Where to start looking for affordable health coverage

Medicaid and marketplace insurance are the two main paths to low-cost coverage, and which one works for you depends on your income and state. Medicaid is run by your state and covers people below a certain income threshold — the threshold varies by state, and some states cover more people than others. Marketplace insurance (sold through Healthcare.gov or your state's exchange) is available to anyone, but you pay less if your income falls in a certain range. You cannot be on both at the same time, so the first step is figuring out which one you might reach.

Start by visiting Healthcare.gov and entering your zip code and household income. The site will tell you whether you likely may have access to for Medicaid in your state, what marketplace plans cost you, and whether you would receive a tax credit that lowers your monthly payment. This takes about five minutes and costs nothing. If Healthcare.gov says you may may have access to for Medicaid, you then contact your state Medicaid office directly — not through Healthcare.gov — to complete that process.

Key Takeaways

  • Healthcare.gov shows you in minutes whether Medicaid or marketplace insurance is available to you and what you would pay.
  • Medicaid income limits vary by state, and some states have raised theirs while others have not, so your state matters more than your income alone.
  • Marketplace plans come with tax credits if your household income is between 100 and 400 percent of the federal poverty line, which can cut your monthly cost in half or more.
  • Your state Medicaid office handles Medicaid enrollment directly; Healthcare.gov does not process Medicaid applications.
  • If you lose job-based insurance, you have 60 days to enroll in marketplace coverage without waiting for open enrollment.

How Medicaid income limits work and why they differ by state

Medicaid is jointly funded by the federal government and states, which means each state sets its own income limit. The federal poverty line for a single person in 2024 is roughly $15,000 per year, but states can cover people earning more than that. Some states cover people up to 138 percent of the poverty line; others cover only those below 100 percent. A few states have not expanded Medicaid at all, meaning they cover only certain groups like children, pregnant people, and people over 65.

To find your state's limit, search "[your state] Medicaid income limit" or call your state Medicaid office directly. They can tell you the exact threshold for your household size and whether you fall below it. Income counts as wages, self-employment earnings, Social Security, unemployment benefits, and some other sources — but not all income counts the same way. Your state Medicaid office will explain which of your income sources they count.

What marketplace insurance costs and how tax credits reduce your bill

Marketplace plans range from bronze (cheapest monthly payment, higher deductible) to platinum (higher monthly payment, lower deductible). The actual cost depends on your age, location, and which insurer offers plans in your area. A 30-year-old in one county might pay $150 per month for a bronze plan while a 50-year-old in the same county pays $400 per month for the same plan.

If your household income is between 100 and 400 percent of the federal poverty line, you receive a tax credit that reduces your monthly payment. For 2024, that range is roughly $15,000 to $60,000 for a single person, though the exact numbers change yearly and depend on household size. The credit is calculated based on your expected income for the year, and you can use it to lower your bill right away rather than waiting until tax time. If your income changes during the year, you can update your application and adjust your credit.

Healthcare.gov shows you the actual monthly cost after the credit is applied, so you see what you would really pay before you enroll. You do not have to choose the cheapest plan; you can pick any plan offered in your area.

How to enroll in Medicaid through your state

Once you know you likely may have access to for Medicaid, contact your state Medicaid office. You can find the phone number and website by searching "[your state] Medicaid" or by calling 211, which is a free referral line that connects you to local health and human services. When you call, have your Social Security number, birth date, and proof of income (recent pay stub, tax return, or benefit letter) ready.

Some states let you apply online, by mail, or in person at a local office. Others require phone or in-person applications. The office will ask about your household size, income, citizenship status, and whether you are pregnant, disabled, or over 65. Processing usually takes two to four weeks, though some states are faster. Once you are approved, your coverage typically starts on the first day of the month after approval.

If you are denied, you have the right to appeal. Your state Medicaid office will explain the reason for denial and tell you how to request a hearing. Many denials are due to missing documents or income miscalculations, both of which can be fixed.

