Know the difference
Medicaid vs. the Marketplace: which one are you eligible for?
5 min readReviewed by CoverageCo’s licensed agents
Key takeaways
- Medicaid is for lower incomes; the Marketplace covers people above the Medicaid line.
- In expansion states the cutoff for adults is about 138% of the federal poverty level.
- People just over the Medicaid line often qualify for Marketplace financial help.
- If you're near the line, don't guess — small income differences change which program you use.
The short version
Medicaid is government health coverage for people with lower incomes, run by your state. The Health Insurance Marketplace is where you buy a private plan, sometimes with financial help based on your income. They're designed to hand off to each other: Medicaid covers people up to a limit, and the Marketplace picks up above it.
Where the line is
In states that expanded Medicaid, most adults qualify up to about 138% of the federal poverty level. In states that didn't expand, the rules for adults are stricter — and some low-income adults fall into a “coverage gap” where they earn too much for Medicaid but too little for Marketplace help.
Children and pregnant women usually qualify at higher income levels than other adults, so a family can have kids on Medicaid while a parent shops the Marketplace.
If you're near the line
This is where people get it wrong. A few thousand dollars of income can move you from Medicaid to the Marketplace — or open financial help you didn't know you qualified for. Rather than assume, run the numbers for your household and state, then have a licensed agent confirm before you enroll.
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
Can I have both Medicaid and a Marketplace plan?
Generally no — if you qualify for Medicaid, you can't also get financial help for a Marketplace plan. But different family members can be on different programs (for example, kids on Medicaid, a parent on a Marketplace plan).
What if I make too much for Medicaid but can't afford a plan?
In most states you may qualify for Marketplace financial help that lowers your premium. In states that didn't expand Medicaid, some people fall into a coverage gap — a licensed agent can walk you through every option, including lower-cost plan types.
Keep reading
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.
Lost your Medicaid? Here's exactly what to do next
Losing Medicaid usually opens a 60-day window to get other coverage — often with financial help. Here's how to act fast and avoid a gap.
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.