Why Do So Many Eligible People Never Apply?
Honestly? Shame and confusion, mostly. The income limits are higher than most people assume, and the paperwork feels designed to make you give up halfway through.
I sat with my aunt in Ohio in February 2025 filling out her Medicaid renewal packet, and I watched her hands shake a little as she read the income line. Not because she made too much money. Because the paperwork made her feel like she'd done something wrong just by needing help. That's the thing nobody tells you about Medicaid: the system is confusing on purpose, or close to it, and most people qualify for more than they think. Roughly 72 million Americans are enrolled in Medicaid or CHIP as of early 2025, according to CMS data, yet millions more who'd qualify never apply because they assume they make too much or don't fit some imagined mold of who 'deserves' it.
What Are the 2025 Income Limits, Exactly?
The magic number is 138% of the Federal Poverty Level in expansion states, which lands around $21,597 for one person. That's a lot higher than most people guess, and it's worth checking even if you assumed you'd be denied.
Let's start with the baseline number that drives almost everything: the Federal Poverty Level, or FPL. For 2025, the FPL for a single person in the 48 contiguous states and DC is $15,650 a year. For a family of four, it's $32,150. Medicaid expansion states use 138% of that FPL as the cutoff for adults, which comes out to about $21,597 for one person or $44,367 for a family of four. That's higher than a lot of readers expect. I've had friends assume Medicaid was only for people making under $10,000 a year, and that's just wrong in the 41 states (plus DC) that expanded coverage under the Affordable Care Act.
The State You Live In Changes Everything
If your state didn't expand Medicaid, you could fall into the coverage gap: too poor for marketplace subsidies, too 'able-bodied' for Medicaid. It's the ugliest part of this whole system, in my opinion.
Here's where it gets messier: not every state expanded Medicaid, and that matters enormously depending on where you live. Texas, Florida, Georgia, Alabama, Mississippi, Wyoming, Kansas, Tennessee, and South Carolina are among the holdouts as of mid-2025. If you're a childless, non-disabled adult in one of those states, you may not qualify for Medicaid at all, regardless of how low your income is. I think this is one of the cruelest gaps in American healthcare policy. A single mom in Houston making $14,000 a year can fall into what's literally called the 'coverage gap,' too poor for ACA marketplace subsidies, too 'able-bodied' for her state's narrow Medicaid rules. Georgia's limited Pathways to Coverage program, launched in 2023, adds work requirements on top of that, and enrollment has been sluggish, under 6,500 people as of late 2024 according to state reporting.
Kids and Pregnant Women Have Much Higher Limits
CHIP covers kids in families earning up to 400% of FPL in some states, way higher than adult Medicaid limits. Pregnant women get similar breaks. Don't assume your family's income disqualifies you.
Kids have it easier, and I want parents reading this to know that. CHIP, the Children's Health Insurance Program, covers kids in families earning up to 200% to 400% of FPL depending on the state (Ohio and California both go north of 300%). That means a family of four making $70,000 or even $90,000 in some states can still get their kids covered for free or near-free. I've told at least five parents this over the years and every single one was shocked. Pregnant women also get more generous thresholds nearly everywhere, often up to 200% or more of FPL, because states have a real incentive to fund prenatal care instead of paying for expensive emergency deliveries later.
What About Seniors and Dual Eligibility?
If you're on Medicare and low income, ask about Medicare Savings Programs. They can wipe out your Part B premium and slash your copays to a few dollars, and almost nobody knows to ask.
So what about seniors and people with disabilities? This is where Medicaid overlaps with Medicare, and it gets genuinely complicated. If you're on Medicare but have limited income (generally under about $22,590 a year for an individual in 2025, though this varies by state and program) you might qualify as a 'dual eligible.' That opens the door to Medicare Savings Programs, which can cover your Part B premium ($185 a month in 2025 for most people) plus deductibles and copays. My neighbor in Pennsylvania, 74 years old, living on Social Security alone, didn't know this existed until her pharmacist mentioned it. She'd been skipping doses of a blood pressure medication to stretch her budget. Six weeks after applying, her premium was covered and her drug copays dropped to $4 a prescription. Ask your pharmacist. I mean that. They know more about these programs than most caseworkers.
If You Don't Qualify for Medicaid, Check the ACA Marketplace
Enhanced subsidies mean no hard income cutoff for 2025 coverage, but they're set to expire at year end unless Congress extends them. Shop now, and watch this issue closely heading into 2026.
Now, what if you don't qualify for Medicaid at all? This is where the ACA Marketplace comes in, and 2025 is actually a decent year to be shopping, at least for now. The enhanced premium tax credits from the American Rescue Plan (extended through the Inflation Reduction Act) are still in effect for 2025 coverage, meaning no one is locked out of subsidies just for earning slightly more than 400% of FPL, the old subsidy cliff. But here's the catch, and it's a big one: those enhanced subsidies are scheduled to expire at the end of 2025 unless Congress acts. I'd tell any reader shopping for 2026 coverage to watch this closely, because premiums could jump substantially for millions of people if nothing changes. The Congressional Budget Office estimated premiums could rise by an average of 7.5% or more if the enhanced credits lapse.
Don't Forget Community Health Centers
There are 1,400+ federally qualified health centers charging on a sliding scale, sometimes $20 to $30 a visit no matter your insurance status. This should be everyone's first call before assuming care is out of reach.
Community health centers deserve way more attention than they get. There are over 1,400 federally qualified health centers (FQHCs) across the U.S., serving roughly 32 million patients a year, and they charge on a sliding scale based on income, sometimes as low as $20 or $30 a visit regardless of insurance status. I took my cousin to one in Sacramento when she was between jobs and uninsured. No judgment, no lecture, just a doctor who saw her, ran labs, and charged her $25 based on her income that month. You can find one through the HRSA's Find a Health Center tool at findahealthcenter.hrsa.gov. Honestly, more people should start there before assuming they can't afford care at all.
Your Next Move: Charity Care and Where to Start
Call your hospital's billing department and ask for a charity care application, most nonprofit hospitals must offer one by law. Then check Medicaid, CHIP, and the marketplace in that order before you assume you're stuck with a bill.
Don't sleep on hospital charity care either. Every nonprofit hospital in the country is legally required, under IRS rules tied to their tax-exempt status, to have a financial assistance policy, and many extend free or discounted care to patients earning up to 200%, 300%, even 400% of FPL depending on the hospital. Cleveland Clinic, for instance, offers free care for patients under 250% of FPL and discounted care up to 400%. Most hospitals bury this information in fine print or a phone number you have to dig for on their website. Call the billing department directly and ask for the 'financial assistance' or 'charity care' application. I've seen $8,000 emergency room bills reduced to zero this way. It takes persistence, sometimes multiple phone calls, but it's real money on the table.
Start here, in this order: check Medicaid eligibility on your state's site or Healthcare.gov, look into CHIP if you have kids, price out marketplace plans if you're over the Medicaid cutoff, and find a community health center as a backstop no matter what. Set a reminder for open enrollment (November 1 through January 15 in most states) and don't wait until you're sick to figure this out. I've watched too many people wait for a crisis to start asking questions. Ask now, while you have time to actually compare options and read the fine print.
