Low income health insurance doesn't stop at Medicaid. If your income is at least 100% of the poverty level, or $15,960 for one person, you can get a Marketplace tax credit. For 2027 coverage, it can hold your share of a benchmark silver plan to 2.15% of income. Silver plans also shrink deductibles, and CHIP covers many kids.
- Ten states haven't expanded Medicaid as of October 2026: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.
- KFF estimates that 1.2 million adults fall in the coverage gap, because they earn too little for a tax credit but can't get Medicaid.
- For 2027 coverage, people between 100% and 133% of the poverty level pay about 2.15% of income for the benchmark silver plan.
- Silver plans add extra savings up to 250% of the poverty level, with 2027 out-of-pocket caps as low as $4,000.
- Medicaid expansion states must start 80-hour monthly work requirements for many adults by January 1, 2027.
Low income health insurance when Medicaid isn't an option
Plenty of people think a small paycheck means Medicaid or nothing, but that's not true. In fact, most adults with income between 100% and 400% of the poverty level can get a Marketplace tax credit instead. So if your state denied you Medicaid, or never expanded it, you still have real choices.
Who this guide helps
- Workers who earn just over their state's Medicaid limit
- Adults in the 10 states that haven't expanded Medicaid
- Parents whose kids qualify for CHIP while they don't
- People who lost Medicaid at renewal
Next, we'll walk through each path, from tax credits to CHIP. When you're ready, compare ACA and private plans in your ZIP code with a licensed agent.
The Medicaid coverage gap
Under the ACA, Medicaid was meant to reach adults up to 138% of the poverty level, while tax credits start at 100%. However, 10 states never expanded Medicaid. In those states, many adults below the poverty line can't get Medicaid or a credit. So that's the Medicaid coverage gap.
Overall, KFF estimates that about 1.2 million adults fall into the gap. Most of them, 78%, are adults without children, because these states generally don't cover them at any income. Meanwhile, the median Medicaid limit for parents in these states is just 40% of the poverty level.
However, there are two exceptions. Wisconsin covers adults up to the poverty line through a waiver, so KFF counts no gap there. Georgia also covers adults up to 100% through its Pathways program, although Pathways requires work or other activities. For local details, see plan choices for Georgia residents.
Ways out of the Medicaid coverage gap
- Check your full-year income
Count all expected income, such as side work. If the total reaches 100% of the poverty level, you may qualify for a credit.
- Cover your kids separately
Children qualify for Medicaid or CHIP at much higher incomes than adults.
- Ask about pregnancy coverage
Also, pregnancy raises the Medicaid limit in most states.
- Use a community health center
These clinics use a sliding fee scale, so your bill depends on what you can pay.
Live in a gap state? Then review coverage options for Florida residents or plans and programs across Texas.
How tax credits lower your premium
The premium tax credit limits what you pay for the benchmark plan, which is the second-lowest-cost silver plan in your area. For 2027 coverage, the IRS sets your share on a sliding scale, so lower incomes pay less. Then the credit covers the rest, and you can use it on any metal tier.
| Single adult's income (poverty level) | Your share of the benchmark plan |
|---|---|
| $16,000 (100%) | About $29 a month |
| $20,000 (125%) | About $36 a month |
| $23,940 (150%) | About $86 a month |
| $30,000 (188%) | About $155 a month |
Next, notice the jump after 133% of the poverty level. Then the required share rises from 2.15% to 3.23% of income. Even so, most people at these incomes pay far less than full price. Also, some bronze plans can cost $0 a month after the credit, if you qualify for a subsidy.
Who qualifies for a tax credit
- Your household income is between 100% and 400% of the poverty level
- No job offers you affordable coverage, which means 10.22% of income or less for 2027
- You also can't get Medicaid, Medicare or CHIP
- If you're married, you file a joint tax return
- You're a citizen or an eligible immigrant, a list that narrows in 2027
For the full math, see what you pay at each income level. Then our guide to how premium tax credits are calculated goes deeper.
A licensed Vivna agent can estimate your tax credit, check your kids for CHIP and show plans that fit, at no cost to you.
Silver plans with extra savings
If your income is between 100% and 250% of the poverty level, a silver plan comes with cost-sharing reductions. In turn, these extra savings shrink your deductible, copays and out-of-pocket maximum. However, you only get them when you pick silver. Below 150% of the poverty level, a silver plan pays about 94% of covered costs on average. Then it pays about 87% up to 200%, and about 73% up to 250%.
Those are the 2027 out-of-pocket caps for one person, and family caps are double. To weigh each tier, read how the metal tiers split your costs.
When silver is the smart pick
Choose silver to keep copays low.
Again, silver usually costs less over a year.
A $0 bronze plan may fit, if you qualify for a subsidy.
Check Medicaid first, since pregnancy limits run higher.
