Medicaid provides health care coverage for individuals and families with lower incomes. Agents encounter Medicaid in both ACA Marketplace and Medicare contexts. This article covers general Medicaid eligibility, income thresholds, and how a client applies. For guidance on how Medicaid affects a specific ACA or Medicare scenario, see the linked articles in each section below.
Basic Eligibility Requirements
To qualify for Medicaid, a client generally must:
Be a U.S. citizen or have an eligible immigration status
Live in the state where they are applying for Medicaid
Have a Social Security number, or show that they have applied for one
Households that include non-U.S. citizens can still apply. A parent can apply for a child's coverage even if the parent is not eligible.
Medicaid Expansion for Adults
In states that have adopted Medicaid expansion, adults ages 19 through 64 may qualify for Medicaid if all of the following are true:
The client is not receiving and not entitled to Medicare
The client is not pregnant
The client's household income is below 138% of the Federal Poverty Level (FPL)
The client is an adult without children, or is the parent or caretaker of a child under age 21 who has comprehensive health coverage, whether private or Medicaid
Not every state has adopted Medicaid expansion. If a client's income is near the 138% FPL threshold, confirm whether the client's state has expanded Medicaid before advising them on eligibility.
2026 Income Thresholds by Household Size
The table below shows 2026 annual income thresholds at the percentages of the Federal Poverty Level (FPL) most commonly used for Medicaid, CHIP, and ACA Premium Tax Credit eligibility. Figures are for the 48 contiguous states and the District of Columbia. Alaska and Hawaii use higher thresholds; contact Producer Support for those figures.
Household Size | 100% FPL | 138% FPL | 150% FPL | 200% FPL | 250% FPL | 300% FPL | 400% FPL |
1 | $15,960 | $22,024.80 | $23,940 | $31,920 | $39,900 | $47,880 | $63,840 |
2 | $21,640 | $29,863.20 | $32,460 | $43,280 | $54,100 | $64,920 | $86,560 |
3 | $27,320 | $37,701.60 | $40,980 | $54,640 | $68,300 | $81,960 | $109,280 |
4 | $33,000 | $45,540 | $49,500 | $66,000 | $82,500 | $99,000 | $132,000 |
5 | $38,680 | $53,378.40 | $58,020 | $77,360 | $96,700 | $116,040 | $154,720 |
6 | $44,360 | $61,216.80 | $66,540 | $88,720 | $110,900 | $133,080 | $177,440 |
7 | $50,040 | $69,055.20 | $75,060 | $100,080 | $125,100 | $150,120 | $200,160 |
8 | $55,720 | $76,893.60 | $83,580 | $111,440 | $139,300 | $167,160 | $222,880 |
Source: U.S. Department of Health and Human Services, 2026 Poverty Guidelines.
How to Apply for Medicaid
The best way for a client to find out if they are eligible for Medicaid is to apply. Clients can apply for Medicaid in either of the following ways:
Through their state Medicaid agency, which can be found at medicaid.gov
Through HealthCare.gov, which checks eligibility for both Medicaid and ACA Marketplace plans on a single application
Agents may assist consumers with the Medicaid application process and provide guidance, but the consumer remains the applicant and is responsible for providing accurate information and submitting or confirming their application, unless an authorized representative arrangement applies.
CHIP: Children May Qualify Even If a Parent Does Not
A child may be eligible for the Children's Health Insurance Program (CHIP) even if their parents are not eligible for Medicaid. CHIP provides health coverage to eligible children in families with incomes too high to qualify for Medicaid but who cannot afford private coverage. CHIP eligibility is based on the child's own eligibility requirements, such as household income, age, and residency, not on whether the parent qualifies for Medicaid.
Need Help?
For questions about Medicaid eligibility or how it applies to a specific client, contact Producer Support by asking a question via chat, sending an e-mail to [email protected] or by phone at (866) 568-9649.