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What is the FPL?

  • FPL is an abbreviation for federal poverty level, which is a measure of income used to determine eligibility for Medicaid and the Children’s Health Insurance Program (CHIP), as well as premium subsidies and cost-sharing reductions (cost-sharing subsidies) in the exchange, and other federal programs.
  • The Department of Health and Human Services sets FPL guidelines annually for the 48 contiguous states and separately for Alaska and Hawaii.
  • People in Medicaid expansion states qualify for Medicaid if they earn up to 138% of the FPL, and for premium subsidies if their income is above that level but does not exceed 400% of the FPL. In states that haven’t expanded Medicaid, premium subsidy eligibility starts at 100% of the poverty level, and extends up to 400% of FPL (but there is no assistance available in those states to people with income below the poverty level who aren’t eligible for Medicaid based on the state’s existing non-expansion eligibility rules).
  • If you buy insurance in the state marketplaces (exchanges) you may be eligible for ACA premium subsidies, depending on how your income compares with the federal poverty level, and depending on the price of unsubsidized coverage in your area.
  • If your income is above 138% of FPL (or 100% in states that haven’t expanded Medicaid) and also doesn’t exceed 250% of FPL, you will be eligible for a cost-sharing subsidy (if you buy a Silver Plan).
  • The new FPL numbers are released each year around the end of January. At that point, states start using the new numbers immediately to determine eligibility for Medicaid and CHIP. But the exchanges continue to use the prior year’s FPL numbers to determine subsidy eligibility for all plans effective that year. They don’t switch to using the current year’s FPL numbers until open enrollment begins in November, for coverage effective the following January. So subsidies for a plan with an effective date in August 2020 (for someone using a qualifying event to enroll outside of open enrollment) will be based on 2019 FPL numbers, while a person enrolling in Medicaid in August 2020 will be determined eligible based on 2020 FPL numbers.

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