Yes, several government programs help low-income individuals and families get affordable healthcare. These run at the federal and state level. Eligibility usually depends on your income compared to the Federal Poverty Level (FPL). Understanding these options matters. Delaying or skipping care because of cost often leads to worse health and bigger bills later. That's exactly the kind of problem a Health-to-Wealth system like WellthCare is built to prevent.
The most well-known program is Medicaid, a joint federal and state effort that offers free or low-cost coverage to millions of low-income adults, kids, pregnant women, older adults, and people with disabilities. Eligibility varies by state, especially since the Affordable Care Act (ACA) let states expand Medicaid to nearly all adults with incomes up to 138% of the FPL. In expansion states, a single adult earning under about $22,000 per year might qualify. In non-expansion states, coverage is often more limited, typically covering parents, children, or those with specific disabilities. Start by applying through your state's Medicaid agency or the Health Insurance Marketplace.
How the Affordable Care Act (ACA) Marketplace Helps Low-Income Individuals
If your income is too high for Medicaid but still low, you may qualify for premium tax credits and cost-sharing reductions through the ACA Marketplace. These subsidies lower your monthly insurance premium and reduce out-of-pocket costs like deductibles and copays. For 2026, individuals earning between 100% and 400% of the FPL (about $15,960 to $63,840 for a single person) can get help. Temporary rules that removed the 400% cap from 2021 through 2025 expired at the end of 2025, so the cap is back in effect. The lower your income, the larger your subsidy. Open enrollment runs from November to January, but special enrollment periods exist if you lose other coverage or have a life change.
What You Get with Marketplace Plans
- Premium tax credits paid directly to your insurer to lower monthly costs
- Cost-sharing reductions on silver-tier plans, which lower deductibles, copays, and out-of-pocket maximums
- Essential health benefits coverage including preventive care, emergency services, prescription drugs, and mental health care
- No annual or lifetime dollar limits on covered services
Children's Health Insurance Program (CHIP)
CHIP covers children in families who earn too much for Medicaid but not enough to afford private insurance. In many states, CHIP covers kids up to 200-300% of the FPL. Benefits typically include routine checkups, immunizations, dental and vision care, hospital visits, and prescriptions. Premiums and copays are low or nonexistent. Pregnant women may also qualify for coverage under some state CHIP programs.
Medicare Savings Programs for Seniors and People with Disabilities
If you're 65 or older or have a disability and are on Medicare but have low income, you may qualify for Medicare Savings Programs (MSPs). These help pay for Medicare Part A and B premiums, deductibles, and copays. There are four main types: QMB, SLMB, QI, and QDWI, each with slightly different income limits and benefits. The Extra Help program assists with prescription drug costs under Medicare Part D, covering premiums and deductibles and capping copays at no more than $5.10 for generic drugs and $12.65 for brand-name drugs in 2026.
How to Apply for These Programs
- Start at Healthcare.gov to check eligibility for Medicaid, Marketplace subsidies, and CHIP
- Contact your state Medicaid office directly; this is often the fastest route for Medicaid and CHIP
- For Medicare savings, call the Social Security Administration or your state's State Health Insurance Assistance Program (SHIP)
- Gather documents: proof of income (pay stubs, tax returns), citizenship or immigration status, and household size
- Reapply annually or whenever your income changes
The Coverage Gap in Non-Expansion States
Ten states have not expanded Medicaid under the ACA. In most of them, adults without dependent children who earn below 100% of the FPL ($15,960 for a single person in 2026) can fall into a coverage gap: they make too much for their state's limited Medicaid program but too little to qualify for premium tax credits, which start at 100% of the FPL. KFF estimates roughly 1.2 million uninsured adults remain in this gap. Georgia and Wisconsin run waiver programs that cover some adults up to 100% of the FPL, which closes the gap for many residents in those two states. If you think you fall in the gap, check with your state's Medicaid agency anyway; rules and waivers change, and some states cover more than their expansion status suggests.
The Connection Between Government Aid and Health-to-Wealth Systems
Government programs like Medicaid, CHIP, and Medicare provide a critical safety net, but they often don't address the underlying incentive gap: they treat sickness rather than reward prevention. This is where innovations like WellthCare's Health-to-Wealth approach complement public systems. WellthCare bridges this gap as a Health-to-Wealth Benefit System that rewards every verified preventive action with earned Store dollars and automatic retirement contributions, at no new employer cost, while working alongside any existing coverage. WellthCare turns preventive actions, like using free preventive care available through many of these programs, into automatic retirement contributions and Store reward dollars while reducing overall healthcare waste. For low-income individuals, combining government coverage with a benefit system that pays you back can transform healthcare from a financial drain into a tool for building long-term financial health.
If your income is low, you likely qualify for some form of government help. The most important step is to apply. Don't assume you make too much or too little; rules vary by state. Use the resources above to find out what you're eligible for, and if your employer offers a WellthCare-style benefit alongside traditional coverage, you may be able to turn even subsidized care into long-term wealth.