Health insurance Medicaid Your Coverage Options

How to get health insurance when you’re ineligible for both Medicaid and premium assistance in the state exchange

Written by Diane Archer

Because the Supreme Court gave states the option of expanding Medicaid, it has forced about four million people today into an insurance no man’s land. These four million people live in states that have still chosen not to expand Medicaid. They have incomes too high to qualify for Medicaid and too low to qualify for a subsidy in their state exchanges. The federal government does not subsidize premiums of people who earn less than the federal poverty level in the state exchanges.

The twenty states that have not expanded Medicaid to date have made it very hard for people caught in this “coverage gap.” Medicaid can be a life-saving benefit.  And, unless people in this coverage gap move to a state that has expanded Medicaid, they are ineligible for it. Today, more than half a million people cannot get needed mental health care because they live in states that have not expanded Medicaid.

If they stay put, to get health insurance, people in states that have not expanded Medicaid have no choice but to take on more work. That can mean working two full-time jobs. But, according to the Kaiser Family Foundation, more than half of people caught in this gap have full-time or part-time jobs already and 86 percent of them live in the south.

In Texas, to qualify for Medicaid, your income must be less than 20 percent of the federal poverty level. Only if people can raise their income above 100 percent of the federal poverty level will the federal government pick up a large percentage of their insurance premium through the exchange.

To apply for a subsidy in the state exchanges, you must project your annual income. Fortunately, if your income ends up being less than the federal poverty level, the current rules do not require you to pay back the subsidy. For free or low-cost resources in your community, click here.

People who are uninsured because their states have not expanded Medicaid must complete a form to avoid paying a penalty for not having insurance.


1 Comment

  • The US healthscare system is disgusting and murderous, and needs to be dismantled. We need universal coverage now. If you make $2 over the FPL, you’re just totally screwed from getting coverage at all!
    If you are even at 200-300% of the FPL, chances are you don’t have all this money to pay for insurance, coinsurance, and all these other things that these plans won’t even cover.
    Access to healthcare should not be determined by who employs you or if you work for yourself, followed by what state you live in. Civilized countries don’t put up with this.

    But the solution to obtaining insurance if you fall between the Medicaid eligibility line and buying from the exchange is to just get yet another job? Screw slaving even more for these corporations who make billions and won’t pay a living wage and/or give consistent hours, or underpay for what used to be living wage and beyond living wage jobs. If you have a debilitating and expensive illness like cancer, you might be better off to stop working or take very reduced hours to be eligible for Medicaid.

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