Will My Insurance Work Out Of State

Will My Insurance Work Out Of State - The economic downturn and a change in administration are likely to bring renewed attention to gaps in Medicaid coverage in states that did not expand eligibility under the Affordable Care Act (ACA). In recent months, millions have received health insurance through Medicaid due to the financial impact of the pandemic as well as maintaining eligibility and ongoing coverage requirements related to access to temporarily enhanced Medicaid matching funds.

 However, in the 12 states that have not adopted Medicaid expansion by January 2021, Medicaid eligibility for adults remains limited. At a time when many are losing income and may lose health coverage due to a health emergency, these eligibility gaps leave many without an affordable coverage option and may they contribute to an increase in the uninsured rate. The Biden administration is likely to prioritize expanding coverage for low-income populations, including closing the "coverage gap" for adults in states that do not does not expand.

Adults in the coverage gap have incomes above their state's Medicaid eligibility but below the poverty, minimum income eligibility for tax credits through the ACA marketplace (Figure 1). Medicaid eligibility for adults in states that have not expanded their programs is very limited: the median income level for parents in these states is just 41% of poverty, or an annual income of $8,905 for a family of three in 2020 and almost every state. 

Without expansion, childless adults will remain ineligible.1 Because the ACA envisioned low-income people getting coverage through Medicaid, it does not provide financial assistance to people below the poverty for another cover. , Medicaid eligibility has been expanded to nearly all low-income individuals with incomes at or below 138 percent of poverty ($17,609 for an individual in 20202).

Will My Insurance Work Out Of State

Will My Insurance Work Out Of State

This summary provides estimates of the number of people in non-expansion states who could reach Medicaid if their states accepted the expansion and considers the effects of remaining a -out of ACA coverage expansion. It is based on coverage data from 2019, the latest year available. Since this data predates the pandemic and the associated job and income loss, it is possible that the number of people in the coverage gap has increased since the pandemic began , and these estimates could be a lower bound on how many people are in this area. time in the coverage gap. An overview of the methodology underlying the analysis can be found in Data and Methods and further details are available in the Technical Appendices.

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Nationally, more than two million 3 poor uninsured adults fell into the "coverage gap" as a result of state decisions not to expand Medicaid (Table 1), meaning that their income have above Medicaid eligibility but below the lower limit for higher Marketplace tax credits. These people would be eligible for Medicaid if their state had chosen to expand coverage. Reflecting Medicaid eligibility limits outside of the ACA pathways, the majority of people in the coverage gap (77%) are adults without dependent children.4

Adults left in the coverage gap are spread across states without expanding their Medicaid programs, but are concentrated in states with the largest uninsured populations. More than one-third of people in the coverage gap live in Texas, which has both a large uninsured population and very low Medicaid eligibility (Figure 2). Nineteen percent of people in the coverage gap live in Florida, twelve percent in Georgia, and ten percent in North Carolina. Uninsured adults are not in the coverage gap in Wisconsin because the state grants Medicaid eligibility to adults up to the poverty level based on Medicaid receipt.

The geographic distribution of the population in the coverage gap reflects both population distribution and regional variation in state acceptance of the ACA Medicaid expansion. The South has a significantly higher number of poor uninsured adults than other regions, has higher uninsured rates and more limited Medicaid eligibility than other regions, and accounts for the majority (8 of 12) of states that chose not to expand Medicaid.5 As a result, the majority of people in the coverage gap in 2019 live in the South (Figure 2).

If states that are not currently expanding their programs accept the Medicaid expansion, nearly 2.2 million adults in the coverage gap will be eligible for Medicaid. In addition, 1.8 million uninsured adults with incomes between 100 and 138% of poverty6 (most of whom are currently eligible for Marketplace coverage) will also be eligible for Medicaid (Figure 3 and Table 1) . Although most of these adults are eligible for significant tax credits to purchase Marketplace coverage, Medicaid coverage 7 would likely provide more comprehensive benefits and lower premiums or cost-sharing than they would with Marketplace coverage. For example, research from the early implementation of the ACA showed that coverage of behavioral health services, prescription drugs, rehabilitation and rehabilitation services, and long-term services and supports may be more limited in the marketplace compared to Medicaid.8

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9 Additionally, research examining the population with incomes between 100-138% FPL in expansion and non-expansion states finds that Medicaid expansion coverage resulted in reductions far more than Marketplace subsidized coverage in total average out-of-pocket spending, on average - High-. quality consumption and average cost of cost sharing.

Figure 3: Uninsured adults in non-expansion states who would be eligible for Medicaid if their states expanded, 2019

A smaller number (about 356,000) of uninsured adults in non-expansion states are already eligible for Medicaid under eligibility pathways in place before the ACA. If all states expand Medicaid, those in the coverage gap and those eligible for Marketplace coverage would bring the number of uninsured adults eligible for Medicaid to more than 4.3 million people in the twelve states that do not are not currently extended. The number of people who could be reached by Medicaid expansion varies by state (Table 1).

Will My Insurance Work Out Of State

At a time when many are in need of health care services due to a health care crisis or are facing a loss of financial security due to the economic downturn, millions fall into the Medicaid coverage gap because their state's decision not to extend eligibility. The ACA Medicaid expansion was designed to address historically high uninsured rates among low-income adults by providing a coverage option for people with limited access to employer coverage and limited income to cover a buy individually. In states that expanded Medicaid, millions of people gained coverage and the uninsured rate dropped significantly as a result of the expansion. However, because many states choose not to implement Medicaid expansion, millions of uninsured adults remain outside the ACA's reach and have limited options for affordable health coverage. In 2019, the uninsured rate in non-developing states was nearly double that of developing states (15.5% vs. 8.3%).

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By definition, people in the coverage gap have limited incomes and live below the poverty line. It is likely to be in families that work for very low wages, work part-time or have a fragile or invisible relationship with the workers. Given the economic downturn and the limited offer levels of employer-based coverage for workers with these job characteristics, employer-based coverage may not be a viable option for them.

It's also unlikely that people in the coverage gap will be able to afford ACA coverage because they don't qualify for premium subsidies: in 2021, the national average unsubsidized price for an individual was 40-year-old non-smoker buys individual coverage through the Marketplace for $436 each. month for the lowest-cost silver plan and $328 per month for a bronze plan, which equates to nearly eighty percent of income for those in the lowest income bracket of people individuals in the gap (below 41% FPL) and nearly a third of the income for those in the highest income bracket of people in the gap.

If they remain uninsured, adults in the coverage gap are likely to face barriers to needed health services or, if they need and receive medical care, potentially severe financial consequences bad While the safety net of clinics and hospitals that traditionally served the uninsured population will remain an important source of care for the remaining uninsured under the ACA, that system has been stretched in recent years due to increasing demand and limited resources.

Most people in the coverage gap live in the South, driving state decisions about Medicaid expansion to exacerbate geographic disparities in health coverage. Additionally, because many states that have not expanded Medicaid have large populations of color, state decisions not to expand their programs disproportionately affect people of color, especially black Americans. . As a result, state decisions about whether to expand Medicaid have implications for efforts to address disparities in health coverage, access, and outcomes among people of color.

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There is no deadline for states to opt in to expand Medicaid under the ACA, and some states are still debating whether to expand. In 2020, two states (Missouri and Oklahoma) adopted Medicaid expansion through ballot measures, and both states plan to implement the expansion in mid-2021 (these states are considered Medicaid expansion states in the study this). In addition, there will be a new federal