How Health Benefits Work

Income-Based Medicaid

Look at Medicaid based on income if:

  • You are less than 65 years old

  • You don’t qualify for SSI or Medicare

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

  • Your household has low to moderate income.

Is It 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 Medicaid based on having low to moderate income. 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 Get Covered Illinois/HealthCare.gov.

Do You Meet the Basic Requirements for Income-Based Medicaid?

To qualify for Medicaid based on having low to moderate income, 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 Rules for Immigrants:

Note: Illinois has temporarily paused new enrollment in the Health Benefits for Immigrant Adults and Health Benefits for Immigrant Seniors programs.

Is Your Income Low Enough for Income-Based Medicaid?

These are the main income rules for getting Medicaid based on having low to moderate income:

  • If your family’s income is at or under 138% of the Federal Poverty Guidelines (FPG) ($20,120 per year for an individual; $41,400 for a family of four), you may qualify.
  • If you are 18 or younger and your family’s income is at or under 318% of FPG ($95,400 per year for a family of four), you may qualify for All Kids.
  • If you are pregnant and your family’s income is at or under 213% of FPG ($63,900 per year for a family of four), you may qualify. The unborn baby is counted as a family member.

This way of qualifying for Medicaid, sometimes called "Medicaid expansion," is based on your Modified Adjusted Gross Income (MAGI), which includes most earned and unearned income. However, some income is not counted, including Supplemental Security Income (SSI) benefits, growth of the investments in an ABLE account, 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 you can have in resources for income-based Medicaid and you do not need to have a disability.

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 or All Kids.

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 Medicaid based on having a disability if:

  • You get Supplemental Security Income (SSI) benefits or used to get SSI and now have SSI 1619(b) status. People who get SSI benefits qualify for Medicaid, but need to apply for Medicaid separately.
  • You make more money at work than income-based Medicaid allows. In that case, you could apply for Health Benefits for Workers with Disabilities (HBWD).
  • You also get Medicare. Usually, Medicaid doesn’t cover people getting Medicare, but Aid to the Aged, Blind, and Disabled (AABD) Medicaid does.
  • 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. AABD Medicaid is only for people who have disabilities meeting this standard and seniors who are 65 or older.
  • You have more resources than are allowed by AABD Medicaid and do not work.
  • You make enough money that you would have to pay a monthly premium for HBWD.

Learn more about AABD Medicaid and HBWD.

How to Sign Up

You can apply for Medicaid, All Kids, and other Illinois programs:

The ABE website answers frequently asked questions, including explaining what information you'll need to fill out an application.

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 DHS Family Community Resource Center 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 HBWD.

Learn more