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What if I’m Eligible for Medicaid, But Want to Buy an Insurance Plan in the Marketplace Instead?

Researcher & Writer

January 23, 2016

The income guidelines for an insurance plan through the Marketplace start beyond the income guidelines for Medicaid, so the short answer is no. When you go to the Marketplace website, you will be able to check to see what is available to you. If your estimated income is within Medicaid eligibility, the website will direct you to the Medicaid application process.

When the Affordable Care Act was put into effect, the parameters for Medicaid eligibility were expanded for the sole purpose of making more people eligible for Medicaid and avoiding the need to pay for health insurance.

The initial check is based on the state you live in and the number of people in your household. In short, your household includes the head of the house and all those claimed as tax dependents due to age or disability. Accurately counting the size of your household is crucial in the application process.

Once you enter your household size and state information, you will be provided with a breakdown of what you may qualify for based on your income. For example, if you have a household of 5 people, and you live in Ohio, here is your eligibility breakdown:

Estimated Income	Savings program you may be eligible for
Below $39,206	You’re eligible for free or low-cost Medicaid health care coverage
$39,206 – $71,025	You’re eligible for a health plan through the Marketplace that provides lower monthly premiums AND lower out-of-pocket expenses.
$71,026 – $113,640	You’re eligible for a health plan through the Marketplace that provides lower monthly premiums.
More than $113,640	You are not eligible for any savings programs, but you can still buy health insurance through the marketplace at regular price.

Once it is determined which program you may qualify for, you will be directed to the next application page that will include providing your estimated income, which is what your actual eligibility will be based on for the Marketplace programs.

If you are eligible for Medicaid, you will be directed to your state Medicaid site for more information on how to apply within your state. Each state has different guidelines regarding eligibility, applying, and what documentation is needed when applying. If you do not want to go on Medicaid, you do have the option of buying your own insurance. However, for most, that option is cost prohibitive.

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Eligibility Team

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