FAQ

• What is Medicaid?

  Medicaid can provide free or low-cost health coverage to low-income people, families and children, pregnant women, the elderly, and people with disabilities. In some states, Medicaid programs cover all people below certain income levels.Learn more about medicaid

• What is CHIP?

  In all states, the Children's Health Insurance Program (CHIP) provides low-cost health coverage to children in families that earn too much to qualify for Medicaid. In some states, CHIP covers pregnant women. Each state works closely with its own Medicaid program to determine these rules. In many cases, if you qualify for Medicaid, your children will qualify for either Medicaid or CHIP.

• How does income determine Medicaid eligiblity?

  Medicaid eligiblity is determined using a metric called "Modified Adjusted Gross Income" (MAGI). MAGI includes: adjusted gross household income (taxable income less deductions / adjustments), social security benefits not included in taxable income, tax-exempt interest, and foreign earned income.
  
  Income generated by a working, dependent child in the household may or may not be included in the household's MAGI, depending on their level of income and whether they are expected to file a tax return.
  
  Sources of taxable income include wages/salary, interest, self-employment income, taxable social security benefits, alimony received, retirement benefits, capital gains, investment income, unemployment benefits, rental or royalty payments, court awards, and gambling, prizes, or awards.
  
  Sources of taxable income include wages/salary, interest, self-employment income, taxable social security benefits, alimony received, retirement benefits, capital gains, investment income, unemployment benefits, rental or royalty payments, court awards, and gambling, prizes, or awards.

• What if I'm not eligible for Medicaid based on my income, but my children need coverage?

  In most states, Children's Health Insurance Programs (CHIP) have higher income thresholds to ensure children access to medical coverage. Please see your state's Medicaid website for further information.

• Can I get Medicaid coverage if I don't meet the income requirements in my state?

  You may qualify for Medicaid even if you do not meet the income guidelines. In most states, there are specialty programs for individuals with disabilities or blindness, as well as programs for pregnant mothers, infants, and the elderly. These programs often have more relaxed income requirements than traditional Medicaid. Some states also offer limited benefit programs with expanded eligibilty, such as family planning.

• Is having a low income the only thing qualifies me for Medicaid?

  No, some states require an individual to possess certain characteristics in order to be eligible. Additionally, there may be a limit on assets or resources available to the indivdual in order to be eligible (e.g., funds in a checking or savings accounts).

• What is the difference between Medicaid and Medicare?

  While they may sound the same, Medicaid and Medicare are actually two different programs. Both can help you pay for healthcare and medical expenses, but Medicaid is a public assistance healthcare program for low-income Americans, regardless of their age. Medicare, on the other hand, is an age-based federal health insurance program that guarantees coverage for individuals ages 65 and over, as well as some younger people with disabilities.

• Do I have to be 65 or older to qualify for Medicare?

  No. Generally, Medicare is available for people age 65 or older, as well as younger people with disabilities, individuals with ALS (Lou Gehrig's disease), and those with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant).

• What if I'm eligible for Medicare but I have dependent children in my household?

  Medicare eligibility only applies at the individual level, but your dependents may be eligible for other programs, such as CHIP, Medicaid, or health exchange subsidies. Please see your state's Medicaid website for further information.

• What does "dual eligible" mean?

  If you're over 65 or otherwise qualify for Medicare, you may also be eligible for Medicaid benefits, based on your income.
  
  Four programs providing assistance to individuals on Medicare with low incomes, under the umbrealla of the Medicare Savings Program (MSP), include:
  
  (1) Qualified Medicare Beneficiary (QMB) Program—helps pay Part A (Hospital and Inpatient Insurance) and Part B (Medical and Outpatient Insurance) premiums, deductibles, coinsurance, and copayments (2) Specified Low-Income Medicare Beneficiary (SLMB) Program—helps pay only Part B premiums (3) Qualifying Individual (QI) Progam—helps pay Part B premiums on a first-come, first-served basis (4) Qualified Disabled Working Individual (QDWI) Program—pays Part A premiums for disabled and working beneficiaries under 65, who are not receiving Medicaid and who meet certain income criteria, set by state.
  
  Medicare pays for covered dually-eligible beneficiaries’ medical services first, because Medicaid is generally the payer of last resort. Medicaid may cover medical costs Medicare may not cover or partially covers (such as nursing home care, personal care, and home- and community-based services). Coverage for dually-eligible beneficiaries varies by state.

• When can I enroll in a marketplace health plan?

  The annual open enrollment period for marketplace health plans (also known as health exchange insurance plans) takes place annually in the fall, for coverage beginning in the new year. However, if you've recently lost coverage due to a job loss or other qualifying event (such as having a baby or getting married), you generally have 60 days before or after the event to enroll in a plan.

• How is eligibility for marketplace health plan subsidies determined

  Eligibility for subsidies is based on expected annual adjusted gross income (taxable income less deductions/adjustments) during the coverage year (not a prior year's income). Because income can be hard to calculate during frequent life changes, this tool from healthcare.gov can help you calculate your income and potential for savings.
  
  Sources of taxable income include wages/salary, interest, self-employment income, taxable social security benefits, alimony received, retirement benefits, capital gains, investment income, unemployment benefits, rental or royalty payments, court awards, and gambling, prizes, or awards.