Healthcare Coverage Eligibility Estimator
Estimate your eligibility for Medicaid, CHIP, and ACA Marketplace subsidies based on your household size, annual income, age, and state of residence.
Formulas Used
Federal Poverty Level (2024):
FPL = $15,060 + ($5,380 × (Household Size − 1))
Income as % of FPL:
FPL% = (Annual Income ÷ FPL) × 100
Medicaid Eligibility:
Expansion states: FPL% ≤ 138% | Non-expansion states: FPL% ≤ 100% (conservative estimate)
CHIP Eligibility:
Children under 19 with household FPL% ≤ 200% (federal floor; many states extend to 300%+)
ACA Premium Tax Credit (ARP 2021–2025 extension):
Required Contribution = Annual Income × Required Contribution % (sliding scale by FPL%)
Subsidy = max(0, Benchmark Premium − Required Contribution)
No upper income cap while ARP is in effect (anyone paying >8.5% of income qualifies)
Required Contribution % Sliding Scale:
≤150% FPL: 0% | 150–200%: 0–2% | 200–250%: 2–4% | 250–300%: 4–6% | 300–400%: 6–8.5% | >400%: 8.5%
Cost-Sharing Reductions (CSR):
Available to ACA enrollees in Silver plans with FPL% between 100%–250%.
100–150% FPL → 94% AV | 150–200% FPL → 87% AV | 200–250% FPL → 73% AV
Assumptions & References
- 2024 Federal Poverty Level guidelines from HHS (effective January 2024).
- Medicaid expansion threshold of 138% FPL per ACA Section 2001 for expansion states; non-expansion states use 100% FPL as a conservative adult threshold.
- CHIP federal floor is 200% FPL; many states (e.g., NY, CA) extend to 300%–400% FPL.
- ACA Premium Tax Credit sliding scale per IRS Rev. Proc. 2023-29 and American Rescue Plan Act (ARP) 2021 extension through 2025.
- Benchmark premium estimated using national average age-adjusted second-lowest-cost Silver plan; actual premiums vary significantly by region and insurer.
- Age rating factors based on CMS 3:1 age rating band rules (45 CFR §147.102).
- Employer affordability threshold: 9.12% of household income for self-only coverage (2024 IRS Rev. Proc. 2023-34).
- Medicare eligibility: age 65+ or qualifying disability/ESRD (not modeled here).
- This tool does not account for immigration status, incarceration, or other categorical eligibility factors.
- Sources: HHS.gov, Healthcare.gov, IRS.gov, KFF.org, CMS.gov.