QUESTION

I have a marketplace plan and am receiving premium tax credits. I am now pregnant. Since I’m eligible for pregnancy-related Medicaid coverage, am I required to drop my marketplace plan and lose my financial assistance?

Individuals with no coverage | Eligibility for Premium Tax Credits and Cost-Sharing Reductions
ANSWER

No, you are not required to drop your marketplace plan. You have a choice between your marketplace plan and the Medicaid coverage. You can continue on your plan throughout your pregnancy and continue receiving the premium tax credit. You can also remain on your marketplace plan and receive premium tax credits in situations where your unborn child qualifies for CHIP coverage.

If you opt for pregnancy-related coverage under CHIP that is tied to the unborn child and choose to drop your marketplace plan, you will qualify for a Special Enrollment Period (SEP) to re-enroll in marketplace coverage once you no longer qualify for that public program. (83 Fed. Reg. 16930, April 17, 2018; IRS, Notice 2014-71; CMS, SHO#14-002, Minimum Essential Coverage).

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