What are Federal Poverty Levels Used for?
Federal Poverty Levels (which are also called Federal Poverty Guidelines, Federal Poverty Line, or simply FPL) are used to see if you qualify for cost assistance when buying insurance through the State or Federal Health Insurance Marketplace.
Federal Poverty Levels are also used to help determine Medicaid and CHIP eligibility and to help determine eligibility for some other non-healthcare related assistance programs (see a full list and more details on the guidelines below).
Whatever you want to use the poverty level for, we have the latest poverty levels with detailed explanations below.
TIP: Which guidelines you’ll use depends on which program or purpose you are using them for. Between Medicaid/CHIP, cost assistance, and taxes you’ll need to use more than one year’s guidelines each year. Pay careful attention and take care to use the correct guidelines for the correct purpose. Make sure to check official government websites and official IRS tax documents for the poverty level information you need and pay special attention to what year’s tables you are supposed to use for any given program.
FACT: The Federal Register is where the guidelines are posted every year, you’ll also find the one’s you need for tax filing taxes on the 8962 form (keep in mind the poverty levels you need for tax filing will likely be from past years).
The 2019 Federal Poverty Guidelines (for 2020 Cost assistance and 2019 Medicaid/CHIP)
Below are the 2019 Federal Poverty Guidelines that went into effect in early 2019 (the ones you use for Medicaid/CHIP in 2019 and for 2020 marketplace cost assistance).
These guidelines are the key to all cost assistance under the Affordable Care Act, specifically these guidelines are used for:
- Medicaid/CHIP between Jan 2019 – Jan 2020.
- 2020 marketplace cost assistance on all marketplace health plans held in 2020 and purchased during open enrollment for 2020 (which runs from Thursday, November 1, 2018, to Saturday, December 15, 2018, and which uses the 2019 levels).
- For special enrollment in 2020.
- For ACA taxes for the 2020 calendar year filed in 2021.
NOTE: Our federal poverty guideline list has the 100% poverty level, 138% Medicaid expansion threshold, the 250% CSR subsidy threshold, and the 400% premium tax credit thresholds so you can at a glance see what assistance you qualify for. Please note that for Medicaid Expansion if you make under 138% you qualify, for CSR it is between 100% – 250%, and for tax credits it is between 100% and 400%. See details on subsidies under the ACA.
TIP: For mobile and smaller screen sizes, drag the table below to scroll and see the different poverty levels.
|2019 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA|
|Persons in Family/Household||100% FPL: Minimum to Qualify for ACA Assistance||138% FPL: Medicaid Cap (in States that Expanded)||250% FPL: CSR Subsidies Cap||400% FPL: Premium Tax Credit Cap|
|For families/households with more than 8 persons, add $4,420 for each additional person.|
How to calculate a percentage of the Federal Poverty Level: Medicaid uses the 138% of the Federal Poverty level to determine assistance. Until we update this, take the guideline dollar amount below, multiply by 1.38, and then round up. So $12,490 x 1.38 = $17,236.20. Thus, $17,237 is 138% of the Federal Poverty Level threshold for 2019 Medicaid and CHIP. The methodology is the same for all FPL percentages. We have made the calculations for you above, but it still helps to know the methodology.
Medicaid and CHIP: You can sign up for Medicaid and CHIP 365 days a year. You may qualify for free or low-cost care for Medicaid based on income and family size if you make 138% of the poverty level or, for example, $17236.20 individual or $35,535 for a family of four in 2019. Specifics may differ by state.
Healthcare Cost Assistance: You may qualify for marketplace cost assistance based on income and family size each year if you make between 100% – 400% of the federal poverty level. For 2020 assistance you’ll use the 2019 poverty levels. Thus, if you make between $12,490 – $49,960 as an individual or $25,750 – $103,000 in 2020, you’ll qualify for cost assistance. Please note marketplace cost assistance can be taken in advance based on income projects, but is adjusted for actual income at tax time.
