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How Health Benefits Work

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    How Health Benefits Work

    Medicaid

    You get Medicaid automatically if:

    • You get SSI benefits or qualify for 1619(b)

    Look at income-based Medicaid if:

    • You don't qualify for SSI or 1619(b)

    • You are less than 65 years old

    • You don’t qualify for Medicare

    • You are a U.S. citizen or eligible immigrant, and

    • Your household has low income.

    Is It Right for You?

    Medicaid is government-funded health coverage for people in certain situations. You may qualify if you:

    Answer the questions on this page to see if you might qualify for income-based Medicaid. If so, it’s probably your best health coverage option because it doesn’t usually have a premium, the copayments for services are generally lower than copayments required by private plans, and Medicaid covers more services than most private plans. Also, if you qualify for Medicaid, you cannot get government help paying for an individual plan on kynect.

    Note: The rules for SSI and Medicaid are different if you are less than 18 years old. Learn about them in DB101’s Benefits for Young People article.

    Do You Qualify for SSI or 1619(b)?

    If you have a disability, low income, and low resources, you may qualify for SSI. If you already get SSI benefits, you automatically get Medicaid coverage and do not need to apply separately.

    If you don’t get SSI benefits yet, you should learn whether you might qualify by reading DB101’s SSI article. At the same time, you should apply for Medicaid separately, because it can take Social Security months to review your SSI application and it’s important for you to have health coverage until then.

    If you used to get SSI benefits, but stopped getting them after you started working, you may qualify automatically for Medicaid through a special rule called 1619(b) as long as your gross income is below $45,921 per year. Learn more about 1619(b) in DB101’s SSI article.

    If you do not get SSI benefits and do not qualify for 1619(b), income-based Medicaid might cover you.

    Do You Meet Income-Based Medicaid’s Basic Requirements?

    To qualify for income-based Medicaid, you must:

    • Be under 65 years old
      • You can be 65 or older if you are the parent or caretaker of a child
    • Not qualify for Medicare
      • You can be on Medicare if you are the parent or caretaker of a child or are pregnant
    • Be a U.S. citizen or meet specific noncitizen requirements

    If you are under 65, do not qualify for Medicare, and are either a U.S. citizen or a noncitizen who qualifies, income-based Medicaid might cover you.

    Medicaid’s rules for immigrants:

    • Undocumented immigrants do not qualify for full Medicaid coverage, but they may qualify for Medicaid coverage for emergency services.
    • Most immigrants who have been lawfully present for less than five years do not qualify for full Medicaid coverage. However, they may qualify for private coverage subsidized by the government.
    • Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements qualify for all of the same programs that U.S. citizens can get.

    Is Your Income Low Enough for Income-Based Medicaid?

    These are the main income rules for income-based Medicaid:

    • If your family’s income is at or under 138% of the Federal Poverty Guidelines (FPG) ($20,783 per year for an individual; $43,056 for a family of four), you may qualify.
    • If you are 18 or younger and your family’s income is at or under 218% of FPG ($68,016 per year for a family of four), you may qualify for Kentucky Children's Health Insurance Program (KCHIP) coverage.
    • If you are pregnant and your family’s income is at or under 195% of FPG ($60,840 per year for a family of four), you may qualify. The unborn baby is counted as a family member.

    Income-based Medicaid counts most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect income-based Medicaid eligibility.

    Note: There are no limits to how much money or other resources you can have for income-based Medicaid.

    Health Coverage Income Limits for Your Family

    If your income is low enough and you meet all other requirements, you should sign up for Medicaid.

    Is income-based Medicaid’s income limit 133% or 138% of FPG?

    You may see the income limit for income-based Medicaid listed as 133% of FPG in some places. However, when Medicaid counts your income, they’ll knock 5% of FPG off your income if you make more than 133% of FPG. That's why we say that you can make up to 138% of FPG, because it more accurately shows how much income you could have and still get Medicaid.

    Medicaid if You Have a Disability and Need a High Level of Care

    If you have a disability, but don't qualify for SSI, 1619(b), or income-based Medicaid, you might still qualify for Medicaid benefits. This situation is most common for people who are elderly or have a disability and need the level of care that a nursing home or other institution offers. In this case, you may qualify for a Medicaid Waiver program, which would let you get the services you need to be able to live in your own home. Learn more about Medicaid Waiver programs.

    How to Sign Up

    You can apply for Medicaid and other benefits, such as SNAP (formerly Food Stamps), and Kentucky Transitional Assistance Program (K-TAP), at the same time:

    Note: A quick online pre-screening process can let you see if you might qualify for Medicaid, Kentucky Children's Health Insurance Program (KCHIP), SNAP, or K-TAP.

    For help with your application, visit or call your local Department for Community Based Services (DCBS) office or contact the Call Center at 1-855-306-8959.

    Staying on Medicaid

    Usually, once you are approved for Medicaid, you will continue to qualify as long as your situation doesn’t change. If your income, immigration status, residency, or household size changes, let your Department for Community Based Services (DCBS) office know. When you report your changes, the county will tell you whether you will continue getting Medicaid or if you have new health coverage options, like individual coverage with subsidies.

    Learn more

    Finding the Right Health Coverage For You

    Try this interactive guide to see your health coverage options.

    Benefits for Young People

    Learn about the most important benefit programs for young people.

    Getting Past the Myths

    There are many myths about people losing their benefits if they work that are just not true.