Too Much for Medicaid, Too Little for ACA: Navigating the Coverage Gap

As we delve into the complexities of health insurance, we often encounter situations where individuals fall into a coverage gap. Here, we’re exploring a specific scenario faced by a Pennsylvania resident: too much income for Medicaid but too little for an ACA tax credit.

The Coverage Gap Conundrum

The post highlights the plight of individuals who earn slightly above 138% of the federal poverty level (FPL). This income level disqualifies them from Medicaid but leaves them ineligible for the premium tax credits that lower ACA health insurance costs.

Loophole or Misconception?

The post suggests a potential loophole where individuals can intentionally provide inaccurate income information to qualify for a tax credit. However, it’s crucial to clarify that this is not a legitimate strategy. Providing false information on insurance applications is considered perjury and comes with severe consequences, including potential legal action and repayment of subsidies.

The Path Forward

So, what options are available for individuals in this coverage gap? Here are a few possibilities:

– Short-term Exemption: Individuals may qualify for a temporary exemption from the coverage mandate if they experience a qualifying life event, such as job loss or a significant income change. This allows them to go uncovered for up to 90 days without penalty.

– Limited Duration Insurance: Some states offer temporary health insurance plans specifically designed for individuals in the coverage gap. These plans are typically short-term and have limited coverage, but they can provide some financial assistance.

– Explore Employer Coverage: Individuals may consider seeking employment with an employer that offers health insurance. Even part-time employment can sometimes provide access to affordable insurance coverage.

– Seek Assistance: There are non-profit organizations and state-run programs that can assist individuals in navigating the health insurance landscape. These entities can help explore options, determine eligibility for assistance programs, and provide guidance on accessing affordable coverage.


Navigating the coverage gap can be challenging, but it’s crucial to remember that there are options available. By understanding the complexities of ACA insurance, exploring available exemptions, and seeking assistance from qualified sources, individuals can find the right path to affordable health coverage.

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