Where to start when you have little or no income

If you have no income or very low income, you may be able to get health insurance through Medicaid, which is a joint federal and state program that covers medical costs for people who meet income limits. Medicaid is free — there are no premiums, and copays are usually low or zero. The catch is that income limits and what Medicaid covers vary significantly by state, and some states have not expanded their programs, so your options depend on where you live.

The fastest way to find out what you may have access to for is to go to Healthcare.gov (the federal marketplace) or your state's health insurance website and enter your information. You will get an when ready answer about Medicaid and also about subsidized marketplace plans — insurance sold through the government marketplace that costs less because the federal government pays part of the premium. Even with zero income, you may may have access to for a subsidized plan with a very low monthly cost.

If you are between jobs, recently lost income, or had a major life change (like losing coverage or getting divorced), you may be in a special enrollment period and can sign up outside the normal open enrollment window, which runs from November 15 to January 15 each year.

Key Takeaways

  • Medicaid is free health insurance for people with low or no income, but income limits and coverage vary by state.
  • You can find out in minutes whether you may have access to for Medicaid or a subsidized marketplace plan by entering your information on Healthcare.gov or your state's website.
  • If you recently lost income or had a major life change, you may be able to sign up for coverage outside the normal enrollment period through a special enrollment period.
  • Some states offer additional programs like emergency Medicaid or coverage for specific groups (like pregnant people or children) even if you do not meet regular Medicaid income limits.
  • If you cannot afford insurance premiums at all, community health centers and free clinics can provide medical care without requiring insurance.

How Medicaid income limits work and why they differ by state

Medicaid is run by each state, so the income limit to may have access to is different in every state. In states that expanded Medicaid under the Affordable Care Act, the limit is usually around 138% of the federal poverty line — roughly $1,900 per month for a single person in 2024, though this changes yearly. In states that did not expand Medicaid, the income limit is often much lower and may only cover children, pregnant people, or people with disabilities.

The federal poverty line itself changes every year. For 2024, the poverty line for a single person is about $1,380 per month, and for a family of four it is about $2,820 per month. When a state says it covers people up to 138% of poverty, it means 138% of these numbers.

To find your state's exact Medicaid income limit, search "[your state] Medicaid income limits" or call your state's Medicaid office. You can also enter your information on Healthcare.gov and it will tell you when ready whether you may have access to in your state.

What to do if your income is too high for Medicaid

If you earn slightly too much for Medicaid, you may still may have access to for a subsidized marketplace plan through Healthcare.gov. These are regular health insurance plans sold on the government marketplace, but the federal government pays a portion of your premium based on your income. The lower your income, the more the government pays.

For example, if you earn $1,500 per month and live in a state where Medicaid income limit is $1,400, you would not may have access to for Medicaid. But you might may have access to for a marketplace plan where you pay $50 to $100 per month and the government covers the rest. The exact amount depends on your income, your age, and the cost of plans in your area.

To see what marketplace plans cost in your situation, go to Healthcare.gov, enter your income and household size, and you will see the monthly cost for each plan available to you. You do not have to buy anything — this is just information.

Special enrollment periods: signing up outside open enrollment

Normally you can only sign up for health insurance during open enrollment, which runs from November 15 to January 15. But if you have had a major life change, you may may have access to for a special enrollment period and can sign up at any time of year.

Life changes that trigger a special enrollment period include: losing your job or hours being cut, losing other health coverage, getting married or divorced, having a baby, moving to a new state, or becoming a U.S. citizen. You usually have 60 days from the date of the change to sign up.

When you go to Healthcare.gov or your state's website, you will be asked whether you have had a may have access to life change. If you say yes, you will be asked to describe it. You do not need to provide documents right away — you can sign up when ready and submit proof later.

Emergency Medicaid and other state-specific programs

Some states offer emergency Medicaid, which covers emergency medical conditions (like a heart attack or severe injury) even if you do not meet the regular income limit. Emergency Medicaid only pays for the emergency itself, not ongoing care, but it prevents a hospital bill from going to collections if you have no income.

