ACA Coverage Dropped for Millions — What to Do Next
If you dropped your Affordable Care Act (ACA) Marketplace health insurance plan because the monthly premium became unmanageable, you are not alone — and you are not necessarily out of options. According to NPR reporting, approximately 5 million people have lost or dropped ACA Marketplace coverage following the expiration of enhanced premium tax credits and policy shifts that allowed benchmark premiums to rise sharply. What many of those 5 million people may not know is that several federal and state programs — including Medicaid, the Children's Health Insurance Program (CHIP), and Federally Qualified Health Centers (FQHCs) — may still be available based on income, household size, and state of residence.
This article covers the five most relevant programs, the income thresholds that determine eligibility, the documents you will need, and a concrete action plan to take right now.
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Data Snapshot
According to the U.S. Department of Health and Human Services (HHS) at https://www.hhs.gov, more than 92 million people were enrolled in Medicaid and CHIP nationwide as of early 2025 — making it the single largest source of health coverage for low- and moderate-income Americans. The 2025 Federal Poverty Level for a family of four in the contiguous United States is $32,150 per year. Medicaid expansion covers adults in participating states up to 138% FPL, which translates to approximately $44,367 annually for a family of four at current FPL figures. ACA Marketplace premium tax credits are available to households earning between 100% and 400% FPL — and beyond that ceiling in states with their own expanded subsidy structures — though the value of those credits has shifted significantly with recent legislative changes. For households that fell off coverage because of premium increases, these thresholds are the starting point for understanding what may still be within reach.
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Why Premiums Spiked and What Changed
The enhanced premium subsidies introduced under the American Rescue Plan Act (ARPA) in 2021 and extended through the Inflation Reduction Act substantially reduced monthly costs for millions of Marketplace enrollees. When those enhanced subsidies were not renewed at their full value, benchmark premiums for many households increased by hundreds of dollars per month. For families already managing tight budgets, that increase was enough to make continued enrollment feel financially impossible.
The result is a coverage gap affecting millions of people — many of whom may still be eligible for Medicaid, CHIP, or subsidized Marketplace plans and simply have not had the information or support to pursue those options.
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Program 1: Medicaid
Who It May Cover
Medicaid is a joint federal-state program that provides free or very low-cost health coverage to eligible low-income individuals and families. Eligibility rules vary significantly by state — a critical distinction.
- In Medicaid expansion states (40 states plus Washington D.C. as of 2025): Adults with household incomes at or below 138% of the FPL may be eligible regardless of whether they have children or a disability.
- In non-expansion states (primarily in the South and parts of the Midwest): Eligibility is typically limited to specific categories — pregnant women, children, parents of dependent children, people with disabilities, and elderly adults. Income thresholds in these states are often far lower and may exclude working-age adults without dependents entirely.
How to Apply
- Visit your state's Medicaid agency website or go to HealthCare.gov and begin an application — the system automatically screens applicants for Medicaid eligibility.
- Apply in person at your local Department of Social Services or equivalent state agency if you prefer face-to-face assistance.
- Medicaid applications are accepted year-round. There is no open enrollment window.
Documents You May Need
- Proof of identity (driver's license, state ID, or passport)
- Proof of income (recent pay stubs, most recent tax return, or a letter from your employer)
- Proof of state residency (utility bill, lease agreement, or bank statement)
- Social Security numbers for all household members applying
- Immigration documentation, if applicable
Processing Timeline
Federal rules require most states to process standard Medicaid applications within 45 days — or 90 days for applications based on disability. Many states offer faster determinations, sometimes same-day, for straightforward cases. Once approved, coverage may be retroactive to the date of application or the prior month, depending on your state's rules.
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Program 2: Children's Health Insurance Program (CHIP)
If you have children in your household, CHIP may cover them even if you do not qualify for Medicaid yourself. CHIP is designed specifically for families whose incomes are above Medicaid limits but still too low to afford private insurance.
