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Health Care Reform:

Health Insurance & Affordable Care Act

At-a-Glance: Medicaid Expansion

Medicaid is free or low-cost health insurance. It's for certain people who don't make much money a year. The media has covered its expansion for years now. But between the national and state coverage, it hasn't been easy to follow. Here's the quick overview of what you need to know if you live in a state that is expanding Medicaid or if you live in a state that isn't.

The Decision U.S. States Had

Each state decides if they want to stay with traditional Medicaid or if they want to expand Medicaid based on the guidelines in the Affordable Care Act. There is no deadline for states to make this decision.

In general, no matter what state you live in, regular Medicaid will cover who it has historically:

  • Pregnant women
  • Children under 19
  • People who are blind or disabled

In some states, Medicaid also covers adults with children under 19.

In the past, each state decided how much money you can make in a year to get Medicaid. Each state still makes that decision.

When You Live in a State With Medicaid Expansion

Starting in 2014, you may qualify for Medicaid even if you haven't before. For instance, states that have chosen to expand Medicaid:

  • Cover all adults ages 19-64.
  • Allow people to make more money and still qualify for Medicaid. For 2014, that's less than about $15,856 a year for one person, or less than about $35,500 for a family of four.

There is also financial aid to help lower the premium. This aid is for people who don't make much money but who make too much to qualify for the state's Medicaid plan. Currently, about half the states are moving forward with expansion.

When You Live in a State Without Expanded Medicaid

Don't panic. You still may be able to get help paying for health insurance.  

To find out, go to your state's health insurance Marketplace, also called an Exchange, on the web. Be ready to put in how much money you plan to make this year and how many people you need insurance for.

You may be able to get a type of financial aid called a subsidy. There are two types of subsidies.

  • A tax credit is money that goes directly to the health plan to lower your premiums.
  • A cost-savings subsidy is a type of financial aid that lets you pay less for your health care. It lowers your deductible, which is the amount you have to pay before insurance helps pay. It also lowers how much you pay when you see a doctor or buy a prescription medicine.

You can only get these types of financial aid from the federal government if you buy your health insurance from your state's Marketplace. The amount you can get depends on how much you make each year and how many people you are getting insurance for.

States With Gaps in Coverage

Most states use the federal poverty limit as the maximum amount someone can make and qualify for Medicaid. For 2013, that's $11,490 for one person or less than $23,550 for a family of four. The amounts are higher in Alaska and Hawaii.

Some states, though, have set a lower Medicaid limit. That means you may make less than the federal poverty limit but you can't get Medicaid.

The lowest amount you can make to be eligible for subsidies on your state's Marketplace is the federal poverty limit. So if you make less than that, but more than your state's Medicaid limit, there is not financial help available for you.

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