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Medicaid or Marketplace: what's the difference?

Plans · 4 min read

Medicaid and Marketplace (ACA) plans both provide health coverage, but they're different programs for different incomes. When you apply, you're checked for both.

Medicaid

• Run by your state, for people with very low income
• Usually free or very low cost
• You can apply any time of year
• Rules and income limits are different in every state

Marketplace (ACA) plans

• Private insurance plans sold through the Health Insurance Marketplace
• Tax credits lower the monthly cost based on your income
• You can enroll during Open Enrollment, or with a qualifying life event

You can't get both

If you qualify for Medicaid, you can't get a tax credit for a Marketplace plan. Children in families that earn too much for Medicaid may still qualify for CHIP, which is low-cost coverage just for kids.

What if you fall in between?

Some states haven't expanded Medicaid. In those states, some adults earn too much for Medicaid but too little to get a Marketplace tax credit. This is called the coverage gap. If you think you may be in it, talk to us: there may still be options, including Special Enrollment if your income changes.