What is the Medicaid Unwinding and the Opportunities it brings Insurance Agents?

Written by Sarah Lewis

March 3, 2023

What is the Medicaid Unwinding and the Opportunities it brings Insurance Agents?

The public health emergency caused by COVID-19 is ending soon. Due to this change, an estimated 14 million Americans may lose eligibility for Medicaid benefits. This process is termed the Medicaid Unwinding and provides a unique opportunity to Medicare and ACA agents.

In this article, we’ll discuss what is happening and how insurance agents can help people affected by Medicaid unwinding to find the best option to maintain continuous health coverage.

What is the Medicaid Unwinding?

At the start of the pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included a requirement that Medicaid programs keep people continuously enrolled through the end of the month in which the COVID-19 public health emergency (PHE) ends in exchange for enhanced federal funding. Since the need for affordable healthcare in the U.S. increased, Medicaid enrollment increased dramatically during the pandemic. However, now that the public health emergency is ending, many Americans and their families, who qualified under the Families First Coronavirus Response Act (FFCRA), will no longer qualify for Medicaid in 2023.

Starting in April 2023, states will begin re-determining Medicaid eligibility, regardless of PHE status. Below we will discuss the two most at-risk groups and the suggested solutions insurance agents can present to them.

Who is affected by Medicaid Unwinding?

In September 2022, a significant influx of new enrollments into Medicaid resulted in a massive total of 90.8 million enrollees. This growth reflected the growing economic concerns, expansion of Medicaid, and the effect of the Medicaid continuous enrollment requirement that was put into place. It’s predicted between 5.3 and 14.2 million beneficiaries may lose their health insurance when the Medicaid Unwinding begins in April. The two groups of people who will primarily be affected by Medicaid Unwinding are:
– Medicaid enrollees under 65
– Dual-eligible Medicare beneficiaries

These groups will only include some people affected, but most will fall into one of the two groups. That being said, it’s always best practice for insurance agents to keep clients’ specific needs in mind and remember there is more than a one-size-fits-all solution.

Medicaid Enrollees Under 65

One group affected by the Medicaid unwinding is people under 65 currently receiving Medicaid but are also no longer qualified for Medicaid based on their income. When the continuous enrollment provision ends, this group will be the largest of affected individuals.

In preparation for the Medicaid Unwinding, we suggest agents work on expanding their portfolio to include ACA plans if they don’t already. Marketplace plans are likely the most affordable option for clients losing Medicaid eligibility because of the low initial costs. Many clients will also likely qualify for subsidies, decreasing the client costs even more.
Marketplace plans can also help you reach a new younger set of clients, building a ‘Medicare pipeline’ that has the potential to generate profits year-round. Get the ball rolling on expanding your portfolio with ACA plans today!

Dual-Eligible Medicare Beneficiaries

The second group, dual-eligible Medicare Beneficiaries who no longer meet the Medicaid income requirements, will also be affected by the Medicaid Unwinding. Because these beneficiaries will be losing their Dual-eligible status, they will no longer be qualified for a DSNP and will have to switch to another plan to stay covered.
You can check with your clients individually to see if they have received a notice that their coverage will be ending so you can help them enroll in a new plan suitable for their needs. Because they experienced a loss of coverage, beneficiaries may qualify for a Special Enrollment Period. Along with the Medicaid Unwinding, a new Special Enrollment Period was introduced under the Consolidated Appropriations Act of 2021 to aid many Americans losing healthcare coverage.

What the Medicaid Unwinding Means for the Future.

Changes in health or wealth status can be confusing and scary for anyone, but Medicaid Unwinding provides a unique opportunity for agents to assist beneficiaries in navigating this process. One of the biggest responsibilities in insurance is establishing yourself as a source of reliable information and providing answers and solutions to your client’s problems. Doing this can go a long way in securing clients and creating referrals for years.

Click here to download your copy of the Medicaid Unwinding marketing kit and get started today.

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