Caught in the middle
The Medicaid coverage gap, explained
4 min readReviewed by CoverageCo’s licensed agents
Key takeaways
- The gap only exists in states that didn't expand Medicaid.
- People in the gap earn too much for Medicaid but too little for Marketplace subsidies.
- Small income changes can move you out of the gap and into help.
- A licensed agent can review every option, including lower-cost plan types.
Why the gap exists
When the ACA was written, it assumed every state would expand Medicaid to cover adults up to about 138% of the poverty level. A number of states chose not to. In those states, adults below the poverty line often can't get Medicaid — and Marketplace financial help was designed to start higher up — so a gap opens between the two.
If you think you're in the gap
First, confirm it — the rules for parents, people with disabilities, and pregnant women are different, and you may qualify for Medicaid through a pathway you didn't know about. Second, check the Marketplace anyway; depending on your exact income, you may be closer to financial help than you think.
A licensed agent can look at your specific numbers and walk you through the real options in your state instead of leaving you to guess.
Medicaid eligibility estimator
See what you may qualify for.
Answer three quick questions for a free estimate. If you don’t qualify for Medicaid, we’ll help you find what you do — in one call.
This is a general estimate based only on what you enter — not a determination of eligibility, an application, or an offer of coverage. Only your state Medicaid agency can determine Medicaid eligibility. CoverageCo is a licensed insurance agency, not a government agency.
Common questions
How do I know if I'm in the coverage gap?
You're potentially in the gap if you live in a state that didn't expand Medicaid, earn below the poverty level, and don't qualify for Medicaid through another pathway. Because the rules vary, it's worth confirming rather than assuming — a licensed agent can check.
Can I still get coverage if I'm in the gap?
Often yes, through options worth reviewing case by case — and even a small change in income or household can move you into Marketplace financial help. Don't go uninsured without checking every option first.
Keep reading
Medicaid vs. the Marketplace: which one are you eligible for?
Medicaid and Marketplace coverage serve different income levels. Here's how to tell which one you qualify for — and what to do if you're near the line.
Denied Medicaid? Here are your real coverage options
A Medicaid denial isn't a dead end. Here's how to appeal if it's wrong — and the coverage options if you truly don't qualify.
Medicaid income limits, explained
Medicaid income limits are set as a percentage of the federal poverty level and vary by state, household size, and who's applying. Here's how they actually work.
If Medicaid isn’t a fit
Many people just over the Medicaid line qualify for Marketplace coverage with financial help that lowers the monthly cost.
Reviewed by CoverageCo’s licensed insurance agents · Last updated August 2026. Sources: Medicaid.gov; HealthCare.gov and state Health Insurance Marketplaces; KFF; HHS federal poverty guidelines. This article is general information, not a determination of eligibility.
Important disclosures
The Coverage Company (“CoverageCo”) is a private, licensed insurance agency. This website is not Medicaid, Medicare, HealthCare.gov, or any federal or state government program, and is not affiliated with, endorsed by, or connected to any government agency.
The eligibility estimator and any figures shown are for general education only. They are based on the limited information you provide and published federal poverty guidelines, are not guaranteed to be current, and are not a determination of eligibility, an application, or an offer of coverage. Only your state Medicaid agency can determine Medicaid eligibility. If you contact us, a state-licensed insurance agent may help you review private coverage options; enrollment in any plan is subject to eligibility and the plan’s terms.