How Health Benefits Work
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Income-Based Medicaid
Look at income-based Medicaid if:
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You are less than 65 years old
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You don’t qualify for SSI or Medicare
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You are a U.S. citizen or eligible immigrant, and
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Your household has low income.
Is Income-Based Medicaid Right for You?
Medicaid is government-funded health coverage for people in certain situations. You may qualify if you:
- Have low income, no matter how much you have in resources or whether you have a disability. Income-based Medicaid is explained on this page.
- Get Supplemental Security Income (SSI) benefits or qualify for SSI’s 1619(b) rule, which helps people who used to get SSI. In either case, you automatically get Medicaid coverage and don’t need to worry about the rules discussed here. Learn more in DB101’s SSI article.
- Have low income, low resources, and a disability. Learn more about SSI-related Medicaid.
- Have a disability and work, even if your income is higher. Learn more about Freedom to Work.
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 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.
Do You Meet Income-Based Medicaid’s Basic Requirements?
To qualify for income-based Medicaid, you must:
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Be under 65 years old
- You can be 65 or older if you are the parent or caretaker of a child.
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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 the same programs that U.S. citizens can get.
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) ($20,783 per year for an individual; $43,056 for a family of four), you may qualify.
- If you are 18 or younger and your family’s income is at or under 217% of FPG ($67,704 per year for a family of four), you may qualify.
- If you are pregnant and your family’s income is at or under 200% of FPG ($62,400 per year for a family of four), you may qualify. The unborn baby is counted as a family member.
Income-based Medicaid is based on your Modified Adjusted Gross Income (MAGI), which includes most earned and unearned income. (That's why some people call it "MAGI Medicaid.") 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: If you are 21 or older and your household's income is between 100% of FPG and 138% of FPG, you may have to put a small amount of money each month in a special account called a MI Health Account (MIHA). Get more information about MIHA accounts.
Note: There are no limits to how much money or other resources you can have for income-based Medicaid.
Your family size: | |
Income limits for your family: | |
$15,060 | |
$5,380 | |
$15,060 | |
$5,380 | |
Income-based Medicaid, adults (138% FPG) | |
Healthy Kids (195% FPG) | |
MIChild (217% FPG) | |
Subsidized private plans, reduced fees (250% FPG) | |
Subsidized private plans (no income limit) | -- |
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules.
Notes:
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If your income is low enough and you meet all other requirements, you should sign up for Medicaid.
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 217% of FPG as the limit, instead of 212%.
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 SSI-related Medicaid if:
- You get Supplemental Security Income (SSI) benefits.
- You make more money at work than income-based Medicaid allows. In that case, you could apply for Freedom to Work.
- You also get Medicare. Usually, Medicaid doesn’t cover people getting Medicare, but SSI-related Medicaid does. It may even help pay your monthly Medicare premiums.
- 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. SSI-related Medicaid is only for people who have disabilities meeting this standard.
- You have more resources than are allowed by SSI-related Medicaid.
- You make enough money that you would have to pay a monthly premium for Freedom to Work.
Learn more about SSI-related Medicaid and Freedom to Work.
How to Sign Up
You can apply for Medicaid:
- Online using MIBridges or HealthCare.gov, or
- By using form DCH-1426 and giving it to your county human services agency.
Note: With MIBridges, you can apply for the Food Assistance Program (formerly Food Stamps), the Family Independence Program (FIP), and other benefits at the same time as you apply for Medicaid.
For help with your application, visit or call your local county human services agency or call the Medicaid Beneficiary Help Line at 1-800-642-3195 or 1-866-501-5656 (TTY).
Staying on Medicaid
Usually, once approved for Medicaid, you continue to qualify as long as your situation doesn’t change. If your income, immigration status, residency, or household size changes, let your county human services agency know within 10 days of the change. You can do this in person, by phone, or by email. When you report your changes, the county tells you whether you continue to get Medicaid or if you have new health coverage options, like individual coverage with subsidies or Freedom to Work.
Learn more
Getting Past the Myths: The Truth About Working
Get the facts about how benefits support work.
Supplemental Security Income (SSI)
SSI helps people with disabilities and seniors who have low income and resources.
Social Security Disability Insurance (SSDI)
SSDI helps people with disabilities who worked and paid Social Security taxes.
Find Help
Ask a Michigan Benefit-to-Work (B2W) Coach your questions about work and benefits.
A B2W Coach can help you understand how Social Security disability benefits and other public benefits are impacted by work.
SSI and SSDI
How Work Affects SSI and SSDI
- Contact a Benefits Planner
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Call the Ticket to Work Help Line
1-866-968-7842
Medicaid
- Contact your county human services agency
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Call the Michigan Medicaid Beneficiary Helpline
1-800-642-3195
Medicare
Work Preparation
- Contact your Michigan Rehabilitation Services (MRS) office
- Contact your Bureau of Services for Blind Persons (BSBP) office
- Contact your Michigan Works! One-Stop Service Center
Veterans Benefits
- The Michigan Veterans Affairs Agency at 1-800-MICH-VET
- VA's Detroit Regional Office
- Claims Reps & VSOs
- Find a Veteran Navigator
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