Along with the new federal mandates that govern health insurance under the Affordable Care Act, aka Obamacare, many states have also expanded Medicaid programs to provide coverage for Americans who have household incomes that are below a specific level. The qualifications for Medicaid coverage are dependent upon whether or not the state in which you live has expanded their program.
In order to qualify for health insurance through the Medicaid program you must meet certain requirements that may vary from state to state. Although the basic qualifications are somewhat common throughout the country, the limits and other specific rules may be different between each state.
In most every case, determining if an individual qualifies for Medicaid coverage is accomplished by taking into account a variety of factors. These include annual income, size of the household, family status, any disabilities that the individual may be dealing with, and a list of additional various other factors and eligibility rules.
However, the qualifications are made somewhat easier in those states that have expanded their Medicaid coverage. In these instances, an individual would only need to qualify based solely on their annual income and whether or not it falls below the federal poverty level. Most states have set the standard at 138% below the poverty line, though there are some states that have set a different percentage.
States Without the Medicaid Expansion
Your options look a little different if you live in one of the states that has not expanded their Medicaid program. If you don’t meet the current eligibility requirements, then you will not qualify for Medicaid. However, if your income is above a certain level, then you also won’t be able to take advantage of savings programs and tax credits offered by the Health Insurance Marketplace.
Just because you don’t qualify doesn’t mean that you’re out of options. You still have some choices available to you. Importantly, you are eligible for an exemption from having to pay a penalty for not having insurance when tax time comes around. The Affordable Care Act prescribes a fee for those who do not have health insurance, but since you were unable to get coverage due to your state not expanding Medicaid you are not subject to the penalty.
Those who do not qualify for Medicaid or savings through the Marketplace may get the care they need from a local health center located in their community. Through the Affordable Care Act, additional funding has been extended to clinics and health centers so that the uninsured may still receive the medical attention they need. The costs you would be expected to pay for these services is determined by your income.
You can try to meet the eligibility requirements again in the future after you’ve already made your first attempt and if your expected annual income rises to a level that falls between 100% and 400% of the poverty line. At this point you could qualify for a health care plan through the Marketplace with premiums reduced through advance payments of the premium tax credit.
Submit your questions below or start a conversation in the comments!