What Is the Coverage Gap?
The coverage gap affects adults in states that have not expanded Medicaid. In these states, people earning below 100% of the Federal Poverty Level (~$15,060/year for an individual) don't qualify for Medicaid (which has strict eligibility rules for non-expansion states) AND don't qualify for ACA marketplace subsidies (which start at 100% FPL). They fall into a gap with no affordable coverage option.
States That Have NOT Expanded Medicaid (2026)
- Texas (5 million uninsured)
- Florida (2.7 million uninsured)
- Georgia (1.4 million uninsured)
- South Carolina
- Mississippi, Alabama, Tennessee, Wyoming, Kansas, Wisconsin (partial)
Options If You're in the Coverage Gap
- Short-term health insurance: $50-$200/month, enroll any time, but limited coverage and no pre-existing condition protections
- Fixed indemnity plans: Pay fixed amounts per visit, no coverage cap
- Community health centers: Federally qualified health centers charge on a sliding scale based on income
- Free clinics: Limited services but no cost
If your income increases above 100% FPL (~$15,060), you become eligible for marketplace subsidies and can enroll during a Special Enrollment Period triggered by the income change. This is true even outside of Open Enrollment.
Check your state's status. States periodically expand Medicaid. North Carolina expanded in 2024. Others may follow. If your state expands, you may qualify for free coverage through Medicaid.
Related Terms
- Subsidy (Premium Tax Credit)
- Special Enrollment Period (SEP)
- Pre-Existing Condition
- Open Enrollment Period
Last updated: March 30, 2026.
