Quick answer
You’re in the Medicaid coverage gap if you live in a state that hasn’t expanded Medicaid, your income is below the poverty level, and you don’t qualify for your state’s traditional Medicaid. You can’t get Medicaid, and Marketplace premium tax credits don’t start until 100% of the poverty level, which is $15,960 a year for one person for 2027 coverage. KFF estimates about 1.2 million uninsured adults were in the gap in 2024.
Key takeaways
- Ten states haven’t expanded Medicaid: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.
- Georgia and Wisconsin cover adults up to the poverty level through waivers, so KFF counts no one in the gap there, though Georgia’s Pathways program requires 80 hours a month of work or other activities.
- In the other eight states, adults without children generally can’t get Medicaid at any income, and parents qualify only at low incomes, as little as $4,098 a year for a family of three in Texas.
- Once your expected income reaches 100% of the poverty level, you can generally get a premium tax credit, and for 2027 the benchmark silver plan costs about 2.15% of income for people under 133%.
- Community health centers, hospital financial assistance and, for some people, catastrophic plans can help while you’re in the gap.
On this page
Why the coverage gap exists
The Affordable Care Act was written to expand Medicaid in every state to adults with incomes up to 138% of the poverty level. Because of that, Marketplace premium tax credits were set to start at 100% of the poverty level. A 2012 Supreme Court ruling made the expansion optional. As of October 2026, 41 states, counting DC, have expanded Medicaid and 10 have not.
The 10 states that haven’t expanded still cover some groups through Medicaid, such as children, pregnant women, people with disabilities and parents with very low incomes. But HealthCare.gov says that if your state hasn’t expanded Medicaid, your income is below the poverty level and you don’t qualify under your state’s current rules, you won’t qualify for Medicaid or for savings on a Marketplace plan.
How many people are in the gap
KFF’s latest estimate, published in July 2026 using 2024 data, puts about 1.2 million uninsured adults in the coverage gap. Most of them (78%) are adults without dependent children. Six in ten live in a family with a worker, and more than four in ten work themselves.
Georgia and Wisconsin haven’t fully expanded Medicaid, but they cover adults up to the poverty level, so KFF counts no one in the gap there. That leaves the gap in Alabama, Florida, Kansas, Mississippi, South Carolina, Tennessee, Texas and Wyoming. In 2024, 14.5% of people under 65 in non-expansion states were uninsured, nearly twice the 8.0% rate in expansion states.
Medicaid limits in the 10 states
| State | Parents | Adults without children |
|---|---|---|
| Alabama | 18% | Not eligible |
| Florida | 26% | Not eligible |
| Georgia | 100% (Pathways) | 100% (Pathways) |
| Kansas | 38% | Not eligible |
| Mississippi | 21% | Not eligible |
| South Carolina | 67% | Not eligible |
| Tennessee | 105% | Not eligible |
| Texas | 15% | Not eligible |
| Wisconsin | 100% | 100% |
| Wyoming | 43% | Not eligible |
In Texas, a parent in a family of three who earns more than $4,098 a year, or $342 a month, earns too much for Medicaid. The median limit in the 10 states is 40% of the poverty level, about $10,928 a year for a family of three. Children and pregnant women qualify at much higher incomes in every state; see Medicaid income limits by state.
Wisconsin covers adults up to the poverty level through a Medicaid waiver. Georgia’s Pathways program does too, but only for adults who log 80 hours a month of work, job training, school or community service, or who qualify for an exemption. Enrollment has stayed small, about 18,500 people, according to state records reported in August 2026. Pathways’ current federal approval runs through December 31, 2026, unless it’s renewed, and starting January 1, 2027, Georgia has to follow the new federal Medicaid work rules.
When your income reaches the poverty level
The Marketplace looks at your expected income for the year. For 2027 coverage, 100% of the poverty level is:
| Household size | 100% of poverty level |
|---|---|
| 1 | $15,960 |
| 2 | $21,640 |
| 3 | $27,320 |
| 4 | $33,000 |
Once your expected income is at least that amount, you can generally qualify for a premium tax credit. If your income is under 133% of the poverty level, the benchmark silver plan costs about 2.15% of your income for 2027. A single adult expecting to earn $18,000 would pay about $32 a month for that plan, and at that income a silver plan comes with cost-sharing reductions that lower the deductible and copays. See 2027 Obamacare income limits.