Low income health insurance for kids and pregnancy
Children and pregnant people qualify for Medicaid or CHIP at much higher incomes than other adults. For example, KFF reports a median limit of 255% of the poverty level for children and 213% for pregnancy. As a result, many families split coverage, with kids on CHIP and parents on a Marketplace plan.
How CHIP works
- You can apply any time of year, and coverage can start right away
- Plus, well-child and dental checkups come with no copay
- Some states charge a small premium, but yearly costs can't top 5% of family income
- Each state also sets its own rules and income limits
Our guide to health coverage choices for your children covers Medicaid, CHIP and family plans.
Apply for the whole household on one application, and list every person and every income. On the phones, we often find kids who qualify for CHIP while a parent qualifies for a credit. Then we enroll both at once, so nobody falls through the cracks.
New Medicaid and Marketplace rules to know
A 2025 federal budget law changed several programs, so these updates can decide where you get coverage next year.
Medicaid work requirements
By January 1, 2027, expansion states must require many adults ages 19 to 64 to show 80 hours a month of work, school, community service or a work program. Earning at least 80 times the federal minimum wage, or $580 a month in 2026, also counts. In addition, expansion adults face renewals every 6 months, starting with renewals on or after December 31, 2026.
- Parents and caregivers of a child 13 or under are exempt
- Pregnant and postpartum people are exempt too
- So are people who are medically frail
- Native Americans and Alaska Natives are also exempt
If your state can't confirm you meet the rule, it must send a notice and give you 30 days to respond. So answer every Medicaid letter quickly. People denied Medicaid for missing the work rule also can't get Marketplace tax credits.
Marketplace changes
- Since 2026, plans bought through an income-based special enrollment period get no tax credit
- Also, starting with tax year 2026, there's no cap on repaying extra advance credits
- Since 2026, lawfully present immigrants under 100% of the poverty level can't get credits
- In 2027, credits narrow to green card holders, COFA migrants and certain Cuban and Haitian entrants
Other low-cost care options
First, community health centers offer primary medical and dental care whether or not you have insurance. Because they charge on a sliding fee scale, your bill depends on what you can pay. They can also help you apply for Medicaid, CHIP or a Marketplace plan.
Timing matters too. You can apply for Medicaid and CHIP any time, but Marketplace plans open each fall. For 2027 coverage, Open Enrollment runs November 1 to January 15, and you should enroll by December 15 for a January 1 start. Learn how the yearly enrollment window works.
Losing Medicaid or CHIP usually opens a special enrollment period, so read about coverage changes after a major life event. Budget-minded shoppers can also review lower-cost coverage ideas worth comparing. Questions? Call a licensed Vivna agent at 888-730-6001.
Low income health insurance: FAQs
Can I get low income health insurance without Medicaid?
Yes. If your income is between 100% and 400% of the poverty level, you can usually get a Marketplace tax credit. For 2027 coverage, the floor is $15,960 for one person. Also, silver plans add extra savings up to 250% of the poverty level. Some people even find a $0 bronze plan, if they qualify for a subsidy.
What is the Medicaid coverage gap?
The Medicaid coverage gap happens in states that didn't expand Medicaid. There, adults below the poverty line often earn too little for a tax credit, yet they can't get Medicaid either. In fact, KFF estimates about 1.2 million adults fall in the gap. Children and pregnant people, however, can often still qualify for Medicaid or CHIP.
How much does low income health insurance cost?
Overall, it depends on your income, age and ZIP code. For 2027 coverage, a single adult earning $16,000 pays about $29 a month for the benchmark silver plan. At $30,000, that share rises to about $155 a month. Meanwhile, bronze plans can cost less, sometimes $0, if you qualify for a subsidy.
Should I choose a silver plan on a small income?
Often, yes. That's because below 250% of the poverty level, only silver plans carry cost-sharing reductions. As a result, they can cut your out-of-pocket cap to $4,000 for 2027, compared with $12,000 on other plans. However, if you rarely use care, a $0 bronze plan may still make sense. So compare both before you choose.
Can I enroll any time with a small income?
For Medicaid and CHIP, yes, you can apply any time of year. For Marketplace plans, though, you generally need Open Enrollment or a qualifying life event, such as losing other coverage. Since 2026, plans bought through an income-based special enrollment period no longer get a tax credit. Our library of health coverage answers covers more enrollment rules.
Vivna's licensed agents compare plans from 50+ carriers. Call Monday through Friday, 9am to 6pm.
Sources
- KFF: Status of state Medicaid expansion decisions
- KFF: The coverage gap in states that did not expand Medicaid
- IRS: Revenue Procedure 2026-26
- CMS: 2027 cost-sharing limits
- CMS: Medicaid community engagement requirement fact sheet
- KFF: Health provisions in the 2025 budget law
Vivna Insurance is a licensed, independent health insurance agency (NPN 19168641). We are not affiliated with HealthCare.gov or any government agency. Plan availability, networks and benefits vary by state and change over time.