Most states cover children in families earning between 138% and 200%–300% FPL. Some states extend CHIP eligibility up to 400% FPL for children. Coverage typically includes routine checkups, immunizations, dental care, vision services, emergency care, and prescription drugs. Premiums and cost-sharing are minimal or nonexistent for most enrolled families.
Apply through your state's CHIP agency or through HealthCare.gov. Like Medicaid, CHIP enrollment is open year-round — there is no deadline to apply.
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Program 3: ACA Marketplace Special Enrollment Period (SEP)
Dropping a Marketplace plan does not permanently close the door to Marketplace coverage. If you experienced a qualifying life event, you may be able to enroll in a new plan outside of the standard Open Enrollment Period, which typically runs November 1 through January 15.
Qualifying Life Events That May Trigger an SEP
- Loss of other health coverage, including losing a job-based plan or dropping a Marketplace plan
- Change in household size (marriage, divorce, birth, or adoption)
- Change in income that affects subsidy eligibility
- Moving to a new coverage area
- Gaining citizenship or lawful immigration status
You generally have 60 days from the qualifying event to enroll. Premium tax credits may still reduce your monthly cost if your household income falls between 100% and 400% FPL — or higher in states with their own expanded subsidy programs. Benefit amounts vary by household size and income.
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Program 4: Federally Qualified Health Centers (FQHCs)
Even if you cannot secure insurance coverage right now, Federally Qualified Health Centers (FQHCs) — commonly called community health centers — provide primary care, dental services, mental health care, and substance use treatment on a sliding-fee scale based on your income. No patient is turned away for inability to pay.
There are more than 1,400 FQHC organizations operating over 14,000 service delivery sites across the United States, including in rural and medically underserved areas. FQHCs serve all patients regardless of insurance status or immigration status. To find the nearest location, use the HRSA Health Center Finder at https://findahealthcenter.hrsa.gov.
For people whose Medicaid or Marketplace applications are still being processed, an FQHC can be a critical bridge for immediate care needs.
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Program 5: State-Specific Coverage Programs
Several states operate health coverage programs that go beyond federal minimums. These programs vary widely in scope and eligibility:
- California: Medi-Cal covers adults up to 138% FPL and has expanded to cover income-eligible adults regardless of immigration status.
- New York: The Essential Plan covers adults earning between 138% and 200% FPL with zero monthly premiums.
- Washington: Apple Health (the state's Medicaid program) and the Washington Health Benefit Exchange offer additional coverage tiers for low- and moderate-income residents.
- Illinois: Has expanded state-funded coverage to certain income-eligible immigrants not covered by federal Medicaid.
Check your state's health and human services agency website for programs specific to where you live. Program eligibility and availability vary by state.
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How to Get Free Enrollment Help
Navigating these programs alone can feel overwhelming — and you do not have to. Certified Navigators and Certified Application Counselors (CACs) are trained, federally funded enrollment helpers who can walk you through your options at no cost. They do not sell insurance and receive no commission based on what plan you choose.
To find a Navigator near you: - Visit LocalHelp.HealthCare.gov - Call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325), available in multiple languages - Contact your nearest community health center or local Department of Social Services
Note on online forms: If you submit any online form to request enrollment assistance, you are providing consent to be contacted regarding your inquiry. Review the form's privacy and consent language before submitting to understand how your information will be used.
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Step-by-Step Action Plan
- Screen for Medicaid first. Go to HealthCare.gov or your state Medicaid agency website and start a screening — it takes roughly 10–15 minutes and covers both Medicaid and CHIP in a single application.
- If you have children, apply for CHIP at the same time. Most state applications screen for both programs simultaneously.
- Check your SEP window if you recently lost coverage. You may have up to 60 days from the date you lost coverage to enroll in a new Marketplace plan.
- Gather documents before you apply. Having proof of income, identity, and residency ready will reduce delays in processing.
- Contact a Navigator if you feel stuck. Free, in-person help is available in most communities and can significantly reduce errors that slow down applications.
- Use a community health center for immediate care needs. If your application is still pending, an FQHC can provide care on a sliding-fee scale while you wait for a coverage determination.
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Program eligibility and availability vary by state. Not affiliated with any government agency.