Annual redetermination is the process your state Medicaid agency or the ACA Marketplace uses each year to verify that you still qualify for the coverage or subsidies you’re receiving. It typically happens around the time of your plan’s renewal and ensures that your eligibility is based on your current income, household size, and other circumstances.
For Marketplace enrollees, the Marketplace uses information from your tax return and other federal data sources to update your estimated subsidy amount for the upcoming year. If your income or household changes significantly, your Premium Tax Credit may increase, decrease, or be eliminated at renewal.
For Medicaid enrollees, redetermination verifies that your income still falls within the eligibility threshold. After the COVID-19 continuous enrollment protections ended in 2023, states resumed annual Medicaid redeterminations — resulting in many enrollees being removed from Medicaid if they didn’t respond to renewal notices or their income had changed.
What to do at renewal time:
Yes. If you don’t act during Open Enrollment, most Marketplace plans auto-renew — but your subsidy amount will be recalculated using updated income estimates. If your subsidy decreases and you don’t update your application, you may end up paying more than expected or owing money at tax time. Always review and actively confirm your enrollment rather than letting it roll over passively.
Contact your state Medicaid office immediately. Many redetermination notices go to outdated addresses or get missed. In most states, you can still appeal a termination and be reinstated if you respond within a set timeframe. Missing Medicaid redetermination is a qualifying life event that opens a Special Enrollment Period for Marketplace coverage.
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