Medicaid Eligibility in Idaho: Income Limits & How to Apply
Medicaid Eligibility in Idaho
Under the ACA's Medicaid expansion, Idaho residents earning up to 138% FPL can enroll in Idaho Medicaid. For a single adult, that's roughly $21,597 annually; for a four-person household, the cutoff is about $44,367 in 2026.
Key threshold: If your income is below $21,597 (individual) or $44,367 (family of 4), you likely qualify for Idaho Medicaid with free or very low-cost coverage. No premiums, no deductibles.
Under Idaho's expanded program, coverage extends to:
- Adults aged 19-64 with income up to 138% FPL
- Children in families with income up to 200-300% FPL (varies by age)
- Pregnant women with income up to 185-200% FPL
- Seniors and people with disabilities who meet income and asset requirements
About Idaho Medicaid
Idaho Medicaid, also known as Idaho Health Plan Coverage, provides essential health insurance to many residents. If you're an adult under 65, you can qualify for Idaho Medicaid if your household income is up to 138% of the Federal Poverty Level (FPL). For children, the income limits are slightly higher: up to 147% FPL for ages 0-5 and up to 138% FPL for ages 6-18. Pregnant women also qualify with incomes up to 138% FPL, though postpartum coverage currently ends 60 days after birth. For a single person, 138% FPL is about $1,835 per month, and for a household of three, it's about $3,142 per month. There are also pathways for seniors and individuals with disabilities. In 2024, approximately 385,000 people were covered by Idaho Medicaid, representing about 19.3% of the state's population, demonstrating it's a significant program supporting many Idahoans.
If your income is close to the Idaho Medicaid cutoff, understanding your options is crucial. Should your income exceed Medicaid limits, you might transition to subsidized coverage through Your Health Idaho, the state's marketplace. With a benchmark Silver plan around $440 per month, which is lower than the national average, subsidies can significantly reduce what you pay. For example, if your income is between 100% and 138% of the FPL, you may have the option to choose between Medicaid or a marketplace subsidy. Keep in mind that changes in your household income can shift your eligibility between Medicaid and marketplace subsidies, so it's important to report any changes. During the recent "Medicaid unwinding," many Idahoans, including nearly 50,000 children, lost coverage, often due to procedural issues. If you lost coverage but believe you still qualify, you can reapply at any time.
Idaho Medicaid offers comprehensive benefits, typically with little to no cost-sharing. This includes annual physicals, doctor visits, hospital care, prescriptions, mental health services, and dental care. For those needing long-term care, Idaho has an Aged and Disabled (A&D) Waiver program that provides services to help people stay in their homes and communities instead of going to a nursing home. This waiver allows you to self-direct some of your care, even hiring friends or relatives (excluding spouses) to provide services. Additionally, Idaho Medicaid covers telehealth services, including real-time video and audio-only consultations, and remote patient monitoring.
When navigating Idaho Medicaid, be aware of potential challenges. During the recent unwinding period, many disenrollments were due to procedural issues, meaning people didn't complete renewal paperwork, not necessarily because they were ineligible. Always keep your contact information updated with the Idaho Department of Health and Welfare. If you receive a renewal form, complete and return it promptly. Idaho is also transitioning from a fee-for-service system to a managed care model, with the shift delayed until January 1, 2030, so future changes in how you receive care may occur. If you lose coverage, you can apply for marketplace plans through Your Health Idaho within 60 days. To ensure continuous coverage, your concrete action step is to respond immediately to any communication from the Idaho Department of Health and Welfare regarding your eligibility.
