The
Medicaid
coverage gap refers to a group of uninsured individuals in states that did not expand their
Medicaid
programs. They are not eligible for
Medicaid, yet at the same time not eligible for subsidies offered by the Affordable Care Act. Therefore, making both forms of affordable health insurance inaccessible. There are approximately
2.4 million Americans in this coverage gap, according to the Kaiser Family Foundation.
If you live in a state without the
Medicaid
expansion, you could fall within this gap. The exact factors depend on your state but for
Medicaid
the median income limit for parents in these states is just
44% of poverty, or an annual income of $8,985 a year for a family of three.
Medicaid
is generally not available at all to childless adults in states that did not expand
Medicaid. ACA premium subsidies are only available for people with a household income of at least 100 percent of the FPL, up to 400 percent of FPL. (This
chart shows the income limits for
Medicaid
in each state.)
If you do not qualify for
Medicaid
or ACA subsidies, you are in the
Medicaid
gap. To get health insurance, you can pay full price for an ACA Marketplace plan or purchase a private health insurance plan. Both options can be expensive and lack the protections that come with the ACA plans. An often more affordable option is to get low-cost care through a community health center. These health centers generally provide health care services on a sliding scale based on your income. To find a community health center near you, use this tool from the
U.S. Department of Health and Human Services.
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