The 2018 Federal Poverty Guidelines (For 2019 Cost Assistance and 2018 Medicaid/CHIP)
Below are the 2018 Federal Poverty Guidelines that went into effect in early 2018 (the ones you use for Medicaid/CHIP in 2018 and for 2019 marketplace cost assistance).
|2018 Poverty Guidelines for the 48 contiguous states and the District of Columbia|
|Persons in Family/Household||100% Poverty Guideline|
|For families/households with more than 8 persons, add $4,320 for each additional person.|
The 2017 Federal Poverty Guidelines (For 2018 Cost Assistance and 2017 Medicaid/CHIP)
Below are the 2017 Federal Poverty Guidelines that went into effect in early 2018 (the ones you use for Medicaid/CHIP in 2017 and for 2018 marketplace cost assistance).
|2017 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA|
|Persons in Family/Household||100% FPL: Minimum to Qualify for ACA Assistance||138% FPL: Medicaid Cap (in States that Expanded)||250% FPL: CSR Subsidies Cap||400% FPL: Premium Tax Credit Cap|
|For families/households with more than 8 persons, add $4,180 for each additional person|
IMPORTANT: See the 2017 POVERTY GUIDELINES FOR ALASKA AND HAWAII from HHS. See the most recent Federal Register notice of the 2017 poverty guidelines, published January 31, 2017.
Everything You Ever Wanted to Know About the Federal Poverty Guidelines
Below is a quick list of everything you need to know about the poverty guidelines and healthcare.
Skip to the next section for past poverty level guidelines, or see our page dedicated to the 2019 Federal Poverty Guidelines.
Here are some important poverty level facts:
- Each year HHS publishes the Federal Poverty Level guidelines in the Federal Register. On this page we have a collection and explanation of the guidelines, but you can always go directly to the source (HHS) to confirm specifics.
- HHS only publishes the 100% poverty guidelines, we should you how to calculate other guidelines below (like we did for you in the poverty level above). This can be helpful for determining assistance for other assistance programs that use the poverty level.
- The guidelines you need for each years tax season can be found on the 8962 form which is published annually by the IRS. That is the form you’ll use to determine premium cost assistance and repayments.
- It is important to understand that different programs and forms will require you to use different year’s poverty level guidelines, for example the 2019 numbers are used for 2019 Medicaid and CHIP starting after they are published, 2020 premium and out-of-pocket cost assistance on plans held in 2020 (purchased during open enrollment 2019 and via special enrollment in 2020), and for taxes that have to reference the 2019 tables filed in any year. Other poverty programs may have other specific rules, so pay attention to detail here. Consider, the 2019 guidelines will be used for taxes filed April 15, 2021 (as those taxes will deal with 2020 tax credits, which will have been based on the 2019 poverty level).
- With the above said, Medicaid and CHIP always use current guidelines. So as soon as the new guidelines are out, Medicaid and CHIP use the new ones.
- The poverty level is based on household income and household size (details in MAGI below; roughly speaking, it means income after deductions but with some income like most types of social security added back in, but the details are a little complex).
- Tax credit eligibility is based on actual income for the year, but since marketplace cost assistance can be taken in advance, many will base their assistance on projected income.
- If you (or your family) project to make between 100% – 400% of the Federal Poverty Level in MAGI (annual Modified Adjusted Gross Income, which is claimed household income after most deductions), you may qualify for premium tax credits on the Health Insurance Marketplace.
- If you (or your family) make less than 138% of the Federal Poverty Level and your state expanded Medicaid, you may qualify for Medicaid or CHIP.
Note: Medicaid eligibility is effectively 138%, not 133%. Also, CHIP eligibility thresholds are often considerably higher for children and parents, usually scaling down as children get older. Medicaid is generally based on monthly income, not annual. Rules differ depending on if your state expanded Medicaid.
- If you (or your family) make under 100% of the Federal Poverty Level (you are below “the poverty line”), and your state didn’t expand Medicaid, you may fall in the Medicaid Gap and have limited coverage options.
- If you (or your family) make between 100% – 250% of the Federal Poverty Level you may qualify for out-of-pocket cost assistance on Silver plans sold through the Marketplace. The closer to 100%, the more it caps your out-of-pocket costs.
- Other assistance programs have unique eligibility guidelines. For instance the Life-line program (the one where you can get a free or low cost “Obama phone” or broadband) uses 135% of the poverty level as a guideline.
