Health Insurance For Low-Income Families

This article discusses health insurance for low-income families. Health insurance covers part of your medical expenses, but not all people can afford it.

That’s why it’s so important to have health insurance for low-income people and families. There are federal programs like Medicaid and the Children’s Health Insurance Program (CHIP) as well as state programs and savings options to help you get a plan.

What Is Health Insurance For Low-Income Families?

Low-income policies usually come with cheaper health coverage, but not everyone can get it. You usually need to meet certain income requirements to get coverage, but sometimes other groups, like kids or pregnant women, can get coverage.

What Type Of Health Insurance Do Low-Income Americans Get?

A couple of states also have a basic health program, which is for people who don’t qualify for any other low-income insurance programs. You can also save money on health insurance purchased through a marketplace site, as long as you qualify for rebates known as subsidies.

1. Medicaid

Medicaid is one of the best low-income health insurance plans that provides good coverage. While states have some flexibility in setting their eligibility requirements for Medicaid, it is generally income-based.

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Some states require you to meet an income threshold, while others require you to meet other requirements.

In the expanded states, low-income households can qualify solely based on their pretax income in the past year.

For example, in 2023, a single person earning $14, 580 per month can qualify for Medicaid at 138% of their federal poverty level

People in family Maximum income limit
1 $20,120
2 $27,214
3 $34,307
4 $41,400
5 $48,493
6 $55,586
7 $62,680
8 $69,773

Some of the eligibility requirements for Medicaid are set by the federal government, but each state also has the option to provide coverage to additional groups.

For instance, all states (except Washington D.C.) extend Medicaid coverage to people with cervical cancer or breast cancer who make up to $250,000 less than the federal poverty line.

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In the ten states that did not expand Medicaid, income alone is not enough to qualify for coverage. Eligibility is based on income, age, disability, or medical condition.

  • Alabama
  • Florida
  • Georgia
  • Kansas
  • Mississippi
  • Wisconsin
  • Wyoming
  • South Carolina
  • Tennessee
  • Texas

If you’re in North Carolina, you can apply for Medicaid expansion, but it’s not yet in effect. You’ll also need to check if your kids are eligible for the Kids Health Insurance Program, and if they are, you don’t need to buy insurance for them.

Each state has its own rules on how much you can spend on appointments and treatments, like rates, fees, copays, and coinsurance. But federal law has limits on how much those costs can be. If you’re eligible for Medicaid, your kids will get at least 15 benefits, and the state can add more.

  • Outpatient hospital services
  • Transportation to medical appointments
  • Smoking counseling for pregnant women
  • Certified pediatric and family nurse practitioner services
  • Family planning services
  • Nurse midwife services
  • Some screening, diagnostic, and treatment services
  • Certain freestanding birth center services
  • Nursing facility services
  • Doctor appointments
  • Laboratory and X-ray tests
  • Inpatient hospital services
  • Home health services
  • Rural health clinic services
  • Federally qualified health center services

You can also apply for Medicaid through your state. However, the most common way to apply for Medicaid is through the marketplace, which also determines eligibility for individual marketplace plans based on income.

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2. Children’s Health Insurance Program (CHIP)

The Children’s Health Insurance Program (CHIP) provides low-cost health coverage for children (and in some states pregnant women) whose families do not qualify for Medicaid. The household income limit for CHIP varies from state to state.

The CHIP program provides many of the same benefits as Medicaid, including:

  • Immunizations
  • Prescriptions
  • Emergency services
  • Routine checkups
  • Doctor visits
  • Dental and vision care
  • Laboratory and X-ray services
  • Inpatient and outpatient hospital care

CHIP applications can be made on the health insurance marketplace, or through your state’s Medicaid office.

The marketplace will also determine whether you qualify for individual coverage under the Affordable Care Act, based on income, so you don’t have to file a separate application.

3. Basic Health Program (BHP)

A BHP is a type of health insurance that covers people who don’t make enough money to qualify for other plans. Right now, there are only two states that offer BHP coverage: Minnesota and New York.

If you’re a citizen or a legal permanent noncitizen who doesn’t qualify for Medicaid CHIP or any other program, you may qualify for a basic health program.

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Your income must be no higher than or equal to 200% of your federal poverty level

A basic health plan is legally required to provide at least one of the ten essential health benefits under the Affordable Care Act.

