If government websites left you with more questions than answers, you're not alone. Whether you should be on Medicaid or a Marketplace plan comes down to your income and your state. Under the Affordable Care Act (ACA), adults with income up to 138% of the federal poverty level usually qualify for Medicaid in 2026 in states that expanded it, according to HealthCare.gov's Medicaid expansion guide. Above that line, a Marketplace plan is usually the fit.
The federal poverty level (FPL) is an income line the government sets each year. It goes up with the size of your household. You don't have to know which program fits before you apply. One application checks you for both and tells you which one you qualify for.
Should I be on Medicaid or an ACA Marketplace plan?
Two things decide it:
- Your household income compared to the FPL.
- Whether your state expanded Medicaid.
Medicaid expansion is the ACA option that lets states cover most adults under 65 based on income alone. Not every state has taken it. The HealthCare.gov guide linked above shows where your state stands.
For 2026, here's how it usually lines up:
Your household income (2026) | State expanded Medicaid | State did not expand Medicaid |
|---|---|---|
Below 100% of FPL | Likely Medicaid | Coverage gap. Likely neither, unless you fit another Medicaid group |
100% to 138% of FPL | Likely Medicaid | Likely a Marketplace plan with a tax credit |
Above 138% up to 400% of FPL | Likely a Marketplace plan with a tax credit | Likely a Marketplace plan with a tax credit |
Above 400% of FPL | Marketplace plan, no tax credit | Marketplace plan, no tax credit |
A premium tax credit is a discount on your monthly Marketplace bill. It's paid straight to your insurance company, and you pay the rest. For 2026, the credit is available to households between 100% and 400% of FPL, per HealthCare.gov's guide to Medicaid expansion and subsidies. Households above 400% don't get a credit this year. Our guide to the ACA subsidy cliff in 2026 explains why that line came back.
What's the difference between Medicaid and a Marketplace plan?
Both cover doctor visits, hospital care, and prescriptions. They work differently in ways that affect your wallet.
Medicaid | Marketplace plan | |
|---|---|---|
Who runs it | Your state, under federal rules | Private insurers, sold through HealthCare.gov or your state's marketplace |
What you pay | Low or no cost | A monthly premium, lowered by a tax credit if you qualify |
When you can sign up | During Open Enrollment, or after a qualifying life event | |
Which income counts | Generally your current monthly income | Your expected income for the whole year |
A qualifying life event is a change like losing other coverage, moving, or having a baby. It opens a special window to enroll outside the yearly sign-up season.
Which income counts, this month or this year?
This is where a lot of people get tripped up. Medicaid generally looks at what you're earning now. A Marketplace plan looks at what you expect to earn for the full year. Your state's Medicaid agency can tell you exactly how it counts income.
Say you worked full time through spring, then your hours were cut in half in June. Your total for the year might still land in Marketplace range. But your monthly income now may fall under your state's Medicaid limit. Because Medicaid looks at the monthly number, you may qualify today.
Base your Marketplace estimate on your honest best guess for the year. If your real income turns out different, your tax credit gets squared up when you file your taxes.
What if my state didn't expand Medicaid?
This is the hardest spot in the system, and it's worth saying plainly. In states that didn't expand Medicaid, many adults below 100% of FPL don't qualify for Medicaid. They also earn too little to get a Marketplace tax credit. This is called the coverage gap, and HealthCare.gov's Medicaid expansion guide describes it.
Falling in the gap doesn't mean you should skip applying. Non-expansion states still cover certain groups, such as children, pregnant people, some parents, and people with disabilities. The application checks those groups for you.
If your income sits near the 100% FPL line that HealthCare.gov uses for Marketplace tax credits, estimate it carefully. Small changes, like a new part-time job, can move you into Marketplace range.
Can I pick a Marketplace plan if I qualify for Medicaid?
You can buy one, but you'd pay full price. If you qualify for Medicaid, you can't get a premium tax credit or other Marketplace savings, as HealthCare.gov explains.
For most people who qualify, Medicaid costs far less. If you're weighing a Marketplace plan because you want a certain doctor, ask the doctor's office which plans they take first. Many offices accept Medicaid.
Do the rules change for children, pregnancy, or disability?
They can. Kids can often get coverage through Medicaid or the Children's Health Insurance Program (CHIP) at higher household incomes than adults. Pregnant people often qualify at higher incomes too. These limits vary by state, so the application is the most reliable way to check.
If you get Supplemental Security Income (SSI), that often qualifies you for Medicaid, though the process depends on your state. Our step-by-step guide to SSDI and SSI benefits covers how that application works.
What this means for you
- Write down your household size and income. Note what you earn this month and what you expect for the full year. You'll need both numbers.
- Check your state. Find out whether it expanded Medicaid. That tells you which row of the first table above applies to you.
- Fill out one application. It screens for Medicaid, CHIP, and Marketplace savings together. For how to apply where you live, see the state guides on the Turnout blog, including our guide on how to apply for ACA insurance in Texas.
- Apply now if Medicaid might fit. You don't need to wait for Open Enrollment, because Medicaid and CHIP accept applications any time of year.
If you'd rather talk to a person, call the Marketplace Call Center at 1-800-318-2596. Once you're covered, our Health Advocate articles cover what to do when a claim or bill doesn't add up.
Turnout is not a law firm and does not provide legal representation. You can read more in our terms of use.
FAQ
Can I have Medicaid and a Marketplace tax credit at the same time? No. If you qualify for Medicaid, you can't also get a premium tax credit. If your Medicaid ends, you can apply for Marketplace savings then.
What happens if my income goes up and I lose Medicaid? Losing Medicaid usually counts as a qualifying life event. That opens a special enrollment period to pick a Marketplace plan. Report your new income promptly so the switch goes smoothly.
I just lost my health insurance from work. Which one should I look at? Check both, starting with your current monthly income for Medicaid. Losing job-based coverage also lets you enroll in a Marketplace plan outside Open Enrollment. If you're out on disability, our article on whether your employer can cancel your health insurance during disability walks through your options.
Will applying for one program hurt my chances at the other? No, it won't. One application checks you for Medicaid, CHIP, and Marketplace savings together. It will show which one you qualify for.
It's your turn
You don't have to sort out every income rule by yourself. Visit Turnout's benefits page to learn more about programs you may qualify for, including health coverage. You'll come away knowing where to start.