

The exact rules vary by state, and Medicaid or CHIP may have different income limits for children, pregnant people, and other groups.

Why can't I just shop for a Marketplace plan with financial assistance?

Federal rules generally don't allow you to receive Marketplace premium tax credits if you're eligible for Medicaid or CHIP.

That's why we use the information in your health profile to determine which type of coverage and financial assistance you may qualify for. If our information indicates that you may qualify for Medicaid or CHIP, we'll direct you to that program rather than showing you Marketplace plans with financial assistance.

What if I don't want Medicaid?

If you still want to purchase a Marketplace plan, you can choose to shop without government financial assistance. Update your health profile and indicate that you don't want to use government assistance.

You'll be able to shop for Marketplace plans at the full price, but you won't receive premium tax credits or other government financial assistance.

Keep in mind that if you qualify for Medicaid or CHIP, those programs may offer coverage at a lower cost than a full-price Marketplace plan.

What if only my child qualifies for Medicaid or CHIP?

It's possible for members of the same household to qualify for different types of coverage.

For example, an adult may qualify for Marketplace coverage and financial assistance while their child qualifies for Medicaid or CHIP. In some cases, enrolling the child in Medicaid or CHIP may be required for the household to receive the maximum Marketplace financial assistance available.

If you want everyone in your household to stay on the same Marketplace plan, you may be able to purchase coverage for your child at the full price.

What should I do next?

If you're redirected to Medicaid or CHIP, follow the instructions provided to apply and confirm your eligibility. The state Medicaid agency or Marketplace will make the final determination about whether you qualify.

If your income, household size, or other information has changed, you can also go back and update your health profile on Stride. Your coverage options may change based on the updated information.