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Wondering if your income is above or below Obamacare’s Medicaid cutoff? Read this.

Medicaid expansion protest

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.):

2013 FPL chart

2014 FPL chart

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.

{ 10 comments… add one }
  • Alexandra papadopoulos September 12, 2016, 6:15 pm

    Please explain to me if im entitled to Medicaid
    My husbunds SS is $837.00 monthley
    Mine is $1.035 monthly
    We live in illinois
    I read on the computer but i dont understand.
    Please help me !
    Sinscerely
    Alexandra Papadopoulos

  • Rob Cullen November 22, 2016, 10:42 pm

    @Alexandra: If I did my math right, your income is $22,464, and the cutoff for Medicaid under the ACA is 138% of the Federal Poverty Line, which is currently $22,108 for a family of two. So based on those numbers, your income would be too high to qualify for Medicaid (barely).

    However since your income is so close to the cutoff, I would check with someone who can look at your situation more closely. You can talk to a “navigator” in your area for free (you can find one here: https://localhelp.healthcare.gov/) or you could just apply through your state’s Medicaid agency. When you give them your income information, they’ll be able to tell you if you qualify.

  • Kelsie Bender February 16, 2017, 1:05 am

    Hello, last year my husband and I got separated and I received 300$ monthly in food stamps, as well as full Medicaid coverage for myself and toddler son. His parents bought him a new house in November and I have moved in, since I no longer have a vehicle. My income from child and spousal support last year was about 1500$ monthly. I no longer receive that since we live together and have a signed separation agreement that says he is exemp from paying me if we reside together. Anyways, I have applied for the New Years benefits, and I turned in a copy of our separation agreement from last year. They scheduled a phone interview for Friday. The lady that I talked to acted like my exes income should count, thus cutting off my benefits since we live together now. That isn’t fair because I wouldn’t survive without the health insurance and I have no income. His life and mine are separated. He alone makes 65k a year, but again, I make nothing and we are not together. Do you think they will cut me off? Is there anything I can do to keep my benefits? Would it help if we draw up a 6 month lease agreement that says I am temporarily renting here? Thanks

  • Rob Cullen February 20, 2017, 11:54 am

    @Kelsie: I don’t think a lease agreement saying that you are temporarily renting there would help. Your eligibility for Medicaid or ACA subsidies is based on the Adjusted Gross Income on your tax form– so I believe if you still file together, his income would be counted and you wouldn’t qualify for Medicaid; if you file taxes separately, then you probably would still be eligible, regardless of your address. But I would either talk to a professional tax preparer or contact someone from the Marketplace to be sure.

  • Marilynn Smith April 7, 2017, 12:49 pm

    I was turned down for medicade I make less than the amount it shows.
    I make $10,444.00 a year and I’m single the amount it shows $11,490.00 and $11,670.00 which either chart you show. Explain to me why I was TURNED DOWN?

  • Rob Cullen April 9, 2017, 11:30 am

    @Marilynn: It’s hard to say without knowing more about your situation– it might be that you live in a state that didn’t expand Medicaid, it might be that whatever agency checked your income found something that pushed you above the limit… or it could just be a mistake.

  • Chrissi April 22, 2017, 10:11 pm

    Hi.. I live in Alabama and my husband draws 688.00 a month on disability. I am a full time student and all my children are on full Medicaid as well as my husband, however I do not qualify because of his income. They say with a family of 5 we have to make less than 400 a month to qualify for Medicaid, but I don’t understand this… how is a family of 5 suppose to live on 400 a month and pay for insurance!?! Is there any way I could get on Medicaid with this income!?!

  • Rob Cullen April 23, 2017, 9:08 pm

    @Chrissi: If you lived in a state that had expanded its Medicaid program under the Affordable Care Act, your husband’s income is low enough that you would qualify. However, Alabama chose not to expand Medicaid under that ACA, and yeah, in many states without the expansion, the income cutoff for most people is very very low. Unfortunately, there’s not a lot you can do to get around that– maybe try contacting one of the free ACA Navigators in Alabama, and see if they have any ideas. They would know more about local options if there are any. You can find a Navigator here: https://localhelp.healthcare.gov/#intro

  • Elizabeth October 3, 2017, 11:45 pm

    I make 49,998 dollars a year for my family of 5 will I qualify for Medi-Cal. I live in California.

  • Rob Cullen December 15, 2017, 10:20 am

    @Elizabeth: The cutoff for Medicaid is 138% of the poverty line, which for a family of five this year is about $39,716, so you probably wouldn’t be eligible. Still it’s worth applying anyways– in California, Medi-Cal also administers CHIP (the Children’s Health Insurance Program), and CHIP tends to have higher income cutoffs. You might not qualify for coverage, but your kids probably would.

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