COVID-19 Health Emergency Ending Means Big Changes for Medicare-Medicaid Enrollees

If you’re a Medicare and Medicaid enrollee, be on the lookout, as your Medicaid coverage – and eligibility – may change.   

Thursday, May 11, 2023, officially marks the day the U.S. government ends the COVID-19 Public Health Emergency. This announcement means states can resume reviewing their rolls and remove those no longer eligible for Medicaid. Some estimates say as many as 3.8 million Medicare beneficiaries may lose their Medicaid coverage.  

If you’re enrolled in Medicaid and Medicare – especially a Dual-Eligible Special Needs Plan (D-SNP) – here is what you should know regarding your eligibility over the next year and benefit changes. 

The Impact of Covid-19 on Medicaid Coverage

The COVID-19 pandemic caused a seismic shift in the health care industry in 2020. At the pandemic’s start, the federal government prohibited states from removing people from the program, even if they were no longer eligible for Medicaid.  

Before the pandemic, states removing people from their Medicaid program was a regular, annual occurrence. Commonly, people lose their eligibility if they start making too much money, obtain an employer-sponsored health insurance plan or move to a different state.  

There are roughly 84 million people in the Medicaid program nationwide, with 20 million enrolling since Jan. 2020.¹ 

Over the next year, states will review each Medicaid enrollee who reapplies to the program and notify them if they need to find a new insurance plan.  

At the same time, insurance carriers will be changing certain COVID-19 benefits.

Insurance Benefit Changes Following the End of the COVID-19 Public Health Emergency

Starting May 12, 2023, out-of-pocket expenses for certain COVID-19 benefits may change depending on the insurance plan. Some of these COVID-19 benefits changes may include:  

• Lab Tests: A copay may be required 
• Treatments: A copay may be required 
• Over-the-Counter Tests: Now may only be covered if the plan contains an OTC benefit 

COVID-19 vaccines, including boosters, will still be free to all, regardless of whichever insurance plan you may have. 

When Will I Find Out if I Lost My Medicaid Coverage? 

Over the next year, states will start contacting their enrollees so they can reapply for Medicaid. The notification process began in April and will continue throughout the year.  

Once your state begins the review process, not everyone will be removed simultaneously. Each state informs people differently – such as by county or alphabetically – and the process can take almost a year to complete.  

Below is a breakdown of when states will begin disenrolling people from their Medicaid programs.²  

What Happens if I Lose Medicaid Eligibility While on Medicare?

Once you reapply for Medicaid and learn you’re no longer part of the program, you’ll have to find a new health insurance plan.  

Once you receive your rejection notice, you’ll have a 60-day special enrollment period that’ll allow you to find a new plan. If you have a D-SNP, you may get an extended grace period in coverage but you’ll still need to find a new plan. Your two options are: revert to Original Medicare or switch to a Medicare Advantage Plan.  

If you’re a D-SNP user, you may find similar – but not all the same – benefits with a Medicare Advantage Plan.
The number of benefits, costs and copays will vary based on policy and insurance provider.  

To learn about your Medicare Advantage Plan options, contact an Ensurem Team Member by calling
844-847-3800 or go to Ensurem’s Learning Center to get your Medicare insurance questions answered.