Can I have ACA insurance and Medicaid?

ACA and Other Insurance
Written By Jerdon Johnston

Is it possible to have both ACA health insurance and Medicaid coverage at the same time?

No, it is generally not possible to have both ACA health insurance and Medicaid coverage at the same time. If you qualify for Medicaid, you will typically be enrolled in that program instead of purchasing an ACA plan through the Marketplace. Medicaid provides comprehensive health coverage for individuals and families with low incomes, and its benefits and costs are typically more favorable than those of ACA plans. Here’s what you need to know about the relationship between ACA health insurance and Medicaid:

1. Eligibility for Medicaid vs. ACA Health Insurance

Whether you are eligible for Medicaid or an ACA plan depends on your household income and state of residence:

A. Medicaid Eligibility

  • Income requirements: Medicaid eligibility is based on your household income in relation to the Federal Poverty Level (FPL). States that expanded Medicaid under the ACA cover individuals with incomes up to 138% of the FPL.

  • Automatic enrollment: If your income falls below the Medicaid threshold, you will generally be automatically enrolled in Medicaid if you apply through the ACA Marketplace or directly through your state’s Medicaid program. You will not be able to purchase an ACA plan with premium subsidies if you qualify for Medicaid.

B. ACA Marketplace Plan Eligibility

  • If your income is above your state’s Medicaid eligibility level but below 400% of the FPL, you can qualify for premium tax credits and other cost-sharing reductions through the ACA Marketplace.

  • If your income is too high for Medicaid but low enough for ACA subsidies, you can purchase a Marketplace plan with financial assistance to reduce the cost of premiums and out-of-pocket expenses.

2. Why You Can’t Have Both Medicaid and an ACA Plan

Medicaid is designed to provide health coverage for low-income individuals and families, while ACA plans are intended for those who do not qualify for Medicaid but still need affordable health insurance. Here’s why you can’t have both:

  • Overlap in coverage: Medicaid provides comprehensive health coverage at little or no cost, making it unnecessary to have an additional ACA plan.

  • Automatic disqualification: If you qualify for Medicaid, you are not eligible for premium tax credits or other subsidies to help pay for an ACA plan. You’ll be directed to enroll in Medicaid instead.

3. Switching Between ACA and Medicaid

You may switch between Medicaid and an ACA plan if your income changes:

  • From ACA to Medicaid: If your income drops during the year and you become eligible for Medicaid, you can switch from your ACA plan to Medicaid through a Special Enrollment Period. The ACA Marketplace will notify you if you qualify for Medicaid based on your income update, and you’ll be enrolled automatically in most cases.

  • From Medicaid to ACA: If your income increases and you no longer qualify for Medicaid, you’ll be eligible to purchase an ACA plan during a Special Enrollment Period. You may qualify for premium tax credits and other subsidies to help reduce the cost of the plan.

4. Special Cases: Dual Eligibility with Medicare and Medicaid

In some cases, individuals may qualify for both Medicaid and Medicare at the same time (this is called being "dual-eligible"). However, this is different from ACA plans. If you qualify for both Medicaid and Medicare, Medicaid can help pay for Medicare premiums and out-of-pocket costs.

5. How to Check Your Eligibility

If you're unsure whether you qualify for Medicaid or an ACA plan, you can:

  • Apply through the ACA Marketplace: When you apply for health insurance on the ACA Marketplace, the system will automatically check your eligibility for Medicaid and notify you if you qualify.

  • Check with your state’s Medicaid program: Each state has its own Medicaid program with specific eligibility criteria, so you can check directly with your state’s Medicaid office or website.

Key Takeaways:

  • You cannot have both Medicaid and an ACA health plan at the same time. If you qualify for Medicaid, you will be enrolled in that program and will not be eligible for ACA subsidies.

  • If your income changes, you may move between Medicaid and ACA coverage during the year through a Special Enrollment Period.

  • Medicaid offers comprehensive coverage for those who qualify, typically at little or no cost.

For help understanding your eligibility for Medicaid or ACA coverage, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.

Jerdon Johnston
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