I Can't Get Medicaid. Now What?

If your income is above the Medicaid threshold, you may qualify for substantial subsidies on ACA Marketplace plans. Many people who believe they cannot afford coverage are surprised by what subsidies can cover. Visit healthcare.gov or your state's marketplace to check subsidy eligibility. Enhanced subsidies are available in many states — premiums can be as low as $0/month for qualifying incomes. Open enrollment is typically November 1 to January 15, but qualifying life events trigger special enrollment.

Federally Qualified Health Centers provide care on a sliding fee scale based on income. They are not insurance — but they are a source of affordable primary and preventive care regardless of coverage status. Search findahealthcenter.hrsa.gov for locations near you. Services include primary care, dental, mental health, and pharmacy. No one is turned away for inability to pay.

Many states operate programs that fall between Medicaid and commercial coverage. These include Children's Health Insurance Program (CHIP) for children in families that earn too much for Medicaid, state pharmaceutical assistance programs, limited benefit Medicaid programs for specific conditions or populations, high-risk pool programs, and county indigent care programs. A hospital social worker or case manager can often identify state-specific programs you qualify for — ask for it at any hospital or community health center.

If coverage for medications is the primary need, consider: NeedyMeds.org — database of patient assistance programs by medication; RxAssist.org — manufacturer-sponsored assistance programs; GoodRx — discount pricing at pharmacies, no insurance required; manufacturer patient assistance programs — apply directly through the drug company; 340B drug pricing program — reduced cost medications at qualifying health centers.