For $0 plan premium
Exclusions and limitations apply.
Helping you transition from Medicaid
Plan options and resources for you
You’re in the right place to learn more about Aetna CVS Health® individual & family plans. Here, you can find helpful resources, answers to your questions, and more.
Looking for coverage?
You may qualify for a no or low-cost plan
When you apply for an Affordable Care Act (ACA) plan, you may qualify for a premium tax credit, or subsidy. This can lower your monthly premium or even give you a $0 monthly premium. Exclusions and limitations apply. Now's the time to check out your options.
Medicaid eligibility FAQs
Have questions? Find helpful answers and resources.
Helping you understand Medicaid eligibility
What is Medicaid redetermination?
This is the process that states use to ensure that Medicaid enrollees continue to be eligible for Medicaid coverage. This is also called “renewal,” “redetermination” or “recertification” review.
Here’s how it works: Your state will send you a renewal letter 30 to 45 days before your renewal date to recertify your Medicaid eligibility.
- If you complete your recertification and still qualify: You don't need to do anything else. You’ll remain a Medicaid enrollee.
- If you don’t complete your recertification by the renewal date: You’ll be disenrolled from Medicaid. You’ll need to re-apply.
- If you complete your recertification and don’t qualify: You’ll be disenrolled from Medicaid. You can apply for an Aetna CVS Health individual & family health plan.
I’ve heard the federal public health emergency has ended. Is that affecting Medicaid eligibility?
Yes. The public health emergency (sometimes called “PHE”) was announced in March 2020, when the COVID-19 pandemic began. As part of the PHE, state Medicaid agencies continued health care coverage for people enrolled in Medicaid, even if they were no longer eligible. The continuous coverage rule ended on March 31, 2023. The federal PHE for COVID-19, declared under Section 319 of the Public Health Service Act, expired at the end of the day on May 11, 2023.
Do I still get to keep my Medicaid coverage as long as the PHE continues?
The continuous coverage rule ended on March 31, 2023. So even if the PHE continues, you will need to show you’re still eligible for Medicaid. Your state will send you a renewal letter 30 to 45 days before your renewal date to recertify your Medicaid eligibility. Be sure to complete it and return it by the deadline. You can learn more about your state’s eligibility requirements on the Medicaid website.
Other health coverage is available to you
I don’t qualify for Medicaid coverage. What are my options?
You can check out Affordable Care Act (ACA) plans here, or on the Health Insurance Marketplace®. ACA plans make affordable health insurance available to individuals and families so you and your family can stay covered for less. In fact, you may be able to qualify for a $0 or low plan premium. Exclusions and limitations apply.
Want to learn more? Explore Aetna CVS Health ACA plans.
What’s the difference between Medicaid and ACA coverage?
Both Medicaid and ACA coverage provide health insurance to millions of Americans. But these two types of coverage are often confused. Let’s go over some differences:
Medicaid
Medicaid is a government program. It provides health insurance to eligible low-income adults, children, pregnant women and people with disabilities. The coverage is based on financial need. Medicaid is different in each state. That means your eligibility depends on where you live.
ACA plans
Affordable Care Act (ACA) plans are offered through the Health Insurance Marketplace® and private health insurance companies, like us. Anyone who is a U.S. citizen, national or lawfully present, can get ACA coverage, no matter your income. And you can’t be denied coverage, or charged more for coverage, for a past health problem.
Want more eligibility details? Check out this quick guide to the Health Insurance Marketplace.
ACA plans are a great option for you if:
o You don’t qualify for Medicaid coverage
o You recently lost your Medicaid coverage
o You don’t have health coverage through your job
ACA plans cost more than Medicaid. The great news is financial help is available to make your ACA plan more affordable. You may be able to qualify for a $0 or low plan premium. Exclusions and limitations apply.
What do Affordable Care Act (ACA) plans cover?
Every ACA health plan covers 10 essential benefits. This includes:
Prescription drugs
Pregnancy, maternity and newborn care
Pediatric services, including oral and vision care
Mental health and substance use disorder services
Preventive and wellness services, and chronic disease management
Laboratory services
Emergency services
Hospitalization
Ambulatory services
Rehabilitative and habilitative services and devices
What do Aetna CVS Health individual & family plans cover?
Every ACA plan includes prescription drugs, maternity and newborn care and mental health benefits. With Aetna CVS Health ACA plans, you get even more, like the convenience of virtual care and walk-in clinics. Check out the covered benefits and services included in every Aetna CVS Health plan to help you feel your best.
We can help you shop for a health plan today
How can I explore Aetna CVS Health ACA individual & family plans?
Had a big life change or one coming up? You may qualify to get coverage today. Examples of big life changes include losing your health plan, having a child or getting married.
How do I know which plan is right for my budget?
Every ACA plan is assigned a metal tier: Platinum, Gold, Silver or Bronze. All plans offer the same quality of care. The metal tier is based on how you and your plan split the costs. Understanding plan levels and costs can help you pick the right plan for you.
Will I qualify for a subsidy?
When you apply for an Affordable Care Act (ACA) plan, you may qualify for a premium tax credit, or subsidy. This can lower your monthly premium or even give you a $0 monthly premium. Exclusions and limitations apply. Other help may also be available. Visit the Health Insurance Marketplace® to check if you can save money on health insurance before you shop.
Connect with us. We’re here to help.
Get in touch with us
Our licensed agents can answer your questions and help you choose the right plan for your needs.
Legal notices
Health plans are offered or underwritten or administered by Aetna Health of California Inc., Aetna Health Inc. (Florida), Aetna Health Inc. (Georgia), Aetna Life Insurance Company, Aetna Health of Utah Inc., Aetna Health Inc. (Pennsylvania), or Aetna Health Inc. (Texas) (Aetna). Aetna, CVS Pharmacy and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health® family of companies.
Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Information is accurate as of the production date; however, it is subject to change.
The member-compensated testimonials on this website reflect enrollees' experience with Aetna CVS Health® individual & family plans.
Health benefits and health insurance plans contain exclusions and limitations.