Medicaid Gap Checker 2025
Find out if you fall in the Medicaid coverage gap — where you earn too much for Medicaid but too little for ACA subsidies.
What Is the Medicaid Coverage Gap?
In states that did not expand Medicaid under the ACA, people earning below 100% of the Federal Poverty Level fall into a gap: they earn too much for traditional Medicaid, but too little to qualify for ACA marketplace subsidies (which start at 100% FPL). This leaves millions of Americans without any affordable coverage option.
2025 FPL for 1-person household: $15,650
Enter your information above to check eligibility
Select your state, household size, and enter your income to check coverage options.
States That Have NOT Expanded Medicaid (2025)
These 10 states still have the coverage gap. If you live here and earn below 100% FPL, you may have no affordable coverage options.
All other states + DC have expanded Medicaid and cover individuals up to 138% FPL.
Key Facts About the Medicaid Gap
How it happened: The ACA originally required all states to expand Medicaid, but a 2012 Supreme Court ruling made expansion optional. States that didn't expand left millions without coverage.
Who's affected: Primarily working adults in low-wage jobs — retail, food service, construction, home care — who don't get employer insurance and earn less than about $15,000–$20,000/year.
The 100% FPL cliff: ACA subsidies start exactly at 100% FPL. Even $1 above this threshold can unlock hundreds of dollars in monthly premium tax credits. Below it in a non-expansion state? Nothing.
It could change: States can expand Medicaid at any time — Missouri and Oklahoma both expanded via ballot initiative. Political pressure continues in remaining holdout states.
Based on 2025 FPL guidelines and Medicaid expansion status as of January 2025. Medicaid eligibility varies by state and may depend on additional factors (age, disability, household composition). This is for educational purposes only — verify your eligibility at HealthCare.gov or your state's Medicaid agency.