Your estimate has to be your honest best guess. Keep pay stubs, a job offer letter or other records that back it up in case the Marketplace asks.
If your income goes up during the year, HealthCare.gov says you can become eligible for a Marketplace plan with a tax credit once your expected yearly income is between 100% and 400% of the poverty level. You have to call the Marketplace Call Center within 60 days of the change and confirm that you weren’t eligible for Medicaid or a tax credit when you first applied.
Options while you’re in the gap
- Apply anyway. You can apply for Medicaid any time of year, through the Marketplace or your state Medicaid agency. You may qualify if you’re pregnant or have a disability, and your children may qualify even if you don’t. See health insurance for children.
- Community health centers. Federally funded health centers serve everyone, even people who can’t pay, and set fees by income and family size. Many offer dental and mental health care and discounted prescriptions. Find one at findahealthcenter.hrsa.gov.
- Hospital financial assistance. Nonprofit hospitals must have a written financial assistance policy that explains who qualifies for free or discounted care and how to apply. Ask for it before planned care or as soon as a bill arrives. See what can happen if you don’t pay a medical bill.
- A catastrophic plan. You can buy one if you’re under 30, or if you’re 30 or older and get a hardship or affordability exemption. HealthCare.gov’s list of hardships includes being ineligible for Medicaid because your state didn’t expand it. For 2026 coverage, CMS also let people qualify if their income made them ineligible for tax credits, but that broader rule doesn’t carry over to 2027. You’d pay full price, though the plan covers preventive care and at least three primary care visits a year before the deductible. See catastrophic health insurance.
- Job-based coverage. If you or your spouse can get coverage through work, check what it costs. It doesn’t depend on your state’s Medicaid rules.
- Check again when things change. Medicaid looks at your current monthly income, so a pay cut, a pregnancy or a new baby can change what you qualify for. A raise that lifts your expected yearly income above the poverty level can open up a tax credit.
Immigrants with income under the poverty level
Through 2025, lawfully present immigrants with incomes below 100% of the poverty level who couldn’t get Medicaid because of their immigration status, such as during the five-year waiting period, could get Marketplace tax credits. The 2025 tax and spending law ended that starting January 1, 2026. Starting in 2027, Marketplace tax credits are limited to green card holders, certain Cuban and Haitian entrants, and people living here under the Compacts of Free Association. See health insurance if you’re not a U.S. citizen.
Medicaid work requirements start in 2027
Starting January 1, 2027, and earlier in a few states such as Nebraska, Montana and Iowa, expansion states must require most adults ages 19 to 64 in the expansion group to show 80 hours a month of work, school, volunteering or a work program, unless they qualify for an exemption. KFF expects the rules to reach Georgia’s and Wisconsin’s partial expansions too. People who are denied or lose Medicaid for not meeting the requirement can’t get Marketplace tax credits either. See Medicaid work requirements.
Expect your income to reach the poverty level next year? Compare Marketplace plans by ZIP code.
Frequently asked questions
Which states have a Medicaid coverage gap?
KFF counts people in the gap in eight states: Alabama, Florida, Kansas, Mississippi, South Carolina, Tennessee, Texas and Wyoming. Georgia and Wisconsin haven’t fully expanded Medicaid but cover adults up to the poverty level.
Can I buy a Marketplace plan if I’m in the gap?
You can apply, but you won’t get a premium tax credit unless your expected income is at least 100% of the poverty level, so you’d pay the full premium. Ask the Marketplace to check whether you qualify for a catastrophic plan when you apply.
What if my income goes up during the year?
If your expected yearly income rises to between 100% and 400% of the poverty level, call the Marketplace Call Center within 60 days of the change. You may be able to enroll in a plan with a tax credit.
Do children fall into the coverage gap?
Usually not. Every state covers children through Medicaid or CHIP at much higher incomes than adults, so your kids may qualify even if you don’t.
Sources
This article is general information, not insurance, tax or legal advice. Medicaid rules and income limits vary by state and can change, so check with your state Medicaid agency or the Marketplace about your situation. Last reviewed October 2026.