All income thresholds in this article use the 2026 federal poverty guidelines published by HHS in January 2026; state rules and the 2025 reconciliation law provisions cited take effect on the dates noted inline.
TL;DR — Quick Verdict
- In 2026, a single adult earning up to $22,025 per year (138% of the federal poverty level) qualifies for Medicaid in the 41 states and DC that adopted ACA expansion, per KFF and HHS.
- For a family of four, the 2026 income limit is $45,540 — expansion Medicaid applies no asset test, so savings and home equity do not count.
- Expansion Medicaid costs most enrollees $0 in premiums; a subsidized benchmark silver marketplace plan averages $625 per month gross in 2026 before tax credits.
- Ten non-expansion states leave roughly 1.2 million adults in a coverage gap — earning too much for Medicaid but too little for marketplace subsidies.
- Starting January 1, 2027, most expansion adults must log 80 hours a month of work or qualifying activity to keep coverage under the 2025 reconciliation law.
- Recommendation: check your state’s expansion status and your MAGI against the 138% line before open enrollment — the gap between free Medicaid and a $625 premium is decided almost entirely by geography.
A single adult in Texas earning $18,000 a year has no path to Medicaid in 2026. Move that same person across the border to New Mexico and they qualify for free comprehensive coverage — same income, same age, radically different outcome. That divide is the central fact of Medicaid expansion, and it decides health coverage for millions of low-income Americans based on nothing more than which side of a state line they live on.
Medicaid expansion under the Affordable Care Act extended eligibility to nearly all adults ages 19 to 64 with incomes up to 138% of the federal poverty level. According to KFF’s expansion tracker, 41 states including the District of Columbia have adopted it as of 2026; 10 have not. This article breaks down the exact 2026 income limits by household size, what expansion Medicaid actually costs compared with a subsidized marketplace plan, how the coverage gap traps people in non-expansion states, and what the new federal work requirements mean for anyone relying on this coverage. Every figure here is drawn from HHS, CMS, and KFF primary data.
2026 Medicaid Expansion Income Limits by Household Size
Expansion Medicaid uses a single income test: Modified Adjusted Gross Income (MAGI) at or below 138% of the federal poverty level. The federal law technically sets the line at 133% FPL, but a mandatory 5-percentage-point income disregard pushes the effective limit to 138%. HHS published the 2026 poverty guidelines in January 2026, and the table below applies the 138% multiplier to each household size for the 48 contiguous states and DC.
Source: U.S. Department of Health and Human Services, 2026 Poverty Guidelines (verify at aspe.hhs.gov). 138% column calculated from official 100% figures.
Alaska and Hawaii use higher thresholds. In Alaska, 138% FPL for one person reaches $27,531; in Hawaii the 100% line is $18,360, lifting the 138% cutoff to roughly $25,345. One feature makes expansion Medicaid distinct from traditional aged-and-disabled Medicaid: there is no asset test under MAGI rules. A checking account, a paid-off house, and a retirement fund are all invisible to the income calculation, which matters enormously for anyone weighing their options against a high-deductible plan HSA strategy.
What Expansion Medicaid Actually Costs You
Free is close to accurate, but not the whole story. Expansion Medicaid charges no monthly premium for the overwhelming majority of enrollees, because federal law bars states from charging premiums to anyone with household income at or below 150% FPL — and the expansion population tops out at 138%. Compare that to the individual market, where understanding the deductible and out-of-pocket maximum mechanics becomes a monthly financial exercise.
Cost-sharing is where nuance enters. Federal rules cap total out-of-pocket Medicaid spending — every copay and premium combined — at 5% of household monthly income, a limit codified at 42 CFR 447.52. For a household earning $2,000 a month, that ceiling is $100. Once hit, the state must waive all further charges for the period. Nominal copays run roughly $4 for a standard doctor visit or generic prescription and $8 for non-emergency ER use, though many states charge nothing at all.
Sources: Medicaid.gov Cost Sharing Framework and Peterson-KFF Health System Tracker (verify at healthsystemtracker.org). Marketplace figures are 2026 national averages for a 40-year-old.
The 2025 reconciliation law adds a wrinkle: for the first time, it requires states to impose some cost-sharing on expansion adults with incomes between 100% and 138% FPL, phasing in after 2028. Even then, primary care, mental health, and substance use services stay exempt, and the 5% aggregate cap holds.
Expansion vs. Marketplace: Which Is Better If Your Income Is Near the Line?