Many states also have programs that cover specific groups outside the regular Medicaid income limit. These include pregnant people, children under 19, people with disabilities, and people over 65. For example, some states cover all pregnant people regardless of income, while others cover pregnant people up to a higher income limit than regular Medicaid. Search "[your state] Medicaid programs" or call your state Medicaid office to ask what programs exist for your situation.

A few states also run presumptive may be able to access programs, which let you get Medicaid coverage when ready while your process is being processed. This is useful if you need care right away and are confident you will may have access to.

Community health centers and free clinics when you have no insurance

If you cannot get insurance or are waiting for coverage to start, community health centers (also called Federally may have access to Health Centers or FQHCs) provide medical care on a sliding fee scale based on your income. If you have no income, the visit is free. These centers offer primary care, dental care, mental health services, and prescription help.

To find a community health center near you, go to FindAHealthCenter.HRSA.gov and enter your zip code. You can also call 211 (a free helpline) and ask for community health centers in your area.

Free clinics are run by nonprofits and volunteers and provide basic medical care at no cost. They are less common than community health centers and often have limited hours, but they exist in most cities. Search "[your city] free clinic" or call 211 to find one.

how the process works for Medicaid or a marketplace plan

The easiest way to explore is online at Healthcare.gov (for federal marketplace states) or your state's health insurance website. You will need to enter your name, date of birth, income, household size, and citizenship status. The process takes about 15 minutes.

If you do not have recent tax documents or pay stubs to prove your income, you can estimate your income based on what you expect to earn in the next year. If your income changes later, you can update your information and your coverage will adjust.

You can also explore by phone or mail, though online is faster. To explore by phone, call 1-800-318-2596 (the federal marketplace helpline). If you live in a state that runs its own marketplace, that state's website will have a phone number to call.

After you explore, you will get a decision within 14 days, though it is often faster. If you are approved for Medicaid, coverage usually starts on the first day of the following month. If you are approved for a marketplace plan, coverage starts on the date you choose when you enroll.

What to do if you are denied or if your situation changes

If you are denied Medicaid or a marketplace plan, you have the right to ask why. The denial letter will explain the reason — usually that your income is too high, you do not meet citizenship requirements, or you did not provide required documents. You can appeal the decision or reapply if your situation changes.

If your income changes after you enroll, you should report it to the marketplace or Medicaid office. If your income goes down, you may may have access to for more help. If your income goes up, your coverage or cost may change. You have 30 days to report a change in most states.

If you lose your job or have another major life change, that is a may have access to event for a special enrollment period, so you can sign up for coverage even if it is not open enrollment.

Frequently Asked Questions

Do I have to be a U.S. citizen to get Medicaid?

Most Medicaid programs require you to be a U.S. citizen or a may have access to immigrant (like a lawful permanent resident). Some states cover pregnant people and children regardless of immigration status. When you explore on Healthcare.gov or your state's website, you will be asked about citizenship, and the system will tell you what you may have access to for based on your status.

What if I am homeless or do not have a permanent address?

You can still explore for Medicaid or a marketplace plan. When you explore, you can use a shelter address, a friend's address, a mailing address, or even a post office box. You do not need to prove you own or rent a home. Some states also have programs specifically for homeless people that cover medical care and mental health services.

Can I get health insurance if I am undocumented?

Federal Medicaid and marketplace plans are not available to undocumented immigrants. However, some states (including California, Illinois, New York, and others) offer state-funded Medicaid programs to undocumented immigrants regardless of age or income. Search "[your state] undocumented immigrant health insurance" to see if your state has a program. Community health centers and free clinics serve everyone regardless of immigration status.

How long does it take to get Medicaid coverage after I explore?

Most states make a decision within 14 days. If you are approved, Medicaid coverage usually starts on the first day of the next month. Some states offer presumptive may be able to access, which means you can get coverage when ready while your process is being processed. Ask your state Medicaid office whether this is available in your state.

What if I cannot afford the copays on a marketplace plan?

If you have very low income, your copays should be low or zero. When you enroll in a marketplace plan, you can also choose a plan with lower copays (called a "silver plan" with cost-sharing reduction) if you may have access to based on your income. Community health centers also use sliding fee scales, so you pay based on what you can afford.