When is open enrollment for Medicaid?
Medicaid open enrollment is the annual period when you can review your Medicaid health coverage plan and make changes if you need to.
- Unlike Medicare or Marketplace insurance, Medicaid is run by each state, not the federal government.
- That means there’s no single national open enrollment period.
- Your open enrollment dates, and the process for changing plans, depend on the state you live in and how your state delivers Medicaid services.
Here’s how Medicaid open enrollment works, when you can change plans, and how it differs between states.
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How does open enrollment work for Medicaid?#how-does-open-enrollment-work-for-medicaid
When people talk about open enrollment for Medicaid, they’re usually referring to the period of time when your state lets you change your Medicaid health plan, often called a managed care plan.
A managed care plan is a private health insurance plan from a company that contracts with your state to provide your Medicaid benefits. More than two-thirds of people with Medicaid nationwide have one of these plans.
Why does your Medicaid Managed Care Plan matter?#why-does-your-medicaid-managed-care-plan-matter
All states must follow federal rules to cover basic services like doctor visits, hospital care, and emergency services under Medicaid.
However, the specifics of your Medicaid coverage can vary depending on your managed care plan.
For example, your plan can determine:
- Which doctors and hospitals are in-network
- Whether you need referrals to see specialists
- What prescription drugs are covered
- Which extra services (like vision or transportation) are covered
During open enrollment, you can review these details and switch to a plan that better fits your needs, like one with your preferred doctor or a pharmacy closer to your home.
How does open enrollment for Medicaid differ by state?#how-does-open-enrollment-for-medicaid-differ-by-state
Medicaid open enrollment can look very different depending on where you live. For example:
- Some states hold a single open enrollment window for all Medicaid managed care members (once or twice a year)
- Some states tie open enrollment to your Medicaid renewal, when you confirm your eligibility and update your household information
- A few states, especially those with fee-for-service systems, don’t use Medicaid Managed Care plans or have open enrollment periods at all
When can you change your Medicaid health plan?#when-can-you-change-your-medicaid-health-plan
While you can apply for Medicaid any time of year, most states only allow you to switch between managed care health plans during specific times.
Here’s when you can usually change Medicaid plans:
- When you first enroll: Depending on your state, you usually have 30 to 90 days after approval to change plans if you’re not happy with your initial choice
- During your state’s open enrollment period: Some states hold a once-a-year or twice-a-year window when all members can review and change their plan
- For “good cause” any time: You can request a plan change outside of open enrollment if there’s a valid reason, for example:
- You move to a new county or ZIP code
- Your doctor or hospital no longer accepts your Medicaid plan
- You’re not getting the care or services you need
Each state sets its own rules for how open enrollment works and what qualifies as “good cause,” so be sure to ask your local Medicaid office how it works in your state.
How to find information about your state’s Medicaid open enrollment period#how-to-find-information-about-your-states-medicaid-open-enrollment-period
Because each state runs its own Medicaid program, open enrollment rules can differ depending on where you live. If you’re not sure when or how you can change your plan, here are a few simple ways to find out:
- Visit your state’s Medicaid website: You can find a list of state websites here
- Call your state’s Medicaid member services number: You can usually find this on the back of your Medicaid card or on your plan’s website
- Contact your case worker: Your case worker can tell you whether your state has a specific open enrollment period for Medicaid or help you request a plan change for good cause
- Call or visit a local Medicaid office: You can find your nearest office by searching online or checking your state’s Medicaid or Social Services website
