ACA Medicaid Eligibility: What Happens If You Exceed the Income Limit?

If you’ve recently gone through a change in income, you may be wondering how it will affect your Medicaid eligibility. In this blog, we’ll explore the specifics of Medicaid income limits and what happens if you exceed them.

Medicaid Income Limits

Medicaid is a government-sponsored health insurance program that provides coverage to low-income individuals and families. Each state sets its own income eligibility limits, but they are typically based on a percentage of the federal poverty level (FPL). For example, in 2023, the income limit for a family of three to qualify for Medicaid in most states is $3,542 per month.

What Happens if You Exceed the Income Limit?

If your income exceeds the Medicaid income limit, you will no longer be eligible for the program. However, there are a few exceptions to this rule. For example, if you are pregnant or have a child under the age of 19, you may still be eligible for Medicaid even if your income is above the limit.

If you lose Medicaid eligibility due to an increase in income, you will need to find other health insurance coverage. You can purchase a health insurance plan through the Marketplace or from a private insurer. You may also be eligible for other government programs, such as Medicare or CHIP.

Retroactive Disqualification and Back Taxes

In some cases, you may be retroactively disqualified from Medicaid if it is determined that you were not eligible for the program at the time you enrolled. This can happen if you made a mistake on your application or if your income increased after you enrolled.

If you are retroactively disqualified from Medicaid, you may be required to pay back the benefits you received. The amount you owe will depend on your income and the length of time you were enrolled in the program.

What to Do if Your Income Increases

If you are concerned about exceeding the Medicaid income limit, it’s important to contact your state Medicaid office. They can help you determine if you are still eligible for the program and what options are available to you if you are not.

You can also get help from a health insurance agent or broker. They can help you find a health insurance plan that meets your needs and budget.

Conclusion

Medicaid is an important health insurance program that provides coverage to millions of low-income Americans. If you are concerned about exceeding the Medicaid income limit, it’s important to contact your state Medicaid office or a health insurance agent to learn more about your options.