The 2020 Federal Poverty Guidelines (for 2021 Cost assistance and 2020 Medicaid/CHIP)

Below are the 2020 Federal Poverty Guidelines that went into effect in early 2020 (the ones you use for 2020 Medicaid/CHIP and for 2021 marketplace cost assistance).[1]

These guidelines are the key to all cost assistance under the Affordable Care Act, specifically these guidelines are used for:

  • Medicaid/CHIP between late Jan 2020 – Jan 2021 after the poverty level guidelines are published.
  • 2021 marketplace cost assistance on all marketplace health plans held in 2020 and purchased during open enrollment for 2021 (which runs from Thursday, November 1, 2021, to Saturday, December 15, 2021, and which uses the 2020 levels).
  • For special enrollment in 2021.
  • For ACA taxes for the 2021 calendar year filed in 2022.

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
1 $12,760 $17,609 $31,900 $51,040
2 $17,240 $23,792 $43,100 $68,960
3 $21,720 $29,974 $54,300 $86,880
4 $26,200 $36,156 $65,500 $104,800
5 $30,680 $42,339 $76,700 $122,720
6 $35,160 $48,521 $87,900 $140,640
7 $39,640 $54,704 $99,100 $158,560
8 $44,120 $60,886 $110,300 $176,480
For families/households with more than 8 persons, add $4,480 for each additional person.

NOTE: Alaska and Hawaii use different guidelines (see this link to guidelines as published on HHS.Gov).

FACT: The Federal Register notice for the 2020 Poverty Guidelines was published January 17, 2020.

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 for example $12,490 x 1.38 = $17,236.20. We round up, and 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, $17,609 individual or $36,156 for a family of four in 2020. 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 2021 assistance you’ll use the 2020 poverty levels. Thus, if you make between $12,760 – $51,040 as an individual or $26,200 – $104,800 in 2021, 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.

Citations

  1. notice 2020-00858. Federalregister.gov.