Quick answer
Low-income families can usually get free or low-cost coverage through Medicaid and CHIP, or a marketplace plan with a premium tax credit and, on silver plans, lower deductibles. In the 41 states (including DC) that expanded Medicaid, adults qualify with income up to 138% of the federal poverty level, and children qualify at much higher incomes.
Key takeaways
- Medicaid is free or nearly free. Adults qualify up to 138% of the poverty level in expansion states, and children usually qualify at far higher incomes through Medicaid or CHIP. Starting in 2027, many adults in expansion states will also have to meet Medicaid work requirements.
- For 2026 coverage, marketplace premium tax credits go to households between 100% and 400% of the poverty level.
- If your income is under 250% of the poverty level, silver plans come with cost-sharing reductions that lower deductibles and copays.
- In the 10 states without Medicaid expansion, some adults below the poverty line get no help from either program.
- Medicaid changes in 2027: most expansion states will add work requirements and six-month renewals for adults.
On this page
Medicaid: free or low-cost coverage
Medicaid is health coverage run by each state and paid for jointly with the federal government. It usually has no premiums and very small copays, and it covers doctor visits, hospital care, prescriptions, maternity care and mental health care.
The ACA let states extend Medicaid to nearly all adults with income up to 138% of the federal poverty level, and 41 states, including DC, have done it. Eligibility is based on your current monthly income, and you can apply any time.
| Household size | 138% of poverty level, per year | Per month |
|---|---|---|
| 1 | $22,025 | $1,835 |
| 2 | $29,863 | $2,489 |
| 3 | $37,702 | $3,142 |
| 4 | $45,540 | $3,795 |
Citizenship and immigration status matter. U.S. citizens and many lawfully present immigrants can qualify, though many green card holders have to wait five years. See can I get health insurance if I’m not a U.S. citizen.
Changes are coming. Under the 2025 tax law, starting January 1, 2027, most expansion states will require adults ages 19 to 64 to show 80 hours a month of work, volunteering or school unless they qualify for an exemption, and to renew coverage every six months. From October 2028, expansion adults with income above the poverty line may owe copays of up to $35 per service.
CHIP and Medicaid for children
Kids qualify at much higher family incomes than adults: the median state covers children up to 255% of the poverty level through Medicaid or CHIP. Coverage is free or cheap, and children keep it for 12 months once they’re enrolled. More in health insurance for children.
Marketplace plans with financial help
If you earn too much for Medicaid, a marketplace plan with a premium tax credit is usually next. For 2026 coverage, credits go to households between 100% and 400% of the poverty level, and they cap what you pay for a benchmark silver plan at roughly 2% to 10% of income, depending on what you earn. The larger credits offered from 2021 through 2025 expired, so many families are paying more this year. Here’s how health insurance subsidies work.
Look closely at silver plans if your income is under 250% of the poverty level. They come with cost-sharing reductions that cut deductibles and copays, sometimes to a few hundred dollars. A cheaper bronze plan can end up costing more if someone in the family needs care. Buying for a whole household? See family health insurance.
If your state didn’t expand Medicaid
In the 10 states that haven’t expanded Medicaid, adults without children often can’t get Medicaid at any income, and marketplace subsidies start at 100% of the poverty level. Adults below that line can fall into a coverage gap. Some things to try:
- Check whether you qualify another way, such as through pregnancy, a disability, or caring for a child.
- Ask the marketplace about a hardship exemption to buy a lower-cost catastrophic plan. Catastrophic health insurance explains how it works.
- Use a community health center, which charges on a sliding scale based on income.
- Ask hospitals about financial assistance. Nonprofit hospitals are required to have a charity care policy.
Other ways to lower costs
- Community health centers offer primary, dental and mental health care on a sliding fee scale, whether or not you have insurance.
- Hospital financial assistance can reduce or wipe out bills for people with low incomes. Ask before you pay.
- Prescription help: generic drugs, pharmacy discount programs and drugmakers’ patient assistance programs can cut costs.
- Help for older adults: Medicare Savings Programs and Extra Help lower Medicare premiums and drug costs for people with limited income.
Be wary of “limited benefit” or fixed indemnity plans sold as cheap health insurance. They pay set amounts per service and can leave you with most of a large bill.
Are high-deductible plans and HSAs worth it on a tight budget?
A high-deductible health plan has lower premiums, but you pay more before coverage starts, which is hard on a small income. A health savings account lets you set money aside for medical costs tax-free, and bronze plans have been HSA-eligible since 2026, but it helps most when you have money to put in.
If you get insurance through work, premiums usually come out of your paycheck on a pre-tax basis, which lowers your taxable income.
Related guides: Medicaid income limits by state and 2027 Obamacare income limits.
See what’s available near you: compare plans in your ZIP code.
Frequently asked questions
How do I apply for Medicaid?
Apply through your state Medicaid agency or through HealthCare.gov or your state’s marketplace. If you look eligible, the application goes to the state. You can apply any time of year.
What counts as income?
Medicaid and the marketplace both use modified adjusted gross income: wages, self-employment profit, unemployment benefits, Social Security and most other taxable income. Child support you receive and SSI don’t count.
What if my income changes during the year?
Report it. For Medicaid, higher income can end your eligibility. For marketplace plans, updating your income keeps your credit accurate so you don’t owe money at tax time, and starting with 2026 coverage there’s no cap on how much extra credit you may have to repay.
Is there free health insurance for low-income families?
Medicaid and CHIP are free or nearly free in most states. Some low-income marketplace shoppers also pay little or nothing for a bronze plan once the premium tax credit is applied.
Sources
This article is general information, not legal or insurance advice. Medicaid and marketplace rules vary by state and change often, so check with your state Medicaid agency, HealthCare.gov or a licensed agent for your situation. Last reviewed September 2026.