My eligibility for Medicaid depends on how my income compares to 138 percent of the Federal Poverty Level. Can you spell out what that means in dollars?

Q.  I know that whether I qualify for expanded ­Medicaid depends on whether my income is less than 138 percent of the Federal Poverty Level (FPL). I also understand if I earn too much to qualify for Medicaid, I can buy insurance in the exchange, where I may be eligible for subsidies, again depending on how my income compares to the FPL. Can you spell out what that means in dollars?

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A.  First, in states that have expanded Medicaid you will qualify for Medicaid if you earn up to 138 percent of the FPL. For a single individual in 2018, the upper income limit for Medicaid eligibility is $16,753, and for a family of four, the upper income limit is $34,638 (here’s the federal website that shows the current year FPL for various family sizes).

In states that have not expanded Medicaid, eligibility for Medicaid has remained unchanged as a result of the ACA, and in most cases, able-bodied adults without dependent children are not eligible for Medicaid regardless of how low their income is.

It’s important to note that Medicaid and CHIP eligibility will start to be determined based on the most recent FPL guidelines as soon as they’re published (usually in January each year). But eligibility for premium subsidies in the exchange is based on the prior-year FPL guidelines. So for coverage that is effective in 2018, the 2017 FPL guidelines are used. And for coverage that will take effect in 2019, the 2018 FPL guidelines will be used.

In all cases, the exchange first checks to see if applicants are eligible for Medicaid. Subsidy eligibility is only determined if and when the exchange has determined that the applicant is not eligible for Medicaid. So if a person applies for coverage during a special enrollment period in July 2018, the exchange would first compare the applicant’s income to the 2018 FPL numbers to see if the person is eligible for Medicaid. If they aren’t, the exchange would then compare the applicant’s income to the 2017 FPL numbers to determine subsidy eligibility.

This system is used because open enrollment happens near the end of the year, for coverage effective the following year — but the FPL numbers for the following year aren’t yet available at that point. And although they become available early in the year, the exchanges don’t switch to those new numbers until the next open enrollment period, so that everyone with coverage effective in a given year will have their subsidy eligibility based on the same FPL numbers.

Families USA has a useful FPL page, including dollar amounts up to 400% of FPL for households with up to eight members. Until open enrollment begins for 2019 coverage (in November 2018) that page will show 2017 FPL numbers, which are applicable for people enrolling in 2018 plans.

If you buy insurance in the state marketplaces – or exchanges – you may be eligible for tax credits (subsidies) that help you cover premiums. The tax credits are available if

So in states that have expanded Medicaid, subsidy eligibility starts at 139 percent of the poverty level (ie, above the cutoff for Medicaid eligibility, which is 138 percent of FPL), while in states that haven’t expanded Medicaid, subsidy eligibility starts at 100 percent of the poverty level.

For plans effective in 2018, 100 percent of the poverty level (for subsidy eligibility) is $12,060, and $24,600 for a family of four (keeping in mind that this is based on the 2017 FPL numbers, which are being used to determine subsidy eligibility for all plans with 2018 effective dates).

And 400 percent of the poverty level is $48,240 for a single individual and $115,120 for a family of five.

Cost-sharing subsidies

In addition, if your income is above 138 percent of FPL (or at least 100 percent of FPL in states that haven’t expanded Medicaid) and also doesn’t exceed 250 percent of the FPL, you will be eligible for cost-sharing subsidies if you buy a silver plan in the exchange in your state. Cost-sharing subsidies reduce the maximum out-of-pocket costs for the health plan, and also lower the deductibles and copays that you’ll have to pay if you need care. For a description of how this subsidy works, see this overview of cost-sharing subsidies and this update about cost-sharing subsidies and the Trump Administration.

For coverage effective in 2018, 250 percent of FPL is $30,1505 for a single individual, $51,050 for a family of three, and $82,400 for a family of six.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Jane Groenhoff
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Jane Groenhoff

I work in a restaurant and income Is different weekly. My 2019income tax return was 16944 do I still qualify for Medicaid

Steve Anderson
Admin

Jane, your eligibility depends on the state where you live. If you visit this page https://www.healthinsurance.org/medicaid/ and click on your state, you should find eligibility requirements, as well as a contact number for your state agency (which can tell you definitively whether you’re eligible).

Kendra Sanchez
Guest
Kendra Sanchez

i am a single mom of two and my weekly income is $550. can i qualify for insurance?

Steve Anderson
Admin

Kendra, you can use this calculator to determine whether you’re eligible for a premium subsidy here: https://www.healthinsurance.org/obamacare/subsidy-calculator/. You can also find out about your eligibility for Medicaid and CHIP by clicking on your state here: https://www.healthinsurance.org/medicaid/ Eligibility guidelines are on the top right side of each state page.

Aida
Guest
Aida

What is the most a single person with one child can earn in a year to have just the child on medicaid in NY?

Steve Anderson
Admin

There’s information about eligibility on this page … https://www.healthinsurance.org/new-york-medicaid/ … and also a contact number for New York Medicaid.

Portia Wallenberg
Guest
Portia Wallenberg

Do I qualify for Medicaid ?

Steve Anderson
Admin

The answer is that it may depend on the state where you live. Click on your state here to see the eligibility guidelines for that state: https://www.healthinsurance.org/medicaid/

KENT ATHEN
Guest
KENT ATHEN

How do I get Medicaide ? I’m at 159%
I am out of work at the end of June as they aren’t having me come back. I was a para professional at a HS

Nora Fields
Guest
Nora Fields

I’m currently on medicaid, I got a job offer part time but I’m staying with a friend and currently have no bills so my question is if I take the part time job will it be taking away? I have alot of health issues so I really need medicaid.

Louise Norris
Editor

If you’re in a state that has expanded Medicaid and your current eligibility is based solely on your income, you can earn up to 138% of the poverty level and still be eligible for Medicaid. For a single person in the lower 48 states, that amounts to about $17,600 in income in 2020. If your eligibility is based on the ACA’s expansion of Medicaid, it doesn’t matter what your bills or financial obligations are, since that system only considers income (if you’re enrolled under a “medically needy” program, your financial obligations could be taken into consideration: https://www.medicaid.gov/medicaid/eligibility/index.html ) Medicaid coverage… Read more »

Christine
Guest
Christine

I am also currently on Medicaid.If my income right now
above the Medicaid eligibility threshold . Can I contribute to traditional IRA by the tax return time to lower the MAGI to the Medicaid eligibility level? That way I can keep the Medicaid.