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Are you curious about the Medicaid coverage gap? For citizens earning too little for private insurance, but too much for total Medicaid coverage, Medicaid gap insurance may be available to qualifying applicants. Learn more about States without Medicaid expansion and more.

What Is the Medicaid Coverage Gap?

Residents of states which opted out of the medical expansion are concerned about the Medicaid coverage gap. One might wonder, “What is the Medicaid coverage gap?” To put it simply, recipients who earn insufficient funds to qualify for the ACA’s subsidies and credits, in addition to failing to qualify for Medicaid under the preceding rules, will be in the gap.

Medicaid is limited to specific low-income groups, while marketplace subsidies include a deductible, coinsurance and copays. The no-coverage space in-between is known as the insurance gap. Based on recent findings, the estimated number of Americans who fall into the Medicaid gap insurance category was near three million in January, 2016, with the vast majority residing in the South’s non-expansion states.

More people tend to live in the South than in other regions, thus explaining why the Medicaid coverage gap is so big. Additionally, limited Medicaid eligibility and uninsured rates are greater in the South than in other zones. As a whole, the number of people living in states without Medicaid expansion is affecting 4.3 million of the entire U.S. population.

Understanding what is the Medicaid coverage gap means that the uninsured can potentially receive aid for health care. Review the following Medicaid gap insurance information:

  • What is the Medicaid Coverage Gap and what are the consequences?
  • The current status of the Medicaid Coverage Gap
  • Possible insurance options for residents of states without Medicaid expansion
  • The Real Solution for the Medicaid Coverage Gap

What is the Medicaid coverage gap and what are the consequences?

In 2012, the Supreme Court governed that every state had the opportunity to take on the Obamacare Medicaid expansion. The expansion would change eligibility requirements for Medicaid and federally funded healthcare, and effectively enable millions of Americans to enroll for medical coverage and services otherwise not available.

The coverage gap refers to members of the adult population who struggle to live outside of the poverty bracket, but who do not qualify for Medicaid gap insurance. These people do not earn enough to gain health care through programs that provide financial help. As a result of falling into the coverage gap, low-income adults are likely to remain without insurance coverage.

Furthermore, the divergence between racial and ethnic groups has come to the forefront, with the percentage of colored minorities failing to qualify for Medicaid gap insurance in the United States being significantly higher than the percentage of qualifying Caucasians.

What Is the Status of the Medicaid Coverage Gap?

From 2014 through 2016 the federal government has promised to cover 100 percent of Medicaid expansion costs, with plans to cover 90 percent of the costs in 2020 and beyond. To date, the number of states which have expanded Medicaid totals 32, and the number of states without Medicaid expansion is 19.

A majority of the states which have not chosen to take on the Medicaid expansion did not want to take on the incurred costs of the plan. While the federal government will still be covering 90 percent of the expansion costs to states, 10 percent of the costs translates to millions, if not billions of dollars for which the state is accountable.

A closer look at the state Medicaid gap insurance status shows that the number of people who won’t gain access to health care is as follows:

  • Alabama – 254,000
  • Florida – 1,253,000
  • Georgia – 682,000
  • Idaho – 90,000
  • Kansas – 126,000
  • Maine – 38,000
  • Mississippi – 200,000
  • Missouri – 293,000
  • Nebraska – 72,000
  • North Carolina – 593,000
  • Oklahoma – 246,000
  • South Carolina – 292,000
  • South Dakota – 34,000
  • Tennessee – 352,000
  • Texas – 1,186,000
  • Utah – 116,000
  • Virginia – 235,000
  • Wisconsin – 167,000
  • Wyoming – 19,000

What Are Some Insurance Options for Residents of States Without Medicaid Expansion?

For some people, being included in the Medicaid coverage gap can prove to be a difficult position to be in. Nevertheless, there are alternative options for residents in states without Medicaid expansion, however limited.

In terms of care, recipients can visit federally funded community health centers or depend on the Emergency Medical Treatment and Labor Act (EMTALA). For coverage, a citizen needing medical services can attempt to increase his or her income, acquire a non-ACA compliant plan or make a move to states outside of the Medicaid coverage gap.