  • Outpatient care, like doctor visits
  • Prescription drugs
  • Services and devices for rehabilitation
  • Hospitalization
  • Emergency services
  • Laboratory services
  • Pediatric services
  • Pregnancy, maternity and newborn care
  • Mental health and substance abuse services

If you sign up for a BHPP plan, your out-of-pocket costs, deductible, copay, and coinsurance will be equal to or less than what you would pay on the market.

What Are Other Health Insurance For Low-Income Families Options?

If you can’t afford insurance but don’t qualify for Medicaid or the Children’s Health Insurance Program (CHIP), there are other coverage options, including VFC and community health centers.

1. The Vaccines for Children (VFC) program

The Vaccines for Children (VFC) program is available in every state. It assists in the provision of vaccines to children who are under the age of 19 and belong to the following categories:

  • American Indian or Alaska Native
  • Medicaid-eligible
  • Uninsured or underinsured

2. Community health centers

Community health centers do not provide health insurance for low-income families and individuals. However, they do provide health care services.

Community health centers typically accept low-income health insurance, such as Medicaid or CHIP. The Affordable Care Act increased funding for community health centers.

Community health centers offer low-cost health services to low-income communities that may not otherwise have access to health care.

In addition to low-income households, community health centers also serve agricultural workers, homeless people, and veterans.

  • Baby shots
  • General primary care
  • Referrals to specialized care
  • Prenatal care

How can I lower my health insurance?

You don’t have to sign up for Medicaid or the CHIP program if you don’t want to. You can still get affordable health insurance, but you’ll have to pay more for it than if you signed up for a government-run program. There are ways to make sure your monthly rate is in line with your budget.

1. Premium tax credits

Premium tax credits (also known as premium subsidies) are a great way to save money on health insurance.

When you purchase a bronze, silver, gold, or platinum health plan through a federal or state marketplace, your income level and household size may determine whether you qualify for the premium tax credit.

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The tax credit can be used to reduce the price of any metal tier plan, and can even cover your whole monthly premium.

Premium subsidies aren’t available on catastrophic plans. Your household must be over or below the federal poverty line to qualify. Premium subsidies aren’t available for Medicaid and CHIP.

In the case of premium subsidies, your expected monthly out-of-pocket costs are based on how close you are to the federal poverty line. You can use a premium calculator to see how much you could potentially save on your health insurance rate.

2. Cost-sharing reductions

Cost-sharing reductions don’t lower your monthly rate. Instead, they reduce the cost of your medical treatment. With a CCR, you’ll pay lower copays, coinsurance premiums, deductibles, and OPC maximums. This means you’ll end up paying less for your care and your insurance will pay more.

You’ll need to apply for a CCR and purchase a silver plan through the marketplace.

Frequently asked questions

What is considered a “low income” for health insurance purposes?

If you live in one of the states that have expanded Medicaid, your income must be at least 138% of your federal poverty level to qualify.

For example, a single individual can earn up to 138% of their federal poverty level, which is approximately $20,240 in pretax earnings.

A family of four can qualify for Medicaid with an income limit of up to 41,400.

Other types of low-income health insurance plans offer different income limits for premium subsidies.

You can qualify for premium subsidies if you earn at least 138%.

In 2023, a single person can earn up to $14,590 and a family can earn up to 30,000. A family of four can earn up to 40,000.

What happens in us if you can t afford healthcare?

Many providers are open to working with patients to create payment plans and negotiate bills, particularly for uninsured and underinsured patients. Patients may also seek financial support or charity care from their healthcare provider or other organizations.

What happens when you don’t have enough money to pay for health insurance?

If you can’t afford a health insurance plan, you can look for low-income health insurance coverage. Programs such as Medicaid and CHIP provide low-cost or no-cost health insurance coverage so you don’t have to pay the entire cost of your medical expenses.

The Affordable Care Act used to include a tax penalty for having no health insurance coverage. There is no federal fee as of January 2019, although some states have penalties.

How much does free health care cost in the United States for low-income families?

Medicaid and CHIP are free or low-cost health plans that low-income families can sign up for. You can also get low-cost care from a community health center, even if you can’t get Medicaid or CHIP.

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