Low-Income Health Insurance: Medicaid, CHIP & ACA Savings
Low income does not automatically mean going without coverage. Depending on your state, household size, income, and access to other insurance, you may qualify for Medicaid, CHIP, or financial help with an ACA Marketplace plan.
Reviewed August 30, 2026 · Educational guidance, not an eligibility determination
What coverage can a low-income household qualify for?
Most people should check three paths first. Eligibility is not based on one national income number: Medicaid and CHIP are state-administered, while Marketplace financial help follows federal tax-credit rules and also depends on access to other qualifying coverage.
Medicaid
Free or low-cost coverage for eligible people
- Expansion states generally cover adults up to about 138% of the applicable poverty guideline.
- Children, pregnant people, older adults, and people with disabilities can have different rules.
- Enrollment is available year-round.
CHIP
Coverage for children in qualifying families
- Designed for children in families that earn too much for Medicaid.
- Income limits vary substantially by state.
- Coverage commonly includes routine care, prescriptions, dental, vision, and hospital care.
ACA Marketplace Plans
Private coverage with possible federal financial help
- For 2026, Premium Tax Credit eligibility generally returns to 100%–400% of the applicable FPL.
- Cost-sharing reductions can lower deductibles and copays if you qualify and select a Silver plan.
- Eligibility also depends on employer coverage and other minimum essential coverage.
There are two different poverty-year calculations on this page
This is where many 2026 insurance pages get the math wrong. Current Medicaid program estimates and Marketplace premium-tax-credit calculations do not necessarily use the same poverty-guideline year.
Current 2026 HHS guideline
For the 48 contiguous states and D.C., the 2026 poverty guideline is $15,960 for one person and $33,000 for a household of four. These current guidelines are relevant to many 2026 program eligibility calculations.
2026 Marketplace tax credits
IRS rules use the poverty guidelines most recently published on the first day of that plan year’s Open Enrollment. For 2026 coverage, that means the 2025 guidelines are the applicable basis for the Premium Tax Credit.
No general PTC above 400% in 2026
The temporary rule that allowed Premium Tax Credits above 400% FPL applied through 2025. Beginning in 2026, household income above 400% FPL generally disqualifies a taxpayer from the credit.
2026 HHS poverty guidelines and the 138% expansion benchmark
The table below uses the 2026 HHS poverty guidelines for the 48 contiguous states and Washington, D.C. The 138% column is an estimate commonly used when discussing ACA Medicaid expansion for adults; states apply their own eligibility rules and income methodology.
| Household Size | 2026 100% Guideline | Approx. 138% |
|---|---|---|
| 1 | $15,960 | $22,025 |
| 2 | $21,640 | $29,863 |
| 3 | $27,320 | $37,702 |
| 4 | $33,000 | $45,540 |
| 5 | $38,680 | $53,378 |
| 6 | $44,360 | $61,217 |
Premium Tax Credit and cost-sharing reduction income guide
For 2026 Marketplace coverage, the applicable federal poverty guideline is the 2025 guideline because it was the most recently published guideline on the first day of 2026 Open Enrollment. The table below shows the 100%, 250%, and 400% points for the 48 contiguous states and D.C.
| Household Size | 100% FPL | 250% FPL | 400% FPL |
|---|---|---|---|
| 1 | $15,650 | $39,125 | $62,600 |
| 2 | $21,150 | $52,875 | $84,600 |
| 3 | $26,650 | $66,625 | $106,600 |
| 4 | $32,150 | $80,375 | $128,600 |
| 5 | $37,650 | $94,125 | $150,600 |
| 6 | $43,150 | $107,875 | $172,600 |
100%–400% FPL
You may qualify for a Premium Tax Credit if you meet the other Marketplace eligibility requirements. The amount depends on household income and the benchmark plan available where you live.
Up to 250% FPL
You may also qualify for cost-sharing reductions. These extra savings lower out-of-pocket costs only when you enroll in an eligible Silver Marketplace plan.
Above 400% FPL
Beginning with 2026, the general Premium Tax Credit is no longer available above 400% FPL. You can still buy Marketplace coverage, but without the federal PTC unless a specific exception applies.
Check your likely 2026 coverage path
This tool separates the 2026 Medicaid poverty guideline from the 2025 poverty guideline used for 2026 Marketplace Premium Tax Credit calculations. It is a screening tool only; it cannot determine legal eligibility.
Enter your information above
The estimator will compare your income with the relevant 2026 Medicaid and Marketplace thresholds.
Estimate only. Final eligibility is determined by your state Medicaid agency and/or the Health Insurance Marketplace.What if your income is too low for ACA subsidies?
