Check Your Coverage Options in Georgia
Enter your household size and income before taxes to see where you land in Georgia.
Estimate using 2026 federal poverty guidelines and Georgia's income limits as of January 2026. If you are pregnant, count the baby you are expecting in your household size. People 65 and older or with disabilities follow different rules. This is not an official determination — only Georgia's Medicaid agency or the marketplace can confirm eligibility.
Coverage gap: Georgia has not expanded Medicaid. Adults earning below $15,960/year (100% FPL) who don't fit traditional categories may have no affordable coverage option. Those above 100% FPL qualify for marketplace subsidies.
Georgia Medicaid Income Limits 2026
The following table shows the key income thresholds for Georgia in 2026:
| Household Size | 100% FPL | 138% FPL | 400% FPL (Subsidy Limit) |
|---|---|---|---|
| 1 | $15,960 | N/A | $63,840 |
| 2 | $21,640 | N/A | $86,560 |
| 3 | $27,320 | N/A | $109,280 |
| 4 | $33,000 | N/A | $132,000 |
| 5 | $38,680 | N/A | $154,720 |
| 6 | $44,360 | N/A | $177,440 |
Because Georgia has not expanded Medicaid, the 138% FPL threshold does not apply for adult eligibility. Adults earning between 0-100% FPL may fall into the coverage gap. Those earning between 100-400% FPL can access marketplace subsidies.
About Georgia Medicaid
Who Qualifies in Georgia
In Georgia, Medicaid, known as Georgia Medicaid, has not been expanded to cover all low-income adults. This means that if you are an adult without children, you likely fall into a "coverage gap" where your income is too high for Medicaid but too low for significant marketplace subsidies. Currently, 2.21 million people in Georgia were covered by Medicaid in 2024, representing 19.8% of the state's population. You may qualify for Georgia Medicaid if you are a child, a pregnant woman, a very low-income parent, a senior, or disabled. For children under one year old, the income limit is at or below 220% of the Federal Poverty Level (FPL). Children aged 1-5 can qualify with household income at or below 149% FPL, and children under 19 can qualify at or below 205% FPL. Pregnant women also qualify with family income at or below 220% FPL. For aged, blind, and disabled individuals, the income limit is generally $994 per month for an individual and $1,491 per month for a couple in 2026. Georgia also has a "Pathways to Coverage" program for non-elderly "able-bodied" adults with incomes up to 100% FPL ($1,330 per month for an individual), but it includes a work requirement of 80 hours of work or other qualifying activities per month.
If You're Near the Income Line
If your income is near the Medicaid cutoff, you might transition to marketplace coverage on HealthCare.gov. For those with incomes above 100% FPL, marketplace subsidies become available, significantly reducing your monthly premium. With a benchmark Silver plan costing around $615 per month in Georgia, these subsidies can make coverage much more affordable. If your income fluctuates, you could shift between Medicaid and marketplace eligibility, so it's important to report any changes to ensure you're in the correct program. Many Georgians lost Medicaid coverage during the "unwinding" period after the public health emergency, and if you were among them, you can reapply at any time if your circumstances change and you believe you now qualify.
What Georgia Medicaid Covers
Georgia Medicaid generally covers a comprehensive range of benefits, including doctor visits, prescription medicines, and inpatient and outpatient hospital services. For those who qualify, cost-sharing is typically very low or non-existent. Georgia also offers several waiver programs for elderly and disabled individuals who need help to live at home or in the community instead of an institution. These include the Community Care Services Program (CCSP) and Service Options Using Resources in a Community Environment (SOURCE), which provide services like personal care, home modifications, and adult day care. There's also the TEFRA/Katie Beckett program for eligible children with disabilities. A unique state initiative is the "Planning for Healthy Babies" program, which expands Medicaid eligibility for family planning services to underinsured and uninsured women aged 18-44. Additionally, a postpartum extension demonstration waiver extends Medicaid coverage for new mothers from 60 days to six months after birth, with a proposal to extend it to 12 months.
Options in the Coverage Gap
If you find yourself in Georgia's coverage gap, meaning your income is too high for Medicaid but too low for substantial marketplace subsidies, you still have options for care. Georgia's uninsured rate is higher than the national average, at 11.7% compared to the U.S. average of 7.4% in 2023. You can seek care at community health centers, which offer services on a sliding-scale fee based on your income. Hospital charity care programs can also provide financial assistance for medical bills. Free clinics, supported by organizations like the Georgia Charitable Care Network, offer low or no-cost medical and mental health care, including prescription assistance, to uninsured Georgians. In 2023, charitable clinics in Georgia served over 267,000 unique patients. It is crucial to remember that if your income increases above 100% FPL, you may become eligible for significant subsidies on HealthCare.gov, so regularly checking your eligibility for marketplace plans is a wise step.
