Loss of Medicaid Coverage

Pennie’s got you covered

Pennie is here for you

Pennie is here for those who lost or are losing Medical Assistance coverage, also known as Medicaid or MA. Check out our video below that explains how Pennie can help!

Pennie gets you covered

If you are ineligible for Medicaid, you may be referred to Pennie, Pennsylvania’s official health insurance marketplace. At Pennie you can shop for plans available in your area. Pennie is the only place to get financial savings to help pay for coverage.

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Losing Medicaid Coverage?

How Pennie Can Help:

Pennie and the Pennsylvania Department of Human Services (DHS) are working to ensure that qualified Pennsylvanians have access to health coverage either through Medicaid, the Children’s Health Insurance Program (CHIP), or affordable, high-quality coverage available through Pennie. 

NOTE: If you voluntarily chose to disenroll from Medicaid coverage (or you qualified for Medicaid coverage and chose not to enroll), you will not be eligible for financial savings through Pennie. You can only qualify for one program or the other. That means you will pay full price on a health plan through Pennie if you qualify for Medicaid coverage but chose to disenroll.

Your Income Is Too High For Medicaid

If you respond to your renewal packet and are found ineligible for Medicaid, your account will be automatically and securely transferred to Pennie. A pre-filled application will be created on your behalf, and you will receive a notice with a unique access code for your new Pennie account and an estimate of financial savings to lower the cost of coverage. You will have a limited time to shop for coverage through a Special Enrollment Period. This shopping window will be available already for some customers, or you can select “Loss of Minimum Essential Coverage” when asked.

IMPORTANT NOTE: Pick a health plan within 60 days from the date you lost Medicaid coverage.

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Frequently asked questions

What is Pennie?

Pennie is the Commonwealth of Pennsylvania’s official health insurance marketplace where individuals and families can apply for, shop, and enroll in health coverage that best fits their needs. Pennie is also the only link to financial savings to help reduce the cost of monthly premium payments and/or out-of-pocket costs.

Pennie works closely with the Pennsylvania Department of Human Services (DHS), the Office of Income Maintenance (OIM), and the Children’s Health Insurance Program (CHIP) to develop a “no wrong-door” policy. This policy seamlessly transfers applications for those who are eligible for Pennsylvania’s Medicaid and CHIP programs. In addition, applicants who are denied Medicaid (and likely eligible for marketplace coverage) are transferred by DHS to Pennie to apply and enroll.

I currently have Medicaid coverage and haven’t received a renewal packet; is there anything I should be doing to make sure I am receiving all of the appropriate paperwork?

The best thing you can do now is to make sure your contact information and address are up to date with the Pennsylvania Department of Human Services (DHS). You can update your information through COMPASS and sign up for text or email alerts to get information faster when it is your time to renew. If you cannot access COMPASS, you can update your contact information by calling the Customer Service Center at 1-877-395-8930 or 215-560-7226 in Philadelphia.

If I do not respond to my renewal packet and my Medicaid coverage ends, how do I enroll in health coverage through Pennie?

Follow these simple steps below to enroll in coverage through Pennie.

1. Preview – With our Plan Comparison Tool 

1. Get an estimate of your financial savings 
2. Compare health plans in your area
3. Review each plan’s benefits and costs for health care services

2. Apply – Complete an application to find out your exact financial savings. Make sure you have your household information, tax forms, and other items in our Pennie Shopping Checklist.  

3. Open Shopping Window – You will be asked to provide a Qualifying Life Event to shop for plans.  Select “Loss of Minimum Essential Coverage” and provide documentation verifying that you have lost Medicaid. Click here to learn more about how to submit the required documentation.

4. Shop – Compare and choose the plan that is right for you and your family.

5. Pay – Your coverage cannot begin until you pay your first month’s premium before your policy effective date.  

Note: If you apply for coverage through Pennie and you or someone in your household qualifies for Medical Assistance/Medicaid or CHIP, Pennie will transfer that individual’s account to the right program on their behalf. For enrollment assistance visit pennie.com/connect or call 1-844-844-8040.  Pennie Customer Service is available Monday – Friday, 8:00 am – 6:00 pm. 

Be sure to take action immediately if you have lost Medicaid coverage. You have a limited time to enroll, and if you miss your enrollment window, you will need to wait until the next Pennie Open Enrollment period to get covered. Open Enrollment is every year from October 15 through December 15.

I currently have Medicaid coverage, what if I complete and return my renewal forms and am found ineligible?

If you are found ineligible for MA when your renewal is processed, you will get a notice in the mail telling you that your Medicaid coverage is scheduled to end. You can appeal the decision if you believe it is not correct. Appeal and fair hearing rights and instructions for filing an appeal will be on the notice you will get.

If you are ineligible for Medicaid, you may be referred to Pennie, Pennsylvania’s official health and dental insurance marketplace. You will receive a notice if you are referred to Pennie. Pennie lets you shop for plans available in your area and is the only place to get financial assistance to help pay for coverage and/or out-of-pocket costs.

Children under the age of 19 who are ineligible for Medicaid may be referred to CHIP. CHIP provides high quality, affordable health coverage for families with children that covers all the care your child may need like doctors’ visits, prescriptions, vision, dental care, and more.

Visit the Department of Human Services webpage for more information.

If I am found ineligible for Medicaid, will my information be automatically forwarded to Pennie and/or CHIP?

If you are found ineligible for Medicaid, your information may be automatically forwarded to Pennie and/or CHIP. However, if you do not receive any notice from either Pennie or CHIP, you can reach out through the contact information below.

Pennie

Online: www.pennie.com/connect

Phone: 1-844-844-8040

CHIP

Online: www.chipcoverspakids.com

CHIP Helpline: 1-800-986-KIDS (5437)

If I am found ineligible for Medicaid, what steps can I take to enroll through Pennie?

When you are found ineligible for Medicaid, your information will be automatically and securely transferred to Pennie or CHIP. Once transferred to Pennie, you will receive a notice with your account access information as well as details on the financial savings for which you qualify. Log in to your account by visiting enroll.pennie.com and using your new access code. After logging in, you may need to click through each page in your application to make sure your information is correct. If Pennie has enough information from Medicaid, you may already see that the application is complete. You can then shop for the plan that best fits your needs. Your shopping window will be open, or you can select “Loss of Minimum Essential Coverage” when asked.

If your application isn’t complete, you will receive a notice with information about how to complete your Pennie application.

IMPORTANT NOTE: Pick a health plan within 60 days from the date you lost Medicaid.

How can I find help enrolling in coverage through Pennie?

Pennie offers not only one avenue for assistance, but three! Pennie gets it. Health insurance, especially buying health insurance, can be a tough path to navigate. Pennie is here to help to get you from Start to Covered.  Below are three options to finding help finding the best plan for you.

Option 1: Give us a call at the Pennie Customer Service Center at 1-844-844-8040 and work with our customer service team. Our team is trained to help you get the coverage that meets your needs. This multilingual team can answer tricky questions, direct you to online resources, and connect you to a Pennie-Certified Broker or Assister to help you pick and pay for coverage.

Option 2: Contact a Pennie-Certified Broker. Brokers are professionally trained to work with you one-on-one and can help narrow down options. Unlike other unbiased resources, Pennie-Certified brokers can recommend the plan they feel is best suited for you and your family.

Option 3: Schedule an appointment with a Pennie-Certified Assister. Our assisters are available to walk you through the shopping and enrollment process and have been trained to assist you both in-person or virtually.

Both brokers and assisters can be found on the Get Local Help webpage.

For more information, visit pennie.com, check out our FAQs, or call 1-844-844-8040.

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