- Cost assistance for the Affordable Care Act is based on household income (family income). Household or family income for the purposes of the ACA uses the equation of Modified Adjusted Gross Income (MAGI) of the head of household (and spouse if filing jointly) plus the Adjusted Gross Income (AGI), of anyone claimed as a dependent. If you are filing as single, you only count Modified Adjusted Gross Income.
- Tax credits can be taken in advance, based on of the Federal Poverty Level, and are adjusted on form 8962 at the end of the year.
TIP: Advanced Premium Tax Credits (credits taken upfront to lower premium costs) are based on projected annual MAGI. If you gain or lose income during the year you’ll need to adjust your tax credits by contacting the marketplace. If you take too much upfront you could end up owing money back, if you don’t take enough, you could end up being owed more at the end of the year. This is important to understand for those who gain or lose employment. Meanwhile, Medicaid doesn’t have repayment limits and generally based on monthly income. Learn more about repayments and refunds.
Quick Reference For Assistance Program Thresholds
Each assistance program may use different percentages of the Federal Poverty Level as thresholds. Here is a quick overview of which programs use what.
100% = Baseline Eligibility for Community Service Block Grant (CSBG) funded Programs
125% = Maximum Eligibility for Community Service Block Grant (CSBG) funded Programs
150% = Maximum Eligibility for United Way Rent and Utility Assistance programs, and the Employee Profit Sharing Plan (EPSP) and Emergency Shelter Grant (ESG) programs.
100% – 250% = Eligibility for cost-sharing reduction subsidies on Silver plans bought on the Marketplace. (see 2015 guidelines further down the page).
100% – 400% = Eligibility for Premium tax credits on Health Insurance Marketplace plans (see 2015 guidelines further down the page).
How to Find a Percentage of the Federal Poverty Level (FPL)
As noted above, the 100% Federal Poverty Threshold Guidelines above are a quick and easy way to look at what dollar amount each year’s poverty level is by family size. If you want to see what 400% of the poverty level is, you can multiply The Federal Poverty Level figures by 4. For 300% FPL multiply by 3. For 250% FPL multiply by 2.5. For 138% FPL multiply by 1.38 etc.
TIP: Always round up to the nearest dollar for poverty levels and taxes.
If you are looking for the monthly poverty levels – for determining Medicaid eligibility for instance – divide the annual number by the number of months you are trying to calculate (or see our 6 month and monthly charts below). (i.e., For 2013 100% of the FPL for one person was $11,490. If you divide this number by 12 you get a figure of $957.50 per month)
If you want more details or the want to use a pre-calculated table instead of doing the math yourself, we suggest using additional FPL Guidelines found further down the page. The more detailed Federal Poverty Level Guidelines below will be helpful for calculating assistance amounts for the Premium Tax Credit Form 8962
NOTE: Alaska and Hawaii use different guidelines which are also provided below.
How to Use the Guidelines for Different Assistance Programs
Medicaid and CHIP use the current year’s guidelines, or technically the guidelines that are current at the “time of application” (i.e., Use 2015 guidelines for 2015, use 2016 guidelines when the new ones are released somewhere between January 2016 and February 2016 and are printed in the Federal Register, typically around January 20th).
TIP: If you are applying for Medicaid or CHIP during or around the changeover date, and are close to an eligibility threshold, take extra care of how you are reporting your income. Notice that poverty level dollar amounts increase every year.
For ObamaCare’s subsidies, you should use the guidelines from the year before (ie. use 2014 guidelines for coverage starting in 2015; use 2015 guidelines for coverage starting after January 1st, 2016.).
TIP: If your state expanded Medicaid, and you make between 100% – 138% FPL, you may have to take Medicaid or CHIP. Keep this in mind if your goal is to get a private plan with subsidies rather than state public insurance.
Depending upon what assistance program you are applying for, you may need to look at income for a full 12 month year (like ObamaCare) or, in some cases monthly income, (like Medicaid and CHIP). The guidelines on this page show dollars amounts for 12 months. Either divide any dollar amount in the charts by the number of months you are looking for or see our monthly guidelines below.
Lastly, some assistance programs like the Affordable Care Act (ObamaCare) and Medicaid use Modified Adjusted Gross Income, while others use Adjusted Gross Income, or simply Gross Income. Make sure to understand specifics for any program for which you are applying.
What Do They Mean By “Household Size”?