Picture a single 30-year-old in Ohio (an expansion state) earning $21,000 — just under 138% FPL. She qualifies for Medicaid: $0 premium, no deductible, roughly $4 copays. Now raise her income to $23,000, nudging her over the line. She loses Medicaid and moves to the marketplace, where the benchmark silver premium averages $625 per month gross in 2026. Premium tax credits cushion that, but with enhanced subsidies expired as of January 1, 2026, her net cost and her exposure to a $5,304 average deductible both climb sharply.
This creates a genuine cliff at the eligibility boundary, and it changes how someone should approach ACA marketplace subsidy eligibility and the broader plan selection break-even calculation. A few thousand dollars of extra income can trigger thousands in new out-of-pocket exposure — the definition of a marginal tax on earning more.
Verdict
If your MAGI sits at or below 138% FPL in an expansion state, Medicaid wins decisively on cost — zero premium, no deductible, and a 5% income cap on everything else. Marketplace coverage only becomes the better play when your income exceeds the Medicaid ceiling, at which point a subsidized silver plan with cost-sharing reductions is your floor. The one caveat: Medicaid networks can be narrower, so if you have an established specialist, verify they accept Medicaid before assuming free equals better.
The Coverage Gap: What Happens in the 10 Non-Expansion States
Ten states have refused expansion: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. In nine of them, a cruel arithmetic takes hold. Marketplace premium tax credits historically begin at 100% FPL. Traditional Medicaid for adults in these states cuts off far below that — Texas caps parent eligibility near 15% FPL and covers no childless adults at all. The result is a coverage gap: earn too much for Medicaid, too little for subsidies.
KFF estimates roughly 1.2 million uninsured adults fall into this gap, and 78% of them are adults without dependent children — the exact population expansion was designed to reach. Wisconsin is the technical exception; it covers adults up to 100% FPL through a waiver, eliminating its gap but forgoing the enhanced 90% federal match that expansion states receive. For anyone stuck in a gap state, the realistic fallbacks are limited, and it is worth examining health coverage options for the self-employed and the trade-offs of short-term plan coverage and exclusions before assuming no options exist.
The gap is not evenly distributed. The vast majority of affected adults live in the South, and Texas alone accounts for a large share of the national total. This is the single starkest illustration of why expansion status — not income, not health, not effort — is the dominant variable in low-income coverage.
What Most People Get Wrong About Medicaid Expansion Eligibility
Misunderstandings here cost people coverage they qualify for — or blindside them with denials they never saw coming.
Mistake one: assuming savings disqualify you. Many applicants skip applying because they own a home or hold retirement funds. Expansion Medicaid applies no asset test. The consequence is thousands of eligible adults never enrolling. The correct action: apply based on MAGI alone, ignoring assets entirely.
Mistake two: confusing expansion Medicaid with aged-and-disabled Medicaid. The two programs use completely different rules — the disabled and long-term-care pathways do apply asset tests and spend-down requirements. Treating them as identical leads to wrong expectations. Verify which pathway applies to your situation.
Mistake three: not counting all income sources. MAGI includes unearned income — interest, dividends, and capital gains — not just wages. Underreporting leads to eligibility errors and clawbacks. Add every income stream before comparing to the 138% line.
Mistake four: ignoring the new work requirements. Enrollees who assume coverage is automatic risk losing it starting in 2027. Track your qualifying hours and document them. This mistake connects directly to costly open enrollment mistakes to avoid when transitioning between coverage types.
Mistake five: overlooking prior authorization. Medicaid covers comprehensively but still gates certain services, and enrollees who don’t understand how prior authorization works face avoidable denials for medications and procedures.
What’s Changed in 2026: Work Requirements and the Reconciliation Law
The 2025 reconciliation law — the “One Big Beautiful Bill Act” — reshapes expansion Medicaid more than any change since the program began. CMS published the implementing interim final rule on June 1, 2026, and the headline provision lands January 1, 2027: most non-exempt expansion adults ages 19 to 64 must complete at least 80 hours per month of work, community service, job training, or half-time schooling to keep coverage. Earning at least $580 in a month — 80 hours at the federal minimum wage — also satisfies it.
The projected fallout is significant. The Congressional Budget Office estimates the requirement will push roughly 5.2 million adults off Medicaid by 2034, with CMS’s own rule projecting 2.3 million disenrollments in 2027 alone. Exemptions exist for pregnant enrollees, the medically frail, caregivers, and others, but the administrative burden of proving compliance is expected to drive much of the coverage loss. A second provision requires states to redetermine expansion eligibility every six months rather than annually, doubling the paperwork touchpoints where enrollees can slip through.