This is an important search question because the answer changes depending on where you live. In states that expanded Medicaid, low-income adults generally have a Medicaid path. In states that have not expanded, some adults can fall into the coverage gap: too much income for their state’s Medicaid rules but below the ordinary Marketplace tax-credit floor.
Use this order to find the lowest-cost legitimate coverage
Estimate your 2026 household income
Marketplace savings generally use projected annual household MAGI. Self-employed households should use a reasonable annual estimate and update it when circumstances change.
Check Medicaid and CHIP first
Both programs accept applications year-round. A Marketplace application can also screen household members for Medicaid or CHIP.
Check Marketplace financial help
If you are not eligible for Medicaid or another qualifying coverage, compare ACA plans and see whether a Premium Tax Credit or cost-sharing reduction applies.
Compare total cost, not just the premium
Review deductibles, copays, prescription coverage, provider networks, and the out-of-pocket maximum. If you qualify for cost-sharing reductions, compare Silver plans carefully.
Enroll during the correct window
Marketplace Open Enrollment runs November 1 through January 15. Outside that period, you generally need a Special Enrollment Period. Medicaid and CHIP enrollment is year-round.
Direct primary care can complement insurance
If you are comparing ways to make routine care more predictable, MyPhysicianPlan is a separate direct-care service. It is not health insurance and does not replace Medicaid, CHIP, ACA-compliant major medical coverage, emergency coverage, or specialist/hospital benefits.
Explore MyPhysicianPlan → Sponsored affiliate link. Review the provider’s current terms, services, availability, and pricing before enrolling.Low-income health insurance FAQs
What income qualifies for Medicaid in 2026?
In Medicaid expansion states, adults are generally eligible up to about 138% of the applicable poverty guideline, subject to state rules and eligibility methodology. Using the 2026 HHS guideline, 138% is about $22,025 for one person and $45,540 for a household of four in the 48 contiguous states and D.C. Other Medicaid groups can have different limits.
What is the income limit for ACA subsidies in 2026?
For 2026, the Premium Tax Credit generally applies when household income is at least 100% and not more than 400% of the applicable federal poverty line, assuming the household meets the other eligibility requirements. For 2026 coverage, the applicable poverty guideline is the 2025 guideline because it was the most recently published guideline on the first day of Open Enrollment.
Can someone above 400% FPL get an ACA Premium Tax Credit in 2026?
Generally, no. The temporary expansion that removed the 400% upper-income cap applied through tax year 2025. Beginning in 2026, the general rule again limits the Premium Tax Credit to households at or below 400% FPL.
Can low-income households still find $0-premium Marketplace plans?
Some households may see a $0 net premium after an available tax credit, but it is not guaranteed. The result depends on income, household information, age, location, available benchmark premiums, and other eligibility factors. Compare the full cost of coverage, not only the monthly premium.
Do cost-sharing reductions work with Bronze or Gold plans?
No. If the Marketplace determines that you qualify for cost-sharing reductions, you must select an eligible Silver plan to receive the reduced deductible, copay, coinsurance, and out-of-pocket maximum benefits.
How many states have expanded Medicaid?
As of August 2026, 41 states including Washington, D.C. have adopted the ACA Medicaid expansion, while 10 states have not.
When can I enroll in an ACA Marketplace plan?
HealthCare.gov lists Open Enrollment as November 1 through January 15. Enroll by December 15 for coverage that can start January 1. Outside Open Enrollment, you generally need a qualifying Special Enrollment Period. Medicaid and CHIP applications remain available year-round.
Where to verify your eligibility
- HealthCare.gov — Marketplace application, plan comparison, subsidy determination, Medicaid/CHIP screening.
- HealthCare.gov Federal Poverty Level guide — current poverty-guideline tables and coverage-savings overview.
- IRS Premium Tax Credit overview — tax-credit eligibility requirements.
- IRS Premium Tax Credit Q&A — explains the 100%–400% rule and which poverty guideline applies.
- HHS/ASPE Poverty Guidelines — official 2026 poverty guidelines.
- Medicaid.gov — federal Medicaid and CHIP resources and state contacts.
Ready to compare your coverage options?
Use official eligibility tools first, then compare available plan costs, networks, prescriptions, and out-of-pocket exposure.
Disclaimer: Advocate Health Plans provides educational information and comparison resources. This page is not legal, tax, financial, or insurance advice and does not determine eligibility. Program rules, state Medicaid limits, plan availability, premiums, provider networks, and tax-credit amounts can change. Verify your situation with HealthCare.gov, your state Marketplace, your state Medicaid agency, the IRS, or an appropriately licensed professional. Some links may be affiliate links, which can generate compensation at no additional cost to you.