How do I tell if I’m eligible for Medicaid or if I need to buy a plan through the exchange?

The best way to tell is to go ahead and enroll in the exchange. Once you have done so, you will automatically be directed to the correct types of plans based on your income. You can enroll in Medicaid plans through the exchange same as you can individual plans.

Unfortunately, getting insurance isn’t always easy for those whose income puts them right around the Medicaid/individual plan cutoff. In states without expanded Medicaid programs, there is something called the Medicaid gap. Those who end up in this gap find themselves in a difficult situation, with their income too high to qualify for Medicaid, but too low to make them eligible for subsidies. People in the gap can still purchase plans through the exchange, but because of their limited income and the lack of available subsidies, this is often not financially feasible. The good news is that if you find yourself stuck in the Medicaid gap but later get a job that bumps your income past the subsidy threshold, it can count as a qualifying event for a special enrollment period, allowing you to enroll in a subsidized insurance plan through the exchange without having to wait for open enrollment at the end of the year (assuming your new employer does not offer an insurance plan of their own).

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If I qualify for Medicaid, do I still need to worry about open enrollment?

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