If I Get Married, Will I Lose My Medicaid?

This information is current as of June 23, 2022.

If you are currently on Medicaid and worried that you might lose it, we understand how stressful that can be. Medicaid now helps support the medical costs of more than 75 million people, covering their doctors’ appointments, medications, and more. Yet, if you’re planning to get married, could your new relationship status put you at risk?

If I Get Married, Will I Lose My Medicaid Coverage?

Getting married could affect your Medicaid status, especially if the person you marry has considerable assets. Medicaid eligibility is determined by your annual income, so if your combined payments are more than the cutoff, you could lose Medicaid coverage. Remember, though, that Medicaid does factor in more than just your income. 

If you’re planning to get married, congratulations! Take a moment to read your Medicaid coverage before the big day and prepare for the possible consequences. While you could risk losing coverage, it’s not necessarily a guarantee.

If I Get Married, Will I Lose My Medicaid?

If you are currently receiving Medicaid benefits and are planning to get married, your new relationship status could affect your coverage. Medicaid is a needs-based program, meaning eligibility is based on your annual income and assets. If you are marrying someone with considerable income or assets, your combined total could put you above the cutoff for Medicaid coverage.

It’s essential to remember that Medicaid considers more than just your income when determining eligibility. Your home, personal belongings, and other factors are also considered. So, even if your combined income puts you over the limit for Medicaid, you may still be eligible for coverage if your other assets are low.

How Does Medicaid Decide Eligibility?

To qualify for Medicaid, an individual must have an annual income below a certain level. The income level varies from state to state but is generally based on the federal poverty level. In addition, an individual must be a U.S. citizen or legal resident and be a resident of the state in which they are applying for Medicaid.

Beyond this basic requirement, you may still qualify for Medicaid if you meet the following criteria:

  • You qualify as a senior citizen (65+)
  • You have a long-term disability or are visually impaired
  • You are younger than 18 years old
  • You are pregnant, a parent, or a caretaker
  • You are a former foster child

If you fall into any of these categories, you may be able to keep your Medicaid status even after surpassing the financial cutoff. Please refer to your state-specific website to learn more about how Medicaid determines eligibility.

How to Prepare Before My Wedding?

If you’re worried that getting married might jeopardize your Medicaid coverage, there are a few things you can do to prepare. First, take a close look at your finances and calculate your combined income and assets. This will give you a better idea of where you stand and whether you might be at risk of losing Medicaid coverage.

Next, familiarize yourself with your state’s Medicaid rules and regulations. Each state has different guidelines for Medicaid eligibility, so it’s important to know what the requirements are in your state. This way, you can ensure that you are taking all the necessary steps to maintain your coverage.

Finally, communicate with your soon-to-be spouse about your finances and your Medicaid coverage. It’s essential to be on the same page about your finances and to ensure that you are both taking steps to protect your coverage. If your partner has an existing health insurance plan, you may be able to join the program at a discounted rate.

What If My Partner is Already on Medicaid?

If your soon-to-be spouse is also on Medicaid, you may still qualify for coverage after marriage. This is not guaranteed, though. If your combined income surpasses the cutoff, you will both lose coverage and should seek health insurance elsewhere. However, you may still qualify if your income comes below the cutoff

We recommend familiarizing yourself with your state’s specific requirements to better understand your situation. While marriage doesn’t always affect Medicaid coverage, it is a well-known penalty, even if you and your spouse are enrolled in the program.

If you or your partner has children, they may still qualify for Medicaid support, but you and your spouse are at a higher risk of losing coverage based on your new relationship status.

What Happens If I Get a Divorce?

A divorce will likely not affect your coverage if you are already married and receiving Medicaid. Since Medicaid eligibility is based on your income, divorcing your partner will cut into your total annual income, pushing you further into eligibility. However, getting a new job that earns more could put you at risk of losing coverage.

How to Appeal the Loss of Medicaid Coverage

If you have recently been married and lost your Medicaid coverage, you may be able to appeal the decision. Each state has a different appeals process, so it’s essential to familiarize yourself with the rules in your state. In general, you will need to submit a written request for an appeal, along with any supporting documentation.

Once your appeal is filed, a hearing will be scheduled. This is your opportunity to present your case and to argue why you believe you should retain your Medicaid coverage. After the hearing, the decision will be made, and you will be notified of the outcome. If you are still unsatisfied with the decision, you may be able to file a second appeal.

The second appeal will be heard by a different panel of individuals, and you again can present your case. Fair warning, though, that you must submit an appeal within 90 days of losing your coverage or forfeit your right to the program. Additionally, you will not be able to access Medicaid services while the appeal is being processed.

How to Access Healthcare Insurance Through the Affordable Healthcare Act

If you lose access to Medicaid coverage after getting married, you may be able to obtain health insurance through the Affordable Care Act (ACA). The ACA is a federal law that requires all Americans to have health insurance. If you do not have health insurance through your employer or another source, you can purchase a plan through the ACA Marketplace.

The ACA offers a variety of health insurance plans, some of which are subsidized by the government. This means that your monthly premiums could be reduced, making health insurance more affordable.

In addition, the ACA offers financial assistance to help with the cost of out-of-pocket expenses, such as deductibles and copayments. Please visit the ACA website or speak to a healthcare navigator in your state to learn more about the ACA and how to obtain health insurance.

Although the insurance provided through the ACA is not free, you can find policies that offer decent coverage for as little as $47 a month after subsidies.

Can I Keep My Coverage If I Don’t Report My Marriage to Medicaid?

If you don’t report your marriage to Medicaid, you could be subject to penalties. Medicaid is a needs-based program, meaning your eligibility is based on your income and assets. You could be charged with fraud if you don’t report a change in your marital status.

In some cases, you may avoid penalties if you can prove that you did not intentionally withhold information about your marriage. However, it’s always best to err on the side of caution and report any changes in your circumstances to Medicaid as soon as possible.

Medicaid fraud conviction can result in a fine of $500 or imprisonment for one year, followed by probation. We do not recommend hiding your marriage from the federal government, as this can result in fraud charges from Social Security, the IRS, and Medicaid.

The Bottom Line

Getting married is a big step, both emotionally and financially. If you are receiving Medicaid benefits, you must be prepared for how your new relationship status could affect your coverage. By closely examining your finances and familiarizing yourself with your state’s Medicaid rules, you can help ensure that you maintain your coverage and have a smooth transition into married life.

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