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Side-by-side
| Medicaid | Marketplace plan | |
|---|---|---|
| Who runs it | States, with federal funding | Private insurers, sold through HealthCare.gov or state exchanges |
| Income eligibility (adults) | Up to 138% of poverty in expansion states; much lower elsewhere | Subsidies from 100% to 400% of poverty; anyone can buy at full price |
| Premiums | Usually none | Depends on income and plan |
| Out-of-pocket costs | Very low or none | Deductibles and copays; reduced for Silver plans at lower incomes |
| When you can enroll | Any time | Open enrollment or special enrollment |
| Extra benefits | Often includes non-emergency transport and long-term care | Standard essential health benefits |
Who qualifies for Medicaid
In the 40 states (plus D.C.) that expanded Medicaid, adults aged 19 to 64 generally qualify with incomes up to 138% of the federal poverty level: about $22,025 for one person and $45,540 for a family of four in 2026. Children, pregnant women, people with disabilities and older adults may qualify at higher incomes through other Medicaid categories or CHIP. Ten states have not expanded Medicaid, and in most of them adults without children rarely qualify, however low their income.
The coverage gap
In non-expansion states, some adults earn too much for Medicaid but less than 100% of the poverty level, the minimum for Marketplace subsidies. They fall into a “coverage gap” with no affordable option. If this applies to you, check your state’s Medicaid rules carefully, look for community health centers that charge on a sliding scale, and re-apply if your income rises above 100% of poverty.
Work requirements from 2027
Under a CMS interim final rule issued in June 2026, states must require certain expansion adults aged 19 to 64 to show at least 80 hours a month of work, education, job training or community service, starting no later than January 1, 2027. Exemptions include pregnant and postpartum people, people with disabilities or who are medically frail, American Indians and Alaska Natives, parents and caregivers of young children or people with disabilities, and people meeting SNAP or TANF work rules. Watch for notices from your state Medicaid agency and respond quickly.
Moving between Medicaid and the Marketplace
- If you lose Medicaid because of higher income or work requirements, you have a special enrollment period to buy a Marketplace plan.
- If your income falls during the year, you can apply for Medicaid immediately and end your Marketplace plan once approved.
- When you apply through HealthCare.gov, your application is screened for Medicaid and CHIP automatically.
- Note that the year-round special enrollment period for low-income Marketplace applicants has ended.
How to apply
- Apply through your state Medicaid agency or HealthCare.gov (or your state marketplace).
- Have proof of income, identity, citizenship or immigration status and household size.
- Report changes in income or household promptly.
- Renew on time each year; missing renewal paperwork is a common reason people lose cover.
For Marketplace options, see our Marketplace guide and subsidies guide.
Frequently asked questions
What is the income limit for Medicaid in 2026?
In expansion states, about $22,025 for a single adult and $45,540 for a family of four (138% of the federal poverty level). Limits are lower in non-expansion states.
Can I have Medicaid and a Marketplace plan at the same time?
You generally can’t get Marketplace subsidies while eligible for Medicaid. If you qualify for Medicaid, you’d normally switch.
Can I apply for Medicaid any time?
Yes. Unlike Marketplace plans, there’s no enrollment period for Medicaid.
What are the new Medicaid work requirements?
From 2027, many expansion adults aged 19 to 64 must show 80 hours a month of work, education, training or community service, with exemptions for groups such as caregivers and people with disabilities.
What is the Medicaid coverage gap?
In states that didn’t expand Medicaid, some adults earn too much for Medicaid but below 100% of poverty, so they don’t qualify for Marketplace subsidies either.
Sources
- healthinsurance.org – Medicaid eligibility at 138% of poverty (Aug 2026)
- ADvancing States – CMS interim final rule on Medicaid work requirements
- HealthCare.gov – Pre-existing conditions
- Undue Medical Debt – ACA Marketplace changes for 2027
- healthinsurance.org – Will you receive an ACA premium subsidy?
- CMS – 23.1 million enroll in 2026 Marketplace coverage (Mar 2026)
Insurance prices, discounts and rules change often and vary by state. Figures were checked in October 2026; confirm details with the insurer or your state insurance department.