Georgia Medicaid and CHIP Income Limits for Children and Pregnancy
Children and pregnant women qualify for coverage in Georgia at higher incomes than other adults. Children under 19 are covered up to 252% of the federal poverty level, through Medicaid at lower incomes and Georgia's separate CHIP program above that (CHIP may charge a small premium). Pregnancy coverage runs up to 225% FPL. Parents and caretakers of minor children qualify only up to about 100% FPL, mostly through Pathways to Coverage, which requires 80 hours a month of work or other qualifying activities.
| Household | Children 252% FPL |
Pregnant 225% FPL |
Parents 100% FPL |
|---|---|---|---|
| 1 | $40,219 | — | $15,960 |
| 2 | $54,533 | $48,690 | $21,640 |
| 3 | $68,846 | $61,470 | $27,320 |
| 4 | $83,160 | $74,250 | $33,000 |
| 5 | $97,474 | $87,030 | $38,680 |
| 6 | $111,787 | $99,810 | $44,360 |
Annual income limits for 2026, including the standard 5-point income disregard. A pregnant woman counts as at least two people, so the one-person row does not apply. Georgia sets its parent limit for a family of three, so figures for other household sizes are approximate. Limits as of January 2026, from KFF's annual survey of state Medicaid and CHIP eligibility rules.
Marketplace Insurance in Georgia
Georgia residents who do not qualify for Medicaid can purchase private health insurance through the federal marketplace at HealthCare.gov. The average benchmark (second-lowest cost Silver) plan in Georgia costs approximately $615/month for a 40-year-old (2026 average; 2027 rates are published shortly before open enrollment begins November 1).
Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in Georgia might pay for a Silver plan after subsidies under the 2027 premium tax credit rules, based on the $615/month benchmark:
| Income Level | Annual Income | Your Cost | Monthly Subsidy |
|---|---|---|---|
| 150% FPL | $23,940 | ~$86/mo | $529/mo |
| 200% FPL | $31,920 | ~$180/mo | $435/mo |
| 250% FPL | $39,900 | ~$288/mo | $327/mo |
| 300% FPL | $47,880 | ~$408/mo | $207/mo |
| 400% FPL | $63,840 | ~$544/mo | $71/mo |
These estimates are for a 40-year-old individual on a benchmark Silver plan in Georgia. Actual premiums depend on your age, household size, tobacco use, and plan choice. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays. Georgia uses the federal marketplace at HealthCare.gov.
How to Get Coverage in Georgia
Your path depends on your income:
- Income above $15,960/year (100% FPL): You qualify for marketplace subsidies. Apply through HealthCare.gov during open enrollment (Nov 1 – Jan 15) or after a qualifying life event.
- Income below $15,960/year: Check if you qualify for traditional Medicaid (children, pregnant women, disabled). Apply through Georgia Medicaid.
- Children: Georgia covers children under 19 in families up to 252% FPL ($83,160 for a family of 4), regardless of expansion status.
Calculate Your Subsidy in Georgia
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in Georgia.
Frequently Asked Questions
What is the income limit for Medicaid in Georgia?
Georgia has not expanded Medicaid, so there is no standard income limit for adults. Traditional Medicaid covers specific groups (children, pregnant women, disabled, very low-income parents). Income limits for these groups vary. Children are generally covered up to 200-300% FPL through CHIP.
Is Medicaid expanded in Georgia?
No, Georgia has not expanded Medicaid. This creates a coverage gap for adults earning below 100% FPL who do not qualify for traditional Medicaid categories.
How do I get help paying for health insurance in Georgia?
Georgia residents with household income between 100% and 400% FPL ($15,960 to $63,840 for an individual in 2026) qualify for premium tax credits that reduce the cost of marketplace health insurance. Apply through HealthCare.gov.
What is the name of Georgia's Medicaid program?
Georgia's Medicaid program is known as Georgia Medicaid. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and certain other qualifying groups.
How do I keep my health insurance if I lose Medicaid in Georgia?
If your Georgia Medicaid coverage ends due to income changes or redetermination, you qualify for a Special Enrollment Period on the marketplace. This gives you 60 days to sign up for a private plan through HealthCare.gov. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
What are my options if I'm in Georgia's Medicaid coverage gap?
If you're in the coverage gap (earning below $15,960/year but not qualifying for traditional Medicaid), look into community health centers in Georgia that offer sliding-scale fees based on income. Many hospitals have charity care programs for uninsured patients. Free clinics and the 211 helpline can connect you with local resources. If your income changes, reapply — even small income increases could qualify you for marketplace subsidies.
Will Georgia ever expand Medicaid?
Medicaid expansion has been a politically contentious issue in Georgia. The state legislature has not passed expansion legislation, leaving an estimated coverage gap for adults earning below 100% FPL. Advocacy groups continue to push for expansion, and several neighboring states have recently adopted it. Check with Georgia's legislative updates for the latest status.