Navigating the Marketplace after Medicaid Unwinding

Two woman and a man fist bump.
Outreach and Enrollment Specialist Mary Moynihan fist bumps with Justin and Jessica after helping them to find a Marketplace insurance plan.

When Justin and Jessica received notice that they might lose Medicaid coverage, they didn’t know what they were going to do. Both have chronic health conditions and need continuous health insurance coverage.

Changes at Start of COVID

When the pandemic began, the couple was living with Jessica’s elderly father and Jessica was providing in-home care for him. Both Justin and Jessica also worked outside the home but had to resign to focus on caring for her father. Fortunately, the couple qualified for expanded Medicaid benefits under the COVID-19 Public Health Emergency.

They also received other benefits such as unemployment and food stamps to help them get through the pandemic. Justin said that Medicaid’s low co-pays were very beneficial.

“When you have to pay high co-pays, it takes away from things like food and gas,” Justin said.

End of the Public Health Emergency

With the Public Health Emergency coming to an end, the couple started getting notices saying they might lose their Medicaid coverage due to the unwinding of the Medicaid continuous enrollment provision. They knew they had to act fast so they wouldn’t go without insurance coverage. Jessica has type 2 diabetes and takes insulin daily. Justin has tachycardia and bipolar disorder. He had a stroke two years ago. They both are on a number of medications.

Justin and Jessica are longtime patients of Goodwin Community Health, the Somersworth branch of Greater Seacoast Community Health’s network of community health centers.

“Health care is very important for both of us,” said Justin. “If you don’t have a safety net, you’re not doing too well.”

Justin’s provider suggested that he meet with Mary Moynihan, one of our Outreach and Enrollment Specialists. Mary and other specialists have been busy working with patients to determine if they are still eligible for Medicaid coverage and help them find alternative coverage through the Marketplace under the Affordable Care Act.

“These are people we don’t want to fall through the cracks, especially because of their chronic health conditions,” said Mary. “We worked as a team and decided on the plan that would work best for them. It was a real group effort.”

Jessica and Justin brought in their documentation and Mary crunched the numbers. They were disappointed to discover that they were just over the income level needed to qualify for Medicaid. Since her father has passed away, Jessica went back to full-time employment, which put them over the Medicaid income limit by around $500 a month. While Jessica could get insurance through her work, the premiums would eat over half of her paycheck.

Navigating the Marketplace

The couple worked with Mary to discuss their Marketplace health plan options. After multiple meetings with Mary and a consultation with another Marketplace Navigator through the state, they found a plan with affordable premiums and lower out-of-pocket costs. Justin and Jessica were extremely grateful for Mary’s help.

“If we didn’t have people like Mary, I think we’d be a lot worse off,” said Justin. “Jessica and I have more peace of mind knowing that we’re covered.”

Translate »