Thanks to the Supreme Court decision making the Medicaid expansion optional for states, the federal poverty line (FPL) has become enormously important. Before the decision, the FPL simply determined what kind of coverage you were eligible for: Medicaid for those below, and subsidized private coverage for those above (with some overlap– people making between 100% and 133% of the FPL could get Medicaid or private coverage). But now, in states that have chosen to opt out of the Medicaid expansion, the poverty line will mean the difference between subsidized private coverage and no coverage at all.
So it’s important to know what exactly the income cut off is, particularly if your income is right around that line. However, we’ve heard that some people who have called the healthcare.gov hotline for clarification have been told two different numbers: $11,490 and $11,670 for single people. But here’s the really confusing part: they’re both accurate.
The confusion stems from the fact that the FPL changes every year to adjust for inflation, and so the 2014 FPL ($11,670 for singles) is slightly higher than the 2013 FPL ($11,490) and they’re both being used to calculate eligibility on the Obamacare marketplaces right now:
- The 2013 FPL– which remember is lower– is being used to determine eligibility for private insurance subsidies; and
- The slightly higher 2014 FPL is being used to determine eligibility for Medicaid.
While using poverty lines from two different years is more confusing, it also means that more people will be eligible for coverage. If you live in a state that didn’t expand Medicaid, you only need to get your income up to $11,490 to qualify for subsidized private insurance, instead of $11,670. (Again that’s for single individuals. If you’re married and/or have kids the line is higher– see the charts below.) That’s not a huge difference, but it does mean some people will get coverage who wouldn’t have been able to otherwise.
On the other hand, for those living in states that did expand Medicaid, using the higher 2014 FPL as the cutoff for Medicaid eligibility means more people will have access to the program. In states that expand, anyone making less than $15,521 will have the option of enrolling in Medicaid— if they had used the 2013 FPL, only those making less than $15,282 would qualify. Again, not a huge difference, but across a country of 315 million people a significant number will be in that gap.
Two more things to keep in mind about the FPL:
1. It’s different for different family sizes. We’ve been using the FPL’s for single adults, but if you’re married and/or have kids it’s going to be different. The charts below, from Families USA, show the FPL’s for each year for different family sizes. (And remember, the 2013 FPL is the one that you should most care about if you live in a state that didn’t expand.):
2. Those are the FPL’s for the lower 48 states. If you live in Alaska or Hawaii the federal poverty line will be different. They’re also higher– that’s a problem for Alaska, where Republican governor Sean Parnell has opted out of the expansion. You can see the federal poverty lines for each of those states here.