“The letter isn’t the end of your coverage. It’s the start of a clock.”— Nathan Baughman
The envelope came from the Department of Human Services. Maybe you got a raise, maybe you missed a renewal form, or maybe the new work requirement rules caught you. Either way, the letter says your Medical Assistance is ending on a date that’s closer than you’d like. You’ve got a prescription to refill, a kid with a check-up next month, and no idea what to do first.
I’m Nathan Baughman, owner of BIG Benefits, and I’m going to walk you through the next sixty days one step at a time. Something changed, and that’s exactly what I help people with in Bucks, Montgomery and Lehigh counties. This is a genuine checklist, so I’ve numbered it, but I’ll explain every step in plain sentences.
One definition first. In Pennsylvania, Medicaid is called Medical Assistance, or MA. It’s run by the Department of Human Services, DHS, and you apply and renew through a website called COMPASS. Same program, two names.
1. Read the letter and find two dates
The termination notice has two dates on it. The first is the date your coverage ends. The second is the deadline to appeal.
Write the end date down. It starts your sixty-day window for new coverage, and it’s the most important number in this article. Then look at the reason DHS gave. If your income went over the limit, the rest of this checklist is your path. If you didn’t return renewal paperwork or didn’t verify something, that’s a procedural closure, and step two applies first.
A note on the work requirement. Pennsylvania has been rolling out new work and reporting rules for certain adults on Medical Assistance. If your letter mentions work hours or reporting, you may have lost coverage over paperwork, not eligibility. That’s fixable, and worth a call to your County Assistance Office first.
2. Decide whether to appeal or move on
If your income really did go up and stay up, appealing won’t change the outcome, and the clock is ticking. Move to step three.
If you think DHS got it wrong, or you missed a renewal you could still complete, you can appeal, and if you file before the end date on the letter, your coverage generally continues while the appeal is decided. Call your County Assistance Office and ask: can I still complete my renewal, and does my coverage continue if I appeal now. Do this in the first week, not the fifth. And you can do both: appeal if you have a case, and start a Pennie application in parallel.
3. Know your sixty days
Losing Medical Assistance is a qualifying life event, the industry term for a change in your life that lets you buy coverage outside the normal open enrollment window. Lost coverage, a move, a marriage, a baby, turning twenty-six, a divorce, they all count.
A qualifying life event opens a special enrollment period, or SEP, a sixty-day window to enroll in a plan on Pennie. The state-based marketplace, Obamacare, ACA, Pennie, whatever you want to call it, one and the same. Inside those sixty days you can pick a plan that starts the first of the next month. Miss the window and you’re generally waiting for open enrollment, which for 2027 plans runs November 1, 2026 through January 15, 2027. Sixty days sounds like plenty. It isn’t. My rule is to have the application in during the first thirty.
4. Understand what you may qualify for
Here’s the part people don’t expect: many folks leaving Medicaid end up paying very little on Pennie, and some pay nothing at all.
A premium tax credit, or subsidy, is money the federal government pays toward your monthly premium if your income lands in a certain range. For 2027 coverage, the top of that range is about sixty-three thousand eight hundred forty dollars for a single person and about a hundred thirty-two thousand for a family of four. If you lost Medicaid because your income crossed the MA limit, you’re almost certainly well under that line, and you may qualify for a meaningful credit.
Below roughly two hundred fifty percent of the federal poverty level, about thirty-nine thousand nine hundred dollars for a single person for 2027, there’s a second benefit called cost-sharing reductions. Pick a silver plan and the marketplace lowers your deductible, copays and maximum out-of-pocket. Your deductible is what you pay before the plan starts paying; your maximum out-of-pocket is the most you’ll pay in a year. For people coming off Medicaid, tax credit plus reduced silver is usually the plan I look at first.
Some people, depending on income, household size, age and county, qualify for a plan with a zero-dollar premium. The tax credit is real money that gets reconciled on your return, but it’s zero out of your pocket each month. I say “may qualify” on purpose. I can’t promise it until we run your numbers.
5. Gather three documents before you apply
Having the paperwork ready is the difference between a two-day approval and a three-week back-and-forth.
The first document is your Medical Assistance termination letter, your proof of the qualifying life event. Take a photo of it the day it arrives. The second is proof of current income: recent pay stubs, a job offer letter with a start date and wage, or, if you’re self-employed, a recent profit-and-loss. Pennie wants your expected income for the coverage year, so if you just got a raise, use the new number. The third is identity and household information: Social Security numbers for everyone applying, dates of birth, and your address.
6. Check your kids for CHIP
If you have children, don’t assume they lost coverage when you did. Pennsylvania’s CHIP, the Children’s Health Insurance Program, covers kids in families that earn too much for Medical Assistance. Depending on income, the premium is zero or low, and it’s real coverage with doctors, dental and vision. Apply through COMPASS, or ask Pennie to screen your children for CHIP when you apply for yourself.
