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For millions of beneficiaries, Medicaid provides a much needed lifeline. This ensures they receive access to essential healthcare services. However, one common question Medicaid beneficiaries have is does Medicaid coverage renew automatically. Although the answer depends on the state and specific circumstances of each enrollee, understanding the Medicaid renewal process helps avoid a lapse in coverage.

Medicaid renewal, also known as redetermination, is the process each state uses to determine if a beneficiary is still eligible for Medicaid benefits. Periodically, each state must verify the beneficiary’s income, household size, and other factors to ensure they still qualify for the program.

Click here to apply for Medicaid in each state

Does Medicaid coverage renew automatically

The short answer is: In some cases, Medicaid renewals are automatic, while others require the beneficiary to provide information to their resident state for renewal.

Automatic (passive) renewal

In many states, if the Medicaid office can verify eligibility through their databases (e.g., tax records, Social Security information, or unemployment benefits), coverage may renew automatically. If this happens, beneficiaries receive a notice in the mail informing them that coverage has been renewed without further action required.

Active Renewals

If eligibility cannot be verified automatically, beneficiaries must complete a renewal form and provide the requested documentation. States may typically send a renewal notice by mail or email depending on the beneficiary’s preferences. The notice includes instructions as well as a deadline to submit the required information.

What Triggers the Need for Renewal

Medicaid renewal usually occurs annually, though the exact timing varies according to when each beneficiary first receives Medicaid. Some reasons for renewal are a change in household size or a change in income. State policies differ and may change and require information for a renewal.

How to prepare for Medicaid renewal

Whether renewal is automatic(passive) or requires action, the following tips can help ensure a smooth process:

Beneficiaries must notify their state Medicaid office immediately if their address, phone number, or email changes. This ensures they receive renewal notices and other important information. They should also watch their mail for important notices and respond quickly. It is also important to keep recent pay stubs, or tax returns as proof of income.

Be aware of the deadline for renewal to respond in a timely manor and avoid a lapse in coverage.

Click here to learn the difference between Medicare and Medicaid

What If the renewal deadline passes

Failing to complete the renewal on time can result in a termination of benefits. However, most states offer a grace period that allows beneficiaries to submit renewal documents and have coverage reinstated retroactively.

Whether renewal is automatic or requires action, keeping your information updated and responding promptly to notices are imperative to maintain benefits.

Additional information

Most states have expanded Medicaid programs that cover anyone with a household income below a specific level.

In every state, Medicaid qualification is based on income, household size, disability and other factors. The exact qualifications differ by state. States the have expanded Medicaid coverage offer Medicaid based on income alone. When household income is less than 133% of the federal poverty level. A few states use a different income limit.

Each state has it’s own Medicaid renewal process. Beneficiaries can contact their local department of Social Services/Medicaid office or visit the state’s Medicaid website for detailed guidance.

We receive a lot of questions about original Medicare, Medicare Supplement, Medicare Advantage and Medicare part D plans.  A Q and A of the more common questions has been provided below.

Question:  When does my original Medicare A and B plan start?

Answer: Generally, Medicare A and B starts the first of the month you turn 65.  It never starts on the day you turn 65 unless your birth day happens to be on the 1st.  Example:  Bob is 65 on July 18th 2013.  His Medicare A and B will start on July 1, 2013

Question:  Do I need to sign up for Medicare A and B

Answer:  If you are currently taking Social Security payments, you will automatically be enrolled in Medicare A and B.  If you are not taking Social Security payments, you need to call the social security office and sign up for part B of Medicare or enroll online.

Question: How will I be billed for Medicare?

Answer: If you have elected Social Security payments, the part B premium will be taken out of your check automatically.  If you have not elected Social Security, you will be billed quarterly.

Question: How much is Medicare A and B?

Answer:  Part A cost nothing if you or a spouse worked at least 40 quarters (10 years) and contributed toward payroll taxes.  Part B cost $104 per person (will go up in 2014) and increases for those earning higher incomes.

Question: Do I have to enroll in Part B?

Answer: No, you do not need to enroll in part B of Medicare but you will pay a 10% penalty for every year you are eligible and do not enroll.  The exception to this is if you are actively working  and receiving health benefits through your employer.

Question: Do I need part B if my employer gives me retiree benefits?

Answer:  Its a trick question.  If you are retired and getting retiree benefits, you do not have to enroll in part B BUT, you will still have a penalty if you need to enroll in part B down the road. (for example: The employer drops your retiree coverage)  The only valid waiver to the penalty is if you are getting benefits and are actively working.

Question: Does Medicare A and B give me drug coverage?

Answer:  No, Medicare A and B is for medical only.  Drug coverage needs to be purchased through a Part D plan offered by a private insurance company.

Question: What levels of coverage do Medicare A and B provide?

Answer: Generally speaking, Medicare Part A provides hospital coverage and Medicare Part B provides coverage for physicians, testing and other outpatient care.  For a full summary click the link MEDICARE A AND B BENEFITS

Question: How do people cover the things that Original Medicare does not cover?

Answer: They can purchase a Medicare Supplement plan (Also called Medigap) and a part D rx plan or they can purchase a Medicare Advantage plan (MAPD plan). Some people stay on A and B only and simply purchase a stand along Rx plan. (More often they take a supplement or MAPD plan however)

Review our MEDICARE FOR DUMMIES blog for additional information