If your income changed following a life transition, like losing a job or getting married, you probably have plenty of items on your to-do list. Updating your information with Medicaid might be at the bottom of that list, but providing Medicaid with accurate income information is crucial to ensuring you receive the appropriate benefits.
Here’s our advice: if you have Medicaid, report an income change right away. Of course, dealing with any government or health insurance agency can feel overwhelming. In this blog, we’ll cover when you need to report changes, how to go through the process, and what happens if you forgot to report income changes to Medicaid.
Medicaid uses your household income to calculate your benefits eligibility. So keeping your income information up-to-date ensures you receive the correct amount of financial assistance — no more and no less. Failing to report an income change can result in financial and legal complications.
If you wind up making less money than you report to Medicaid, you could miss out on benefits for which you’re eligible. In most cases of over-reporting income, you can receive a tax credit or a refund at the end of the year. The bigger issues, however, come from underreporting income. If you make more money than you report to Medicaid, you might receive benefits for which you are not eligible. As a result, you might:
At the end of the day, nobody wants to face fines, legal problems, or the risk of losing coverage, so inform Medicaid of income changes right away.
So, what sorts of events would require a change-of-income report to Medicaid? Put simply, making more money or making less money as a household. But, to provide more clarity, we’ve made a complete list.
If you experience any of these life changes, Medicaid needs to know.
Most states require you to inform Medicaid of a change of income within 10 days of becoming aware of the change. Some states allow up to 30 days to report the change. Each state has its own Medicaid program. Check your state’s Medicaid guidelines to ensure you comply with local regulations.
Now that you know when to inform Medicaid of an income change, let’s discuss how to report income changes to Medicaid. You have several options when it comes to how and where you’ll report these changes.
Making changes to your income is fast and easy online. Simply take the following steps:
This process will not impact your current coverage — it will only impact the amount of financial assistance you receive.
If you’d like assistance over the phone, you can get in touch with the Marketplace Call Center at 1-800-318-2596. TTY callers can call 1-855-889-4325.
Prefer to receive assistance in person? Visit your state’s Medicaid office. You can find a list of your state Medicaid offices at CountyOffice.org/medicaid-office/.
Some states allow consumers to mail in their documents. However, because financial documents often contain sensitive information, submitting changes online or over the phone are the two most secure options.
You might be wondering why you need to report a change in your household size, even if there has been no change of income. Medicaid determines benefits eligibility based on the number of individuals in a household, relative to the total household income.
Here’s a simpler way to look at it: Let’s say your household of five people brings in $100,000 per year. Your neighbor’s household also brings in $100,000 per year, but they only have two people under their roof. That $100,000 has to be stretched much further in your household than in your neighbor’s. As a result, your household will likely be eligible for more financial aid than your neighbor’s. That’s why it’s important to notify Medicaid if you gain or lose a household member — even if your income hasn’t changed.
Notifying Medicaid when you have a baby or adopt a child is especially important. You might qualify for the Children's Health Insurance Program, a low-cost healthcare program available to some families who make too much money to qualify for Medicaid.
Think you need to report changes in income to Medicaid? Your specific life change will determine which documents you need to show. Here are common documents Medicaid asks for:
You only need to provide proof of identity if you are reporting a new household member, such as a new spouse or a baby.
Once you’ve provided Medicaid with the necessary documents to show your change in income, you’ll receive your new eligibility results. Depending on the unique nature of your income change, you might:
If you suspect you make too much money to continue receiving Medicaid, it’s a good idea to begin researching other coverage options now.
Let’s go over some common errors to avoid when reporting changes to Medicaid:
If you’re ever unsure about a question on your application, simply call the Marketplace Call Center at 1-800-318-2596 (TTY callers can call 1-855-889-4325) and a Medicaid expert can assist you.
Whether you’re enrolling in Medicaid for the first time, or need assistance choosing a new plan after a change in coverage, Insurance ‘N You is here to help! We’re all about empowering consumers with the information they need to not only select the perfect plans for their lives, but also ensure they receive the financial aid for which they’re eligible.
Speak to our AI agent today if you have questions about Medicaid eligibility, like which life changes to report and how to report them. Looking for a new plan? We’ll show you health insurance quotes for plans that fit your wellness needs and financial goals.
Once you’re set up with a plan that revolves around you, you can organize important documents in our handy digital wallet. We’re your ally when it comes to finding quality plans, at competitive rates. Get your quote today!
Looking for more information about Medicaid? We’re here to de-mystify all things insurance, so you can find answers to common Medicaid questions below!
Medicaid can find out about income changes, even if you do not report them. That’s because Medicaid communicates with other government agencies, such as the IRS and Social Security, to gather information about your household income.
Failing to report an income change to Medicaid can result in you having to pay back benefits, pay a penalty, and, in some cases, even lose coverage.
You will need to report both earned and unearned income to Medicaid. Examples of earned income can be wages, salary, and tips. Unearned income can include alimony payments, royalties, and investment income.
If you make more money than you report to Medicaid, you may be asked to pay back some or all of the benefits you received during the year. You may also face a penalty charge, or legal complications if Medicaid suspects fraud.
