Some states have expanded their Medicaid programs to cover all people with household incomes below a certain level. Others have not. (FLORIDA HAS NOT EXPANDED MEDICAID)
Whether you qualify for Medicaid coverage depends partly on whether your state has expanded its program.
- In all states: You can qualify for Medicaid based on income, household size, disability, family status, and other factors. Eligibility rules differ between states.
- In states that have expanded Medicaid coverage: You can qualify based on your income alone. If your household income is below 133% of the federal poverty level, you qualify. (Because of the way this is calculated, it turns out to be 138% of the federal poverty level. A few states use a different income limit.
IF YOUR INCOME IS LOW AND YOUR STATE HAS NOT EXPANDED MEDICAID
If your state has not expanded Medicaid and 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 either health insurance savings program: Medicaid coverage or savings on a private health plan bought through the Marketplace.
IF YOU DO NOT QUALIFY FOR EITHER MEDICAID OR MARKETPLACE SAVINGS
- 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 for millions of Americans. These centers provide services on a sliding scale based on your income.
- If you don’t have any coverage, you don’t have to pay the fee. Under the law, most people must have health coverage or pay a fee. But you won’t have to pay this fee if you live in a state that hasn’t expanded Medicaid and you would have qualified if it had. This is called having an exemption from the fee. You can get an exemption when you apply for coverage in the Marketplace. Or you can apply for the exemption without having to fill out a Marketplace application.
- If your expected yearly income increases so it’s between 100% and 400% of the federal poverty level, you become eligible for a Marketplace plan with advance payments of the premium tax credit. In this case, you may qualify for a Special Enrollment Period (SEP) that allows you to enroll in a Marketplace plan any time of year. You must contact the Marketplace Call Center within 60 days from the date your income changed to request this SEP. When you call, you’ll need to attest that you:
– Weren’t eligible for Medicaid when you first applied because you live in a state that hasn’t expanded Medicaid.
– 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 yearly income that now qualifies you for a Marketplace plan with tax credits.