People treat this as a preference. It is not. Your income, your household size and whether your state expanded Medicaid decide which door is open to you, and the marketplace will not give you a subsidy if you qualify for Medicaid.
Where the line falls in 2026
The 2026 federal poverty level is $15,960 for one person, plus $5,680 for each additional person in the household. In a state that expanded Medicaid, adults generally qualify up to 138% of that — about $22,025 a year for one person. Above that line you move to marketplace subsidies, which run out entirely above 400% of the poverty level: $63,840 for one person in 2026.
What each one costs you
| Medicaid | Marketplace plan | |
|---|---|---|
| Premium | None, or a nominal amount in some states | Sliding scale after the premium tax credit; full price above 400% FPL |
| Cost sharing | Very limited by federal rule | Deductible and coinsurance, capped at $12,000 single / $21,200 family for 2027 |
| When you can enroll | Any time of year | Open Enrollment, or a special enrollment period after a qualifying event |
| Network | Providers who accept that state's program | The plan's own network |
Silver plans carry one extra advantage worth knowing: below 250% of the poverty level, cost-sharing reductions cut the deductible and out-of-pocket maximum on Silver only. A Bronze plan at that income throws that away.
The gap in states that did not expand
In a non-expansion state, adults below the poverty level can fall into a gap: too much income for that state's narrow Medicaid rules, too little to qualify for marketplace subsidies, which start at 100% of the poverty level. It is not a loophole you can argue your way out of. What it does mean is that projected annual income matters enormously, and for self-employed people whose income is an estimate, projecting it accurately is the whole ballgame.
Moving between them mid-year
Medicaid enrollment is open year round, so a drop in income can move you onto it at any time. Losing Medicaid works the other way: it is a qualifying event that opens a 60-day window to take a marketplace plan. Do not let that window close — after it, you are waiting for Open Enrollment.
Not sure which side of the line you are on? Enter your ZIP code below with your household size and expected income and a licensed agent will tell you, or call (713) 575-9904.