Medicaid vs Marketplace Insurance Calculator

In states that expanded Medicaid, the limit is 138% of the Federal Poverty Level — about $20,783/year for a single person in the continental US (2026 plan year). Non-expansion states generally use 100% FPL or lower limits. Children can qualify up to 200% FPL or higher through CHIP depending on the state.

As of 2026, the following states have not expanded Medicaid: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming. Residents in these states face a coverage gap if income falls below 100% FPL — they earn too little for ACA subsidies but don't qualify for full Medicaid.

Generally no — if you're eligible for Medicaid you're not eligible for ACA subsidies (APTC). Medicaid is primary. You can buy a Marketplace plan without subsidies if you prefer the network, but it rarely makes financial sense given Medicaid's $0 premium.

CHIP (Children's Health Insurance Program) provides free or low-cost coverage for children under 19 in households earning too much for Medicaid but too little for full Marketplace premiums — typically up to 200% FPL or higher (varies by state). Adults generally do not qualify for CHIP. Apply through HealthCare.gov or your state CHIP program.

CSR reduces your deductibles, copays, and out-of-pocket maximums when you enroll in a Silver plan and have income between 100–250% FPL. The Silver 94 tier (100–150% FPL) is most valuable — deductibles can drop to near $0. CSR is ONLY available on Silver plans, so choosing Bronze or Gold forfeits it even if you qualify.

If you're in a non-expansion state and earn below 100% FPL, you may be in the 'Medicaid gap' — ineligible for ACA subsidies (which start at 100% FPL) but also not qualifying for full Medicaid. Options include Federally Qualified Health Centers (sliding-scale fees), state-specific programs, or waiting for potential Medicaid expansion in your state.