User Avatar

By Ryan Kennelly

March 19, 2024

Topics:

  • Individual & Family Health Insurance
BACK TO BLOG

What is the Medicaid gap?

March 19, 2024

  • Individual & Family Health Insurance
The Medicaid coverage gap refers to a group of uninsured individuals in states that did not expand their Medicaid programs. They are not eligible for Medicaid, yet at the same time not eligible for subsidies offered by the Affordable Care Act. Therefore, making both forms of affordable health insurance inaccessible. There are approximately 2.4 million Americans in this coverage gap, according to the Kaiser Family Foundation.
If you live in a state without the Medicaid expansion, you could fall within this gap. The exact factors depend on your state but for Medicaid the median income limit for parents in these states is just 44% of poverty, or an annual income of $8,985 a year for a family of three. Medicaid is generally not available at all to childless adults in states that did not expand Medicaid. ACA premium subsidies are only available for people with a household income of at least 100 percent of the FPL, up to 400 percent of FPL. (This chart shows the income limits for Medicaid in each state.)
If you do not qualify for Medicaid or ACA subsidies, you are in the Medicaid gap. To get health insurance, you can pay full price for an ACA Marketplace plan or purchase a private health insurance plan. Both options can be expensive and lack the protections that come with the ACA plans. An often more affordable option is to get low-cost care through a community health center. These health centers generally provide health care services on a sliding scale based on your income. To find a community health center near you, use this tool from the U.S. Department of Health and Human Services.

Want to Join Independent
Health Agents?

We’d be happy to have your join our team of independent agents.

JOIN NOW