Medicaid, Medicare, and the ACA: Finding the Right Coverage
Healthcare coverage in the U.S. comes from overlapping federal and state programs that serve different populations. The right program for you depends on your age, income, disability status, and whether you have access to employer coverage.
Which Program Is Right for Me?
→ I am 65 or older
Apply for Medicare. Also check if you qualify for Medicaid to cover costs Medicare doesn't pay.
→ I have a disability and receive SSDI
You will qualify for Medicare after 24 months. Apply for Medicaid immediately if your income qualifies.
→ My income is below ~$20,000/year (single)
You likely qualify for Medicaid if you're in an expansion state. Apply at healthcare.gov.
→ I have children under 19
Children may qualify for CHIP at higher income levels than adults. Apply at healthcare.gov regardless of your income.
→ My income is above the Medicaid limit but I'm uninsured
Check the ACA Marketplace at healthcare.gov for subsidized plans. Premium tax credits run from 100% to 400% of the federal poverty line. The ceiling was suspended for tax years 2021 through 2025 and applies again from 2026 unless Congress extends it, so check your projected income against the current limit before you enroll.
Key Programs
MedicaidCenters for Medicare & Medicaid Services
What It Is
Free or very low-cost health insurance for low-income individuals and families, administered by states with federal funding.
Who Qualifies
In expansion states, adults with income up to 138% of the federal poverty line — about $22,025 for an individual or $45,540 for a household of four in 2026. Non-expansion states still cover children, pregnant women, parents, and elderly and disabled adults at their own thresholds, so living in one is not by itself a reason to skip applying.
What You Get
Comprehensive coverage including doctor visits, hospital care, prescription drugs, mental health, and long-term care. Most services have no or very low copays.
How to Apply
Apply at healthcare.gov (will route to Medicaid if eligible) or directly through your state Medicaid agency. No open enrollment period — apply anytime.
Medicare Part A (Hospital)Centers for Medicare & Medicaid Services
What It Is
Covers inpatient hospital care, skilled nursing facility care, hospice, and some home health services.
Who Qualifies
People 65+ who are U.S. citizens or permanent residents with 10+ years of Medicare-covered employment (or their spouses). Also available to qualifying disabled individuals under 65.
What You Get
Most people pay no premium for Part A if they or their spouse paid Medicare taxes for 10+ years. 2026 deductible: $1,736 per benefit period.
How to Apply
Automatic enrollment at 65 if you receive Social Security. Otherwise, apply during your Initial Enrollment Period at ssa.gov or by calling 1-800-772-1213.
Medicare Part B (Medical)Centers for Medicare & Medicaid Services
What It Is
Covers outpatient care, doctor visits, preventive services, and some home health care.
Who Qualifies
Same as Part A. Part B is voluntary but most people enroll. Late enrollment penalties apply if you delay without other qualifying coverage.
What You Get
Standard premium: $202.90/month in 2026 (higher for higher incomes). Annual deductible: $283. Medicare pays 80% of approved costs after the deductible.
How to Apply
Enroll at ssa.gov or call 1-800-772-1213. Apply during your Initial Enrollment Period (3 months before to 3 months after your 65th birthday month).
Medicare Part D (Prescription Drugs)Centers for Medicare & Medicaid Services
What It Is
Optional prescription drug coverage through private plans approved by Medicare.
Who Qualifies
Anyone enrolled in Medicare Part A or Part B.
What You Get
Premiums average ~$55/month. Low-Income Subsidy (Extra Help) available for qualifying individuals — can reduce premiums to near zero.
How to Apply
Compare and enroll at medicare.gov/plan-compare during Annual Enrollment (October 15 – December 7) or at initial Medicare enrollment.
CHIP (Children's Health Insurance Program)Centers for Medicare & Medicaid Services
What It Is
Health insurance for children in families with income too high for Medicaid but too low for affordable private insurance.
Who Qualifies
Children under 19 in families with income typically between 138%–300% FPL, depending on the state. Some states cover pregnant women.
What You Get
Low or no-cost comprehensive coverage. Premiums and copays are very low — typically under $50/month for the family.
How to Apply
Apply at healthcare.gov or through your state CHIP agency. No enrollment period — apply anytime.
ACA Marketplace (Health Insurance Marketplace)U.S. Department of Health and Human Services
What It Is
Private health insurance plans with federal subsidies (premium tax credits) to reduce costs for eligible individuals and families.
Who Qualifies
U.S. citizens and lawfully present residents with household income between 100% and 400% of the federal poverty line. Must not have access to affordable employer or government coverage. The premium tax credit runs from 100% to 400% of the federal poverty line. Congress suspended that 400% ceiling for tax years 2021 through 2025; absent further legislation it applies again from tax year 2026, so income above 400% is once more a hard cut-off rather than a taper. Check your projected income for the coverage year against the current limit before you enroll.
What You Get
Premium tax credits reduce monthly premiums significantly — many households pay $0–$100/month after subsidies. Cost-sharing reductions available below 250% FPL.
How to Apply
Apply at healthcare.gov during Open Enrollment (November 1 – January 15) or during a Special Enrollment Period after qualifying life events.
Trusted Resources
Trusted tools to help you claim what you've earned
Healthcare.gov — Compare ACA Plans
Official marketplace for ACA health insurance plans. Compare plans and see your subsidy amount before enrolling.
Compare plans at Healthcare.gov →CareSifter.com — Senior Care Options
Explore senior care, assisted living, and in-home care options alongside your Medicare and Medicaid coverage.
Explore senior care at CareSifter.com →