How to enroll in marketplace insurance during open enrollment or after a life change

Open enrollment runs from November 1 to January 15 each year, and that is when most people enroll in marketplace plans. You can enroll anytime during this window by visiting Healthcare.gov, entering your information, comparing plans, and picking one. You choose your coverage start date (usually the first of the following month), and your first bill is due by the date the plan specifies.

If you miss open enrollment, you can still enroll if you have had a may have access to life event — losing job-based insurance, getting married, having a baby, moving to a new state, or losing Medicaid coverage. You have 60 days from the date of the event to enroll. Healthcare.gov will ask you to confirm the event and provide a document proving it (like a termination letter from your employer or a birth certificate). Once confirmed, you can enroll immediately rather than waiting for the next open enrollment period.

If you do not have a may have access to event and miss open enrollment, you cannot enroll in marketplace insurance until the next November. Medicaid, however, has no enrollment period — you can apply anytime.

Other coverage options if you do not may have access to for Medicaid or marketplace plans

If your income is too high for Medicaid and you do not may have access to for a tax credit on marketplace plans (because your income exceeds 400 percent of the poverty line), you still have options. Some employers offer plans to part-time workers or spouses. Professional associations and unions sometimes offer group plans. Short-term health plans exist but cover fewer services and have lower limits than marketplace plans.

If you have a chronic condition or take regular medications, ask your doctor's office or pharmacy whether the drug manufacturer offers a patient assistance program that covers the cost of your medication. Many do, regardless of your insurance status. Community health centers also provide care on a sliding fee scale based on income, meaning you pay less if you earn less.

What to do if your income or household changes during the year

If you are on Medicaid and your income rises above your state's limit, you will lose coverage. Your state Medicaid office will notify you of the end date. Before that date, you can enroll in marketplace insurance if you are within the open enrollment window or if the income change counts as a may have access to life event (it usually does). Contact Healthcare.gov or your state marketplace to enroll.

If you are on a marketplace plan and your income drops, you can update your application to receive a larger tax credit, which lowers your monthly payment. If your income drops below your state's Medicaid limit, you can switch to Medicaid instead. Both changes count as may have access to life events, so you can make them anytime rather than waiting for open enrollment.

Report changes to the program you are on as soon as they happen. Delays can result in overpayments (you owe money back) or underpayments (you miss out on credits you were may have access to to). Healthcare.gov and your state Medicaid office both have online portals where you can update your information without calling.

Frequently Asked Questions

Can I have both Medicaid and marketplace insurance at the same time?

No. If you are on Medicaid, you cannot enroll in a marketplace plan. If you are on a marketplace plan and then become Medicaid-may be able to access, you must drop the marketplace plan and switch to Medicaid. Your state Medicaid office will tell you the effective date of your Medicaid coverage.

What if I am self-employed or have irregular income?

Self-employment income counts toward your Medicaid and marketplace income limits. When you apply, estimate your income for the current year based on what you expect to earn. If your actual income is different, you can update your application. Healthcare.gov and your state Medicaid office both let you report changes online.

Do I need to be a U.S. citizen to get Medicaid or marketplace insurance?

Medicaid requires U.S. citizenship or a may have access to immigration status. Marketplace insurance is available to anyone, but you must have a valid Social Security number or Individual Taxpayer Identification Number (ITIN) to enroll. Some states offer limited Medicaid coverage to undocumented immigrants for emergency services only.

What happens if I do not enroll during open enrollment and do not have a may have access to event?

You cannot enroll in marketplace insurance until the next open enrollment period (November 1 to January 15). However, you can apply for Medicaid anytime. If you do not may have access to for Medicaid and cannot enroll in marketplace insurance, community health centers offer care on a sliding fee scale based on your income.

How do I know if my state expanded Medicaid?

Search "[your state] Medicaid expansion" or call your state Medicaid office. If your state has not expanded Medicaid, the income limit is usually much lower, and you may only may have access to if you are pregnant, disabled, a child, or over 65. Healthcare.gov will tell you whether you may have access to based on your state and income.