Medicaid is a joint federal-state program that provides free or very low-cost health insurance to people with low incomes, including families with children, pregnant women, older adults, and people with disabilities. Unlike Marketplace plans, Medicaid has no monthly premium in most states, and cost-sharing is minimal or nonexistent.
Eligibility is based primarily on income as a percentage of the Federal Poverty Level (FPL). Since the ACA’s Medicaid expansion (adopted by most states), adults earning up to 138% FPL generally qualify in expansion states. Non-expansion states have more restrictive eligibility rules.
Medicaid accepts applications year-round — there is no Open Enrollment Period. If you qualify, you can enroll at any time through your state’s Medicaid office or through HealthCare.gov.
Florida has not expanded Medicaid. Florida residents earning between 100% and 138% FPL do not qualify for Medicaid but can access Marketplace plans with Premium Tax Credits. Residents below 100% FPL face a coverage gap in Florida unless they meet other eligibility criteria (children, pregnant, disabled, or caretaker of a dependent child).
No. Medicaid and Marketplace subsidies are separate programs. If your income qualifies you for Medicaid, you’re generally not eligible for a Premium Tax Credit on a Marketplace plan. The Marketplace will screen for Medicaid eligibility when you apply. If you’re unsure which program applies to your situation, a broker can help you determine where you fall.
Losing Medicaid is a qualifying life event that opens a 60-day Special Enrollment Period for Marketplace coverage. You have 60 days to enroll in a Marketplace plan and may qualify for a Premium Tax Credit based on your income. Don’t wait — missing the window means waiting until the next Open Enrollment Period.
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