For most families, household size is 1 (for yourself) plus the number of people that you can claim as dependents on your income tax return. This may include children, parents, or other relatives who qualify as dependents on your tax return. Children of divorced parents are counted as the family of the parent who claims them as a dependent (even if the other parent has to pay for the child’s health insurance). Do not include children who earn enough to support themselves – and thus are no longer eligible as dependents – even if they still live at home or are included in your family’s health insurance plan.
What Does Income Include?
Expected 2014 gross income (before taxes) includes wages, tips, net profit from self-employment, interest, rental income, other investment income, most pensions, social security payments, and alimony. This will be the amount called “Modified Adjusted Gross Income” (MAGI) shown on your tax return: line 4 of Form 1040EZ, line 21 of 1040A, or line 37 of form 1040. If your only income is from a job, it is the number shown in box 1 of your W2 form. Include income of all dependents (for example, a child’s summer earnings or a dependent’s social security) even if they filed a separate tax return.
What are Federal Poverty Thresholds?
The poverty thresholds are the original version of the federal poverty measure. They are updated each year by the Census Bureau. The thresholds are used mainly for statistical purposes — for instance, preparing estimates of the number of Americans in poverty each year. In other words, all official poverty population statistics are calculated using the poverty thresholds — not the guidelines.
You will use the Federal Poverty Level Guidelines to calculate your cost assistance on the Health Insurance Marketplace and for other assistance programs.
What are Federal Poverty Guidelines?
The Federal Poverty Guidelines are a simplification of the poverty thresholds used for administrative purposes — for instance, determining financial eligibility for certain federal programs. They are issued in January of each year in the Federal Register by the Department of Health and Human Services (HHS).
How Do the Federal Poverty Levels Work?
Federal Poverty Guidelines depend on the total number of persons in a household. For health care purposes, the same figures are used in the 48 contiguous states and the District of Columbia, while higher values (reflecting the higher cost of living) are used for Hawaii and Alaska. The 100% column shows the federal poverty guideline “amount” for each family size and the percentage columns that follow represent income level thresholds commonly used to determine health care costs and eligibility for health programs like the Affordable Care Act. See the full list below for all uses for the Federal Poverty Guidelines.
Cost Assistance and The Federal Poverty Guidelines
As a rule of thumb, if your family income is between one and four times the published Federal Poverty Guideline (100% – 400% FPL) for your household size, and you are not eligible for employer or public assisted health care such as Medicaid or Medicare, then you will be able to receive premium subsidies to help you purchase affordable insurance through the Marketplace.
The Premium Tax Credit (PTC) is a “tax credit” you can file for on your tax return if you had a Marketplace plan and met the requirements. You can also take this tax credit in advance as an Advanced Premium Tax Credit (Advanced PTC) and have the tax credit paid in-part or in-whole directly to the insurance provider you choose.
The amount paid in advance reduces the monthly premium you have to pay. If at the end of the year, your income turns out to be more or less than expected, the PTC will be adjusted (or reconciled) up to the repayment limit for your income, and the difference will either be added to or taken from any tax refund due.
Other cost assistance offered on the Marketplace includes Cost Sharing Reduction subsidies to help with out-of-pocket costs (100%-250% FPL on Silver plans only) and Medicaid. Medicaid eligibility levels differ by state; in states that expanded Medicaid, any household with an income of 138% FPL or less qualifies.
Cost assistance is based on projected income for the upcoming year, although last year’s income can be used to help estimate your assistance amounts.
Federal Poverty Level Facts
• If you make less than four times (400%) of the FPL, you may qualify for reduced premiums through the marketplace due to Advanced Premium Tax Credits.
• If your income is below two and a half times (250%) the FPL, you qualify for a policy with reduced deductibles, copayments, and lower out-of-pocket maximum costs due to Cost Sharing Reduction subsidies (Silver plans only).
• If you live in a State that has agreed to expand Medicaid and your household income is up to 138% of the relevant FPL, you probably qualify for Medicaid. In States that don’t expand Medicaid, the threshold is typically between 100% – 133% FPL (but can be as low as 50% FPL), though many other restrictions can affect your eligibility as well.
