Understanding the Federal Poverty Level (FPL) and Its Impact on Health Insurance Eligibility

What is the Federal Poverty Level (FPL)?

The Federal Poverty Level (FPL) is an annual income threshold issued by the Department of Health and Human Services (HHS). This metric helps determine eligibility for various government assistance programs, including Medicaid, the Children’s Health Insurance Program (CHIP), and health insurance savings through the Health Insurance Marketplace.

Each year, the FPL is adjusted to reflect economic changes, impacting who qualifies for specific benefits. The 2024 income guidelines have been updated and are slightly higher than the 2023 levels, offering more families and individuals access to affordable healthcare options.

2024 Federal Poverty Level (FPL) Income Guidelines

Here is the 2024 FPL based on family size:

Federal Poverty Level (FPL) income guidelines for 2023-2024, showing thresholds by family size. For families/households with more than 8 persons, add $5,380 for each additional person.

*Please note that FPL amounts are slightly higher in Alaska and Hawaii.

How is the Federal Poverty Level Used for Health Coverage Eligibility?

The FPL determines eligibility for various health programs and savings. Here’s how it impacts your health insurance options:

1. Income Above 400% FPL: Individuals and families with income above 400% of the FPL may still qualify for premium tax credits to lower the monthly premium of Marketplace plans. This extended eligibility helps make health insurance affordable, even for those with higher income.

2. Income Between 100% and 400% FPL: If your income falls within this range, you qualify for premium tax credits to help reduce your monthly premium. These credits apply to most Marketplace plans, offering substantial savings.

3. Income at or Below 150% FPL: If your income is at or below 150% of the FPL, and you do not qualify for Medicaid or CHIP, you may have access to a Special Enrollment Period. This opportunity allows you to enroll in or change Marketplace coverage outside of the standard enrollment period.

4. Income Below 138% FPL: If your income is below 138% of the FPL and your state has expanded Medicaid, you may be eligible for Medicaid coverage based on income alone. Medicaid expansion allows more low-income individuals and families to receive essential health benefits without the high costs associated with private insurance.

5. Income Below 100% FPL: Individuals with income below 100% of the FPL may not qualify for Marketplace savings or Medicaid based on income, depending on their state. It’s essential to explore other options and assistance programs available in your area.

What is “Income” for FPL Purposes?

For health coverage eligibility, "income" typically refers to Modified Adjusted Gross Income (MAGI). For most people, MAGI is the same as Adjusted Gross Income (AGI) with certain adjustments. This is not a direct number from your tax return, but it's usually similar to your AGI.

Why the Federal Poverty Level Matters for Your Health Coverage

Understanding where your income falls relative to the FPL is crucial for determining what health insurance options are available to you and the level of assistance you might receive. For individuals and families seeking affordable health insurance through the ACA Marketplace or Medicaid, the FPL acts as a guide to understanding what programs you can access.

At Aura Insure, we’re here to help you navigate your options, from Marketplace plans to Medicaid eligibility. If you have questions or need assistance finding a health insurance plan that meets your needs, our team is ready to guide you through every step.

Learn More with Aura Insure

Understanding your eligibility for savings and health benefits can be complex, but you don’t have to navigate it alone. Explore our blog for more information on ACA plans, Medicaid, and other health insurance topics, or contact us directly to get personalized guidance on finding the best coverage for you and your family.