Getting a Medicaid denial letter can be stressful and confusing. It might feel like your options have run out — but that’s not the case. In Georgia, losing Medicaid doesn’t have to mean losing health coverage.

At Mere Benefits, we help you understand your denial, explore new options, and get the right plan in place so you’re never left without care.

Why You Might Be Denied Medicaid in Georgia

Medicaid eligibility is based on a combination of factors:

• Income – You may be over the income limit for your household size.

• Household changes – Marriage, divorce, or children aging out of coverage can affect eligibility.

• Disability or age status – You may no longer meet the requirements for a specific program.

• Documentation issues – Missing paperwork or outdated contact information can lead to denial.

Step 1: Read Your Denial Letter Carefully

Your denial letter will tell you:

• Why you were denied

• When your coverage ends (if you currently have it)

• How to appeal, if you believe the decision was wrong

If you think your denial is a mistake, you can request an appeal. But while that process plays out, you should also look at other coverage options to avoid a gap in care.

Step 2: Know When You May Qualify for Marketplace Coverage

When you lose or are denied Medicaid, you typically qualify for a Special Enrollment Period (SEP) in the Marketplace. This allows you to get a new health plan — often with a subsidy to lower your monthly premium — outside the regular Open Enrollment period.

You may qualify for Marketplace subsidies if you:

• Lose Medicaid eligibility

• Are denied Medicaid but meet Marketplace income requirements

• Have limited Medicaid benefits that do not count as “minimum essential coverage”

Limited Medicaid Programs That Don’t Count as Full Coverage in Georgia

If you’re only covered by one of these, you may be eligible for Marketplace subsidies right now:

• Medicaid for medically needy individuals (spenddown programs)

• Georgia Planning for Healthy Babies – Family Planning Demonstration

• Limited coverage for:

  • Family planning

  • Emergency Medicaid

  • Tuberculosis services

  • Outpatient hospital services

Medicaid to Marketplace Quick Guide

Do You Have Full Georgia Medicaid… or Just Limited Benefits? (Knowing the difference could save you money on health insurance.)

Full Medicaid – You’re Covered

• Covers doctor visits, hospital, prescriptions, preventive care

• No monthly premium (for most)

• Not eligible for Marketplace subsidy

Limited Medicaid – You May Qualify for Marketplace Savings ⚠

• Only covers specific services listed above

• No full benefits

• You may be eligible for subsidies & lower costs on a Marketplace plan

What To Do Next:

1. Call our office: 📞 904-654-5450

2. We check if you qualify for Marketplace or Medicare coverage

3. We help you apply — No cost. No obligation.

Step 3: Consider Medicare if You Qualify

If you’re turning 65 or qualify for disability-based Medicare, we can help you transition from Medicaid smoothly — making sure you keep the doctors you trust and have the drug coverage you need.

How Mere Benefits Can Help

Our licensed team will:

• Explain your Medicaid denial in plain language

• Identify if you qualify for Marketplace subsidies or Medicare

• Compare plan options and costs for you

• Handle the application process from start to finish — at no cost to you

If you’ve been denied Medicaid in Georgia, call 904-654-5450 today. We’ll make sure you understand your options and get the coverage you need — #simplyforyourbenefit.