To qualify for Medicaid, your income must be at or below certain Federal Poverty Level (FPL) percentages. The exact percentage depends on the specific Medicaid program you are applying for and varies by state. For most adults under the age of 65, the income limit is set at 138% of the FPL. However, states have flexibility and may set higher income limits for certain groups like pregnant women, children, or people in need of long-term care.
There are two categories of Medicaid eligibility
MAGI stands for Modified Adjusted Gross Income Category, it matters because depending on which category you're in, your income limit will differ.
Most people fall under the Modified Adjusted Gross Income (MAGI) category when determining Medicaid eligibility. MAGI is used for most non-disabled adults and children under the age of 65. Non-MAGI typically applies to individuals who are 65+, disabled, blind, or who need long-term care. Different income limits and calculation methods apply to each category.
1. You are MAGI if:
- Singles/Childless couples ages 19 through 64 who are not entitled to or enrolled in Medicare.
- You are pregnant
- Dependent children under the age of 19
- Parents/caretaker relatives of children under 19
2. You are Non-MAGI if:
- You are 65 or older and you are disabled or blind
- You need or receive long-term care services
3. You are neither if:
- You make more than the maximum income threshold.
- You are on Medicare and you are not disabled.
- You are not a U.S. citizen or legal immigrant.
- You are not a NY state resident (then you need to get Medicaid in your state)
If you are not eligible for Medicaid and find options on the exchange unaffordable, Mira could make a good fit at $45/month.
FAQs
For 2024 the COLA is 3.2% and the income limits for “Non-MAGI” Medicaid have increased from $1,563/ month for a single person and $2,106/ month for a couple in 2023, to $1,677/ month for a single person and $2,268/ month for a couple in 2024.
What is the maximum income to qualify for Medicaid in NY in 2024? ›
For 2024 the COLA is 3.2% and the income limits for “Non-MAGI” Medicaid have increased from $1,563/ month for a single person and $2,106/ month for a couple in 2023, to $1,677/ month for a single person and $2,268/ month for a couple in 2024.
What is the maximum income to qualify for Medicaid in New York? ›
Income and Resource Limits for New York State Public Health Insurance Programs
| 2024 MEDICAID INCOME LIMITS MAGI (<65, Not on Medicare) & Non-MAGI (65+, Disabled, Blind) 138% Federal Poverty Level |
|---|
| 1 | 2 | 3 (MAGI only)** |
|---|
| $1,732 up from $1677 | $2,351 up from $2268 | $2,970 |
| 2024 RESOURCE LIMITS - NON-MAGI MEDICAID ONLY |
3 more rowsApr 15, 2024
EWC 2024 Income Eligibility Guidelines
| Number of Persons in Family/Household | Monthly Gross Household Income | Annual Gross Household Income |
|---|
| 1 | $2,510 | $30,120 |
| 2 | $3,407 | $40,880 |
| 3 | $4,303 | $51,640 |
| 4 | $5,200 | $62,400 |
5 more rowsMar 8, 2024
This income limit, now $2,829/month, normally changes on January 1st of each year. This monthly figure represents 300% of the federal SSI benefit amount and is usually revised upwards each year due to inflation. $2,829 is the income threshold amount for 2024.
What happens if my income increases while on Medicaid NY? ›
If your monthly income is over the Medicaid level, you may still be able to get help with your medical bills. The amount your income is over the Medicaid level is called excess income. It is like a deductible.
Can you own a home and get Medicaid in NY? ›
In short, owning a home typically will not disqualify you from Medicaid. However, other assets can put you over the asset limit.
Do you have to pay back Medicaid in NY? ›
Generally speaking, Medicaid will seek repayment for anything it paid for after a person reaches the age of 55. The goal of MERP is to recover the funds Medicaid expended on behalf of a beneficiary.
What is considered low income in NYS? ›
Persons or families of low income are (a) In New York City, those whose family income does not exceed 80% of the median income for the metropolitan statistical area, except that, in the case of a homestead, does not exceed 80% of the median income for the state, (b) outside New York City, where the property is located ...
Who is eligible for Family Health Plus in NY? ›
Family Health Plus provides coverage to adults who do not have health insurance but have income too high for Medicaid. Parents and childless adults aged 19 through 64 are eligible if they live in New York State, have no health insurance and meet income and resource guidelines.
Income-based Medi-Cal counts most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts.
What income is used to calculate healthcare subsidies? ›
Under the Affordable Care Act, eligibility for subsidized health insurance is calculated using a household's Modified Adjusted Gross Income (MAGI). You are expected to pay a premium contribution limit (a percentage of your annual income) for healthcare coverage.
What if my income is too high for Medi-Cal? ›
If your income is too high for Medi-Cal, you may qualify to purchase health insurance through Covered California. Covered California offers “premium assistance.” It helps lower the cost of health care for individuals and families who enroll in a Covered California health plan and meet income rules.
How to avoid nursing home taking your house in PA? ›
In Pennsylvania, you can be eligible for nursing home medical assistance and retain your house provided you (or someone acting on your behalf) express an intent to return to the home.
How much money can you make and still get Medicaid in Pennsylvania? ›
Who is eligible for Pennsylvania Medicaid Program?
| Household Size* | Maximum Income Level (Per Year) |
|---|
| 1 | $20,030 |
| 2 | $27,186 |
| 3 | $34,341 |
| 4 | $41,496 |
4 more rowsHHS Poverty Guidelines for 2024
| 2024 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA |
|---|
| Persons in family/household | Poverty guideline |
|---|
| 1 | $15,060 |
| 2 | $20,440 |
| 3 | $25,820 |
6 more rowsThe Situation Report | January 17, 2023
The 2023 poverty levels have been posted. The new annual levels are: 1 – $14,580. 2 – $19,720.
What is the poverty line in NY? ›
In 2022, under the supplemental measure, a family of New York City renters made up of two adults and two children was considered below the poverty line if it made less than about $44,000. The poverty threshold for a single adult renter was $20,340.
What are the income guidelines for the essential plan in NY? ›
How do you qualify for the NY Essential Plan? You may qualify if you're between ages 19 and 64 and earning between $20,121 and $37,650 annually, or if your family meets the income eligibility. Check the Eligibility Chart to see if you may qualify.
