Medicaid Eligibility Estimator

About the Medicaid Eligibility Estimator

Medicaid provides free or low-cost health coverage to millions of Americans with limited income. Eligibility is primarily based on your Modified Adjusted Gross Income (MAGI) as a percentage of the Federal Poverty Level (FPL).

In states that expanded Medicaid under the ACA, adults with income up to 138% FPL qualify. In non-expansion states, eligibility is more restrictive and varies. Children, pregnant women, and disabled individuals often have higher income thresholds.

This calculator estimates your FPL percentage and whether you may qualify for Medicaid based on income and household size. These are educational estimates only — actual eligibility depends on your state's rules and complete application.

When This Page Helps

Medicaid eligibility rules are complex and many eligible people don't know they qualify. It gives a quick check of your income relative to poverty guidelines, helping you decide whether to apply.

How to Use the Inputs

1. Enter your household size (all people in your tax household).
2. Enter your annual household income (MAGI).
3. Select whether your state expanded Medicaid.
4. Check if you're pregnant or have a disability for higher thresholds.
5. Review your FPL percentage and estimated eligibility.

Example Calculation

Tips & Best Practices

• Medicaid eligibility is based on ongoing income, not last year's tax return — apply if your income has dropped.
• You can apply anytime; Medicaid has no open enrollment period.
• Many states cover children up to 200–300% FPL through CHIP (Children's Health Insurance Program).
• Pregnant women often qualify at higher income limits (185–200% FPL in many states).
• These are educational estimates only. Apply through your state's Medicaid agency or Healthcare.gov for an official determination.
• Some states have asset tests in addition to income — check state-specific rules.

Understanding Medicaid Income Limits

Medicaid uses MAGI-based income counting, which is simpler than the old rules. Most deductions from your tax return apply, making your qualification predictable. The 138% FPL threshold in expansion states includes a 5% income disregard, so the effective limit is technically 133% FPL with a 5% buffer.

The Coverage Gap

In the 10 non-expansion states, adults earning less than 100% FPL may be in a "coverage gap" — too much income for traditional Medicaid, too little for ACA marketplace subsidies (which start at 100% FPL). Approximately 1.6 million Americans fall into this gap.

Transitioning from Medicaid

If your income increases above the Medicaid threshold, you transition to ACA marketplace plans with premium tax credits. The transition should be seamless — report income changes promptly to avoid coverage gaps. ACA subsidies make marketplace plans affordable for those just above Medicaid limits.

Frequently Asked Questions

• What is the Federal Poverty Level (FPL)?

  The FPL is an income measure issued annually by HHS and used to determine eligibility for federal assistance programs. The exact dollar threshold changes by guideline year, household size, and location, with separate amounts for Alaska and Hawaii.

• What is Medicaid expansion?

  The ACA allowed states to expand Medicaid to all adults with income up to 138% FPL. Most states and DC have adopted expansion, while non-expansion states often leave childless adults without a clear Medicaid path even at very low income levels.

• What income counts for Medicaid (MAGI)?

  Modified Adjusted Gross Income includes: wages, salary, self-employment income, Social Security, unemployment, investment income. It does NOT include: child support, workers' comp, gifts, or non-taxable VA benefits. This is generally the same income that appears on your tax return.

• Can I have Medicaid and work?

  Yes! Medicaid is not just for unemployed people. Many working families qualify, especially in expansion states. At 138% FPL, a single person earning $20,783 or a family of 4 earning $43,056 qualifies. Some states also have Medicaid "Buy-In" programs for workers with disabilities.

• What is CHIP?

  The Children's Health Insurance Program covers children in families that earn too much for Medicaid but can't afford private insurance. Income limits vary by state but typically range from 200% to 300% FPL (over $62,000–$93,000 for a family of 4). Coverage is comprehensive with low or no premiums.

• How do I apply for Medicaid?

  Apply through your state's Medicaid agency or at Healthcare.gov. You can apply online, by phone, by mail, or in person. Many states process applications within 45 days. You need proof of income, identity, and residence. Coverage can begin the month you apply or even retroactively.