Medicaid vs. Marketplace

When your income is lower, there are two doors: Medicaid or a Marketplace plan with tax credits. Which door is yours depends on your income and your state — because not every state expanded Medicaid. Here’s how it works in the sixteen states I’m licensed in.

The Basic Split

In states that expanded Medicaid, lower-income adults generally qualify for Medicaid up to 138% of the federal poverty level (FPL), and the Marketplace with tax credits above that. In states that did not expand, there’s a gap — keep reading, because this matters.

States That Expanded Medicaid: AZ, IA, MI, OH

Arizona, Iowa, Michigan, and Ohio expanded Medicaid. If your income is below about 138% of the federal poverty level, you’ll generally be routed to Medicaid — which typically has very low or no premiums. Above that, you shop the Marketplace, where tax credits can lower your premium based on income. I’ll help you figure out which side of the line you’re on.

States That Did NOT Expand: TX, FL

Texas and Florida did not expand Medicaid. That creates a coverage gap: adults below 100% of the federal poverty level generally don’t qualify for Medicaid or Marketplace tax credits. But at 100% of FPL and above, Marketplace tax credits kick in — so an honest, accurate income estimate is everything. Estimate too low and you can fall in the gap; estimate it right and help becomes available.

Why Your Income Estimate Matters So Much

Your tax credits are based on the income you expect for the coverage year — not last year’s tax return. Self-employed? Seasonal work? New job? We’ll build an honest estimate together. Get it right and your credits are right; get it wrong and you settle up at tax time. This is the single most valuable thing I do for lower-income clients, and it’s free.

I’ll Point You to the Right Door

Tell me your state and your situation and I’ll tell you straight whether Medicaid or the Marketplace is your path — and if it’s the Marketplace, we’ll build the income estimate together and compare real plans. If it’s Medicaid, I’ll point you to your state’s application and make sure you know what to expect.

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