For anyone approaching 65, these shifts make it worth reviewing coverage options for early retirees under 65, since the interplay between Medicaid, marketplace plans, and Medicare timing grows more complex under the new rules.
Who Should Rely on Expansion Medicaid — And Is It Worth It?
Worth it is nearly always yes when you qualify, but the conditional logic matters. If your MAGI is at or below 138% FPL, you live in one of the 41 expansion states or DC, and you’re between 19 and 64, expansion Medicaid delivers the lowest-cost comprehensive coverage available anywhere — $0 premium, no deductible, a 5% income cap on the rest. No marketplace plan competes on price.
The calculus shifts in specific cases. If you expect income to rise past the eligibility line mid-year, plan for the transition, because bouncing between Medicaid and a marketplace plan creates gaps and requires understanding how to compare plans beyond the monthly premium. If you manage a serious ongoing condition, weigh Medicaid’s network against your current providers — this is where plan selection with a chronic condition deserves real scrutiny. And if you’re leaving a job, compare Medicaid against COBRA and marketplace coverage after job loss before defaulting to the expensive option.
For a low-income adult in an expansion state with no employer coverage, expansion Medicaid is not just worth it — it is the single best coverage value in the U.S. system. The only thing standing between millions of people and that value is a state line.
Frequently Asked Questions
Does owning a home or having savings disqualify me from Medicaid expansion?
No. Expansion Medicaid uses Modified Adjusted Gross Income (MAGI) rules with no asset test, so a home, savings, and retirement accounts do not count. Only your income matters — up to $22,025 for a single adult in 2026 per HHS guidelines. This differs from aged-and-disabled Medicaid, which does apply asset limits and spend-down requirements.
How much does Medicaid cost per month in an expansion state?
For nearly all expansion enrollees, $0 per month. Federal law prohibits premiums for anyone at or below 150% FPL, and the expansion population caps at 138%. Copays, where charged, run about $4 for a doctor visit or generic drug, and total out-of-pocket costs cannot exceed 5% of household income under 42 CFR 447.52.
What is the Medicaid coverage gap?
The coverage gap traps adults in the 10 non-expansion states who earn too much for their state’s limited Medicaid but too little for marketplace subsidies, which begin at 100% FPL. KFF estimates roughly 1.2 million adults fall into this gap in 2026, with 78% being adults without dependent children — the group expansion was meant to cover.
Will I lose Medicaid under the new 2027 work requirements?
Only if you’re a non-exempt expansion adult who fails to log 80 hours per month of work or qualifying activity, effective January 1, 2027. Earning at least $580 monthly also satisfies it. Pregnant enrollees, caregivers, and the medically frail are exempt. The CBO projects about 5.2 million adults could lose coverage by 2034, largely due to paperwork burdens rather than actual ineligibility.
How We Researched This Article
Every income threshold in this article was verified against the primary federal source: the 2026 poverty guidelines published by the U.S. Department of Health and Human Services, available through the HHS Office of the Assistant Secretary for Planning and Evaluation. The 138% FPL figures were calculated directly from the official 100% amounts rather than pulled from secondary summaries, and cross-checked against CMS-derived values.
State expansion status and counts come from the KFF Status of State Medicaid Expansion Decisions tracker, updated May 2026, which reports 41 states including DC as having adopted expansion. Coverage gap population estimates draw from KFF’s most recent coverage gap analysis. Cost-sharing rules were verified against the federal regulation at 42 CFR Part 447 Subpart A and the official Medicaid.gov cost-sharing framework. Work requirement provisions were confirmed against the CMS interim final rule published June 1, 2026, and Congressional Budget Office coverage-loss projections.
Marketplace comparison figures — the $625 benchmark silver premium and $5,304 average deductible for 2026 — are modeled national averages for a 40-year-old from the Peterson-KFF Health System Tracker, not measured individual costs, and will vary substantially by state, age, and insurer. We note this as a modeled rather than measured comparison. Where sources reported the expansion state count as 40 versus 41, the difference reflects whether DC is counted among states; we use KFF’s convention of 41 including DC. State-specific eligibility rules, copay amounts, and Alaska and Hawaii thresholds vary and should be confirmed with your state Medicaid agency. This research was last conducted in July 2026. All figures were verified against named primary sources before publication.