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How Health Benefits Work

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    How Health Benefits Work

    Income-Based Medicaid

    Look at income-based Medicaid if:

    • You are less than 65 years old

    • You don’t qualify for Medicare

    • You don’t qualify for APA

    • You are a U.S. citizen or eligible immigrant, and

    • Your household has low to moderate income.

    Is Income-Based Medicaid Right for You?

    Medicaid is government-funded health coverage for people in certain situations. You may qualify if you:

    Answer the questions on this page to see if you might qualify for income-based Medicaid. If so, it’s probably your best health coverage option because it doesn’t usually have a premium, the copayments for services are generally lower than copayments required by private plans, and Medicaid covers more services than most private plans. Also, if you qualify for Medicaid, you cannot get government help paying for an individual plan on HealthCare.gov.

    Note: Income-based Medicaid is sometimes called MAGI-Category Medicaid, Adult Medicaid, or Medicaid Expansion.

    Do You Meet Income-Based Medicaid’s Basic Requirements?

    To qualify for income-based Medicaid, you must:

    • Be under 65 years old
      • You can be 65 or older if you are the parent or caretaker of a child
    • Not qualify for Medicare
      • You can be on Medicare if you are the parent or caretaker of a child or are pregnant
    • Be a U.S. citizen or meet specific noncitizen requirements

    If you are under 65, do not qualify for Medicare, and are either a U.S. citizen or a noncitizen who qualifies, income-based Medicaid might cover you.

    Medicaid’s rules for immigrants:

    • Undocumented immigrants do not qualify for full Medicaid coverage, but they may qualify for Medicaid coverage for emergency services.
    • Most immigrants who have been lawfully present for less than five years do not qualify for full Medicaid coverage. However, they may qualify for private coverage subsidized by the government.
    • Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements qualify for all of the same programs that U.S. citizens can get.

    Note: You can get Medicaid coverage if you are a Native American born in Canada or Mexico who has rights to cross the border.

    Do You Qualify for Adult Public Assistance (APA)?

    If you have a disability, low income, and low resources, you may qualify for APA. If you already get APA benefits, you automatically get APA-related Medicaid coverage and do not need to apply separately.

    If you do not get APA benefits, income-based Medicaid might cover you.

    Is Your Income Low Enough for Income-Based Medicaid?

    These are the main income rules for income-based Medicaid:

    • If your family’s income is at or under 138% of the Federal Poverty Guidelines (FPG) ($2,164 per month for an individual; $4,486 for a family of four), you may qualify.
    • If you are 18 or younger and your family’s income is at or under 208% of FPG ($6,761 per month for a family of four), you may qualify. Income-based Medicaid for children is also called Denali KidCare (DKC).
    • If you are pregnant or gave birth within the last 12 months and your family’s income is at or under 230% of FPG ($7,476 per month for a family of four), you may qualify. The unborn baby is counted as a family member.

    Income-based Medicaid counts most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect income-based Medicaid eligibility.

    Note: There are no limits to how much money or other resources you can have for income-based Medicaid.

    Health Coverage Income Limits for Your Family

    If your income is low enough and you meet all other requirements, you should sign up for Medicaid.

    Is income-based Medicaid’s income limit 133% or 138% of FPG?

    You may see the income limit for income-based Medicaid listed as 133% of FPG in some places. However, when Medicaid counts your income, they’ll knock 5% of FPG off your income if you make more than 133% of FPG. That's why we say that you can make up to 138% of FPG, because it more accurately shows how much income you could have and still get Medicaid. For children, this means we show 208% of FPG as the limit, instead of 203% and for pregnant women, we show 230% instead of 225%.

    More Ways to Qualify for Medicaid if You Have a Disability

    There are other ways to qualify for Medicaid if you have a disability. You might qualify for APA-related Medicaid if:

    • Get Adult Public Assistance (APA) benefits. If you get APA, you also get APA-related Medicaid automatically.
    • You make more money at work than income-based Medicaid allows. In that case, you could also apply for the Working Disabled Medicaid Buy-In program.
    • You also get Medicare. Usually, Medicaid doesn’t cover people getting Medicare, but APA-related Medicaid does. It may even help pay your monthly Medicare premiums and other Medicare expenses like deductibles and coinsurance.
    • You are 65 years old or older.

    You might qualify for income-based Medicaid, even though you have a disability, if:

    • Your disability does not meet Social Security’s definition of disability. APA-related Medicaid is only for people who have disabilities meeting this standard and for seniors.
    • You have more resources than are allowed by APA-related Medicaid.
    • You make enough money that you would have to pay a monthly premium for the Working Disabled Medicaid Buy-In program.

    Learn more about APA-related Medicaid and the Working Disabled Medicaid Buy-In.

    How to Sign Up

    You can apply for Medicaid:

    If you use an application form, you can also apply for other benefits at the same time, such as Adult Public Assistance (APA), SNAP (formerly Food Stamps), and Alaska Temporary Assistance Program (ATAP). If you apply for Medicaid online, you have to apply for other benefits separately.

    Staying on Medicaid

    Usually, once you are approved for Medicaid, you will continue to qualify as long as your situation doesn’t change. If your income, immigration status, residency, or household size changes, you need to report within 10 days of when you know about the change. You can report these changes to the Division of Public Assistance (DPA) by calling 1-800-478-7778, by fax to 1-888-269-6520, by email to hss.dpa.offices@alaska.gov, or in person at any Division of Public Assistance (DPA) office.

    When you report your changes, the DPA will tell you whether you will continue getting Medicaid or if you have new health coverage options, like individual coverage with subsidies or the Working Disabled Medicaid Buy-In program.

    Learn more

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    Supplemental Security Income (SSI)

    SSI and Adult Public Assistance (APA) give cash benefits to people with disabilities and seniors who have low income and low resources.