Moving from a Medicaid Plan to an Employer-Sponsored Group Health Plan
I have had at least 12 months of Medicaid coverage without a gap lasting 63 days or more (a significant gap in coverage):
Can a plan refuse to enroll me just because I am sick?
No. Employer-sponsored health plans may not refuse to enroll you just because you are sick. (There are exceptions to these protections for some church and state or local government plans.)
Can a plan charge me more based on my health?
No. Employer-sponsored health plans may not charge you or your family a higher premium than other employees who have a similar position in the company due to your health status.
Can a plan refuse to cover my illness for a period of time just because my illness was preexisting?
No. Since you have had Medicaid, which counts as creditable coverage, for the past 12 months, employer-sponsored health plans cannot refuse to cover your preexisting illness just because the illness was preexisting. However, your new insurance plan may not offer coverage for all of the same benefits covered by Medicaid. Check your policy to see what benefits your plan will cover.
I have had Medicaid coverage for fewer than 12 months without a gap lasting 63 days or more (a significant gap in coverage):
Can a plan refuse to enroll me just because I am sick?
No. Employer-sponsored health plans may not refuse to enroll you just because you are sick. (There are exceptions to these protections for some church and state or local government plans.)
Can a plan charge me more based on my health?
No. Employer-sponsored health plans may not charge you or your family a higher premium than other employees who have a similar position in the company due to your health status.
Can a plan refuse to cover my illness for a period of time just because my illness was preexisting?
Yes. An employer-sponsored health plan may refuse to cover a preexisting illness for a period of up to 12 months. The length of time the plan may refuse to cover the illness will be reduced depending on how much creditable coverage you had when you enrolled in the new plan.
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