• For the purposes of the ACA, Federal Poverty Levels are based on your projected Modified Adjusted Gross Income (MAGI) for the upcoming year. For example, if you think you will make $29,175 in 2015 (taxable income after deductions), you will qualify for both Cost Sharing Reduction subsidies and Advanced Premium Tax Credits (PTC) in the marketplace based on the 2014 guidelines.
NOTE: Not all assistance programs that use the FPL guidelines use Modified Adjusted Gross Income (MAGI); some use gross income. This changes how you calculate your income, not the numbers on the FPL guidelines.
• If your income is below the minimum threshold for filing a tax return ($10,150 for an individual or $20,300 for a couple for 2015), or if the lowest cost coverage offered to you would cost more than 8% of MAGI for self-only coverage, then you are exempt from the fee for not having coverage. However, you may still qualify for marketplace cost assistance or Medicaid. Visit HealthCare.Gov to obtain an exemption or cost assistance.
• To avoid confusion, look at 2013 guidelines for 2014 coverage (when doing taxes in 2015) and 2014 guidelines for cost assistance for the upcoming year 2015 (which you’ll file for in 2016).
Each year Obamacare’s cost assistance eligibility levels are based on the Federal Poverty Level Guidelines that are already in place at the start of open enrollment (Nov 15, 2014, for 2015, Nov 1, 2015, for 2016). For 2016, premium subsidies, cost-sharing assistance, and taxes are based on the 2015 Federal Poverty Guidelines. If you are doing your taxes due April 2015 in regards to 2014, use the 2013 guidelines for reference.
How are Federal Poverty Levels Calculated?
To understand what subsidies you are eligible for, you can calculate where you stand on the Federal Poverty Guidelines. To do this, divide your family’s expected MAGI (Modified Adjusted Gross Income) by the 100% federal poverty level dollar amount for your household size, and then to multiply the outcome by 100.
NOTE: if you don’t expect your income to change much, simply base your MAGI on last year’s tax returns. If you are trying to figure your FPL percentage for another assistance type unrelated to the Affordable Care Act, use AGI or GI when appropriate.
EXAMPLE: In 2015, for a family of 4 making $95,400, using the 2014 base 100% FPL level $23,850:
$95,400 ÷ $23,850 = 4
4 x 100 = 400
which is 400% FPL
We strongly suggest using the charts above if this seems confusing. Your cost assistance will be automatically calculated when you apply for the Health Insurance Marketplace. You can also use this Federal Poverty Level Calculator from safetyweb.org.
What Else is the Federal Poverty Level Used For?
According to HHS, Federal Poverty Guidelines are also used for:
- Department of Health and Human Services:
- Community Services Block Grant
- Head Start
- Low-Income Home Energy Assistance Program (LIHEAP)
- PARTS of Medicaid
- Hill-Burton Uncompensated Services Program
- AIDS Drug Assistance Program
- Children’s Health Insurance Program
- Medicare – Prescription Drug Coverage (subsidized portion only)
- Community Health Centers
- Migrant Health Centers
- Family Planning Services
- Health Professions Student Loans — Loans for Disadvantaged Students
- Health Careers Opportunity Program
- Scholarships for Health Professions Students from Disadvantaged Backgrounds
- Job Opportunities for Low-Income Individuals
- Assets for Independence Demonstration Program
- Department of Agriculture:
- Supplemental Nutrition Assistance Program (SNAP) (formerly Food Stamp Program)
- Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
- National School Lunch Program (for free and reduced-price meals only)
- School Breakfast Program (for free and reduced-price meals only)
- Child and Adult Care Food Program (for free and reduced-price meals only)
- Expanded Food and Nutrition Education Program
- Department of Energy:
- Weatherization Assistance for Low-Income Persons
- Department of Labor:
- Job Corps
- National Farmworker Jobs Program
- Senior Community Service Employment Program
- Workforce Investment Act Youth Activities
- Department of the Treasury:
- Low-Income Taxpayer Clinics
- Corporation for National and Community Service:
- Foster Grandparent Program
- Senior Companion Program
- Legal Services Corporation:
- Legal Services for the Poor
NOTE: Not all programs use Modified Adjusted Gross Income (MAGI) to determine assistance. See each program has its own income and other eligibility requirements.
NOTE: Above we covered most of the important details. Below is mostly just a collection of detailed charts from past years.