How Medicaid Health Care Expansion Affects You | HealthCare.gov
Some states have expanded their Medicaid programs to cover everyone with family income below a certain level. others don’t.
Whether you qualify for Medicaid coverage depends in part on whether your state has expanded its program.
- In all states: You may qualify for Medicaid based on income, household size, disability, family status, and other factors. eligibility rules differ from state to state.
- In states that have expanded Medicaid coverage: You may qualify based on your income alone. if your household income is below 133% of the federal poverty level, you qualify. (Because of the way it’s calculated, it works out to be 138% of the federal poverty level. Some states use a different income limit.)
- You can get care at a nearby community health center. The health care law has expanded funding to community health centers, which provide primary care to millions of Americans. these centers provide services on a sliding scale based on your income. Check out how to get low-cost care in your community.
- You may qualify for a “catastrophic” health plan. if you’re under 30, you can enroll in a “catastrophic” plan. If you are age 30 or older and want to enroll in a “catastrophic” plan, you must claim an exemption to qualify. learn more about catastrophic plans.
- if your expected annual income increases between 100% and 400% of the federal poverty level (fpl), you become eligible for a marketplace plan with advance payments of the premium tax credit (aptc). If your income increases above 400% FPL, you may still qualify for savings. You’ll know for sure when you submit an application. In these cases, and if your income is at or below 150% of the FPL, you may qualify for a special enrollment period that allows you to enroll in a Marketplace plan at any time of the year. You must contact the Marketplace call center within 60 days from the date your income changed. when you call, you will need to certify that you:
- were not eligible for medicaid when you first applied because you live in a state that has not expanded medicaid
- You weren’t eligible for a Marketplace plan with tax credits when you first applied because your income was too low
- had an increase in expected annual income that now qualifies you for a Marketplace plan with tax credits
See if you qualify for Medicaid in your state based solely on income
Find out if your state is expanding Medicaid and if you qualify based on your household income alone. We’ll also tell you if you qualify for savings on a health insurance plan.
find out now
if your income is low and your state has not expanded medicaid
if your state has not expanded medicaid, your income is below the federal poverty level, and you do not qualify for medicaid under your state’s current rules, you will not qualify for any of the health insurance savings programs: medicaid coverage or savings on a private health plan purchased through the Marketplace.
Note: If your income is at or below 150% of the Federal Poverty Level, you may be able to enroll in or change Marketplace coverage through a new Special Enrollment Period. See if you can get health coverage.
apply for medicaid coverage, even if your status hasn’t expanded
Even if your state hasn’t expanded Medicaid and it appears your income is below the level to qualify for financial help with a Marketplace plan, you must complete a Marketplace application.
Each state has coverage options that might work for you, especially if you have children, are pregnant, or have a disability. and when you provide more detailed income information, you can drop in range to save.
learn how to apply for medicaid.