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Medicaid redetermination creates opportunities to capture Individual market sales


March 28, 2023

With the federal COVID-19 public health emergency (PHE) ending May 11, 2023, the Centers for Medicare & Medicaid Services (CMS) has mandated that states must reevaluate their Medicaid membership to redetermine enrollees’ eligibility. This redetermination will continue into 2024.

It is estimated that, with federal funding provided in the Families First Coronavirus Response Act, more than 20 million new Medicaid enrollees were added nationwide during the PHE. Consumers identified as no longer being eligible for Medicaid will be allowed to participate in a Special Enrollment Period (SEP) to enroll in an Affordable Care Act (ACA) Individual Market plan. CMS has directed that proof of losing Medicaid eligibility as a result of this redetermination effort isn’t required for Marketplace or direct Individual enrollment.

Here's a summary of when affected enrollees who are no longer eligible for Medicaid are being notified, and our recommended option(s) in each of our four states.

Idaho

Notices are being mailed to affected consumers and will continue to be mailed for 12 months. Affected consumers have been able to enroll on a subsidy-eligible plan through Your Health Idaho since Feb. 1, 2023. For most rating areas, our IAFN Silver 6500 POS could be an attractive and affordable option.

Oregon

Notices will be mailed to affected consumers beginning in April and will continue to be mailed for 12-14 months. Affected consumers may enroll on a subsidy-eligible plan thru Healthcare.gov beginning Apr. 1, 2023. For consumers in the Portland and Salem areas, our Silver 6500 Legacy could be an attractive and affordable option (see the Silver 6500 IAFN for the Eugene area). Our Bronze products may be a better fit for consumers in other areas.

Utah

Notices are being mailed to affected consumers and will continue mailing for 12 months. Affected consumers may enroll on a subsidy-eligible plan through Healthcare.gov beginning on Apr. 1, 2023. For consumers in northern Utah, the Bronze 8000 Separate Rx Deductible is an attractive and affordable option. The Silver 6500 on the IAFN or SaveWell Silver 5350 is better suited for consumers in all other areas.

Washington

Notices are being mailed to affected consumers and will continue mailing for 12 months. Affected consumers may enroll on a subsidy-eligible plan through the Washington Health Benefit Exchange beginning Apr. 1, 2023. For consumers in most rating areas, our Bronze COD 8500 IAFN plan could be an attractive and affordable option.

You can learn more about our Individual Market plans for 2023 here (be sure to set the ZIP code at the top of the page for your state).

Questions? Please contact your sales representative.