7. Compare plans on the right three things
Once you’re in Pennie with a credit applied, the temptation is to sort by price and click the top one. Please don’t.
Check three things instead. One, is your doctor and your nearest hospital in the network. Many of the lowest-priced plans in our counties are HMOs with local networks, fine if your care is local. Two, are your prescriptions on the formulary, meaning the plan’s covered drug list. Three, what’s the maximum out-of-pocket after cost-sharing reductions. Every Pennie plan has one, and it’s an unlimited contract, meaning no benefit ceiling, so the MOOP is the real worst-case number. I wrote more on this in does your plan have a stop-loss.
8. Don’t buy the first thing that says “coverage”
Search “lost Medicaid” and you’ll get a page of phone numbers promising instant approval. Some are legitimate short-term plans. Some are health benefits plans, indemnity plans or discount cards that aren’t insurance at all.
There’s a time and a place for some of those products, but know exactly what it covers before you give anyone a card number. Ask my three questions: Is there a maximum out-of-pocket? Is it an unlimited contract? Is it guaranteed renewable? If the person on the phone can’t answer all three, hang up. And signing up for something that isn’t ACA coverage doesn’t pause your sixty-day window.
9. When a short-term bridge actually makes sense
Sometimes there’s a real gap. Your Medicaid ends the thirtieth and you’ve got a new job with benefits that start in ninety days. That’s when a short-term plan can fit. Short-term plans are not ACA plans. They ask health questions, have pre-existing condition limits, and in Pennsylvania are capped at four months total, a three-month term plus one one-month renewal, which the Pennsylvania Insurance Department still enforces. They start in days. A bridge, not a place to live. If you have an ongoing condition, a prescription you can’t skip, or you’re pregnant, go straight to Pennie.
10. A worked example: Maria, thirty-four, Norristown
Maria is thirty-four, single, no kids, a dental assistant in Norristown. She got a raise to twenty-one dollars an hour, about forty-three thousand seven hundred a year, and her Medical Assistance closed at the end of September. Her sixty days run through the end of November.
At forty-three thousand seven hundred, she’s under the sixty-three thousand eight hundred forty line, so she may qualify for a premium tax credit. She’s just over the two hundred fifty percent mark of thirty-nine thousand nine hundred, so full cost-sharing reductions won’t apply. Her doctor’s practice takes two of the Pennie carriers in Montgomery County, so the network is the deciding factor, not the last twenty dollars. (Maria is an example for illustration, not a quote.)
She gathers her letter, two pay stubs and her Social Security number, applies in the second week of October, and picks a plan to start November 1. Total gap: one month. Total time: about an hour on the phone with me.
Recap
Losing Medical Assistance in Pennsylvania opens a 60-day special enrollment period on Pennie. Read the letter, find the end date, decide fast whether to appeal.
You may qualify for a premium tax credit, and below about $39,900 single, cost-sharing reductions on a silver plan; some people land at a $0 premium. Kids may qualify for CHIP.
Gather three documents, compare plans on network, prescriptions and maximum out-of-pocket, and don’t buy the first thing that says “coverage.” If you’re leaving Medicaid and want a person to walk it with you, that’s what I do.
Frequently asked questions
How long do I have to get new coverage after losing Medicaid in Pennsylvania?
Losing Medical Assistance is a qualifying life event that opens a sixty-day special enrollment period on Pennie. The clock generally starts on the date your coverage ends, though you can often apply before the end date so there’s no gap. Enroll inside that window and you don’t have to wait for open enrollment. My advice is to have your application in during the first thirty days.
Will I have to pay for a Pennie plan after Medicaid?
Many people coming off Medicaid may qualify for a premium tax credit, and below roughly two hundred fifty percent of the federal poverty level, about thirty-nine thousand nine hundred dollars single for 2027, cost-sharing reductions on a silver plan. Some qualify for a zero-dollar premium. It depends on income, household size, age and county, so I never promise a number until we’ve run yours.
Can my kids stay covered if I lost Medicaid?
Often, yes. Pennsylvania’s CHIP program covers children in families that earn too much for Medical Assistance, with low or no premiums depending on income. Apply through COMPASS, or ask Pennie to screen your kids for CHIP when you apply for yourself. Parents on a Pennie plan and kids on CHIP is a common outcome.
Subsidy eligibility depends on income, household size, age and county. Advance tax credits are reconciled on your federal tax return. Not affiliated with Pennie or any government agency.
Let’s Take a Look
Call or text (910) 526-4322. Send me an age and a zip code and I’ll send back a general idea of what’s available in your area. Happy to answer any and all questions so you can make the most informed decision for you, your family, or your business.
Nathan Baughman, Owner, BIG Benefits. Offices in Doylestown and King of Prussia, PA. Serving Bucks, Montgomery and Lehigh counties.
The information and suggestions provided are for informational purposes only and should not be considered professional advice until you have spoken with a licensed agent first. Please consult with one of our, or any trusted, licensed insurance professionals to discuss your individual circumstances.