Idaho Medicaid Income Limits 2026
The following table shows the key income thresholds for Idaho in 2026:
| Household Size | 100% FPL | 138% FPL (Medicaid Limit) | 400% FPL (Subsidy Limit) |
|---|---|---|---|
| 1 | $15,650 | $21,597 | $62,600 |
| 2 | $21,150 | $29,187 | $84,600 |
| 3 | $26,650 | $36,777 | $106,600 |
| 4 | $32,150 | $44,367 | $128,600 |
| 5 | $37,650 | $51,957 | $150,600 |
| 6 | $43,150 | $59,547 | $172,600 |
If your household income falls below the 138% FPL column, you qualify for Idaho Medicaid. If your income is between 138% and 400% FPL, you qualify for ACA marketplace subsidies to help pay for private insurance.
At $440/month for a benchmark Silver plan, Idaho has some of the more affordable marketplace premiums in the country. Residents just above the Medicaid threshold often pay very little out of pocket after subsidies.
Marketplace Insurance in Idaho
Idaho residents who do not qualify for Medicaid can purchase private health insurance through Your Health Idaho. The average benchmark (second-lowest cost Silver) plan in Idaho costs approximately $440/month for a 40-year-old in 2026.
Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in Idaho might pay after subsidies:
| Income Level | Annual Income | Expected Contribution | Estimated Monthly Premium |
|---|---|---|---|
| 150% FPL | $23,475 | 4.01% of income | ~$78/mo |
| 200% FPL | $31,300 | 6.52% of income | ~$170/mo |
| 250% FPL | $39,125 | 8.33% of income | ~$272/mo |
| 300% FPL | $46,950 | 9.83% of income | ~$385/mo |
| 400% FPL | $62,600 | 9.83% of income | ~$513/mo |
These are estimates for an individual. Actual premiums depend on your age, household size, tobacco use, and the specific plan you choose. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays.
Idaho operates its own state-based marketplace, Your Health Idaho, which manages enrollment and plan selection independently from HealthCare.gov. This can mean different plan options and deadlines than the federal marketplace.
Idaho's Medicaid program goes beyond the ACA's minimum requirements. Idaho Medicaid includes comprehensive benefits, and the state's investment in its own marketplace reflects a broader commitment to accessible healthcare coverage.
How to Apply for Idaho Medicaid
- Online application — Start at Your Health Idaho. Your Medicaid eligibility is checked automatically when you enter your income details.
- State Medicaid office — Apply directly through Idaho's Medicaid agency at any time during the year. Unlike marketplace insurance, Medicaid has no enrollment deadline.
- Phone assistance — Call Idaho's Medicaid helpline for guided help completing your application.
- In-person help — Visit your county human services office or a local navigator for face-to-face support.
Have the following ready: recent pay stubs or tax returns, proof that you live in Idaho, Social Security numbers for everyone in your household, and details on any existing health insurance.
Calculate Your Subsidy in Idaho
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in Idaho.
Check Your Eligibility →Frequently Asked Questions
What is the income limit for Medicaid in Idaho?
In 2026, the Medicaid income limit in Idaho is 138% of the federal poverty level: $21,597 per year for an individual, $29,187 for a household of 2, $36,777 for 3, and $44,367 for a family of 4.
Is Medicaid expanded in Idaho?
Yes, Idaho has expanded Medicaid under the ACA. Adults aged 19-64 earning up to 138% of the federal poverty level qualify for Idaho Medicaid.
How do I get help paying for health insurance in Idaho?
Yes. Idaho residents with household income between 100% and 400% FPL ($15,650 to $62,600 for an individual in 2026) qualify for premium tax credits that reduce the cost of marketplace health insurance. Apply through Your Health Idaho.
What is the Idaho Medicaid program called?
Idaho's Medicaid program is known as Idaho Medicaid. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and adults up to 138% FPL.
How do I keep my health insurance if I lose Medicaid in Idaho?
If your Idaho 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 Your Health Idaho. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
Does working disqualify me from Medicaid in Idaho?
Yes. Medicaid eligibility in Idaho is based on your Modified Adjusted Gross Income (MAGI), not your employment status. If your household income is at or below 138% FPL ($21,597 for an individual), you qualify for Idaho Medicaid even if you work full-time. Many Idaho Medicaid enrollees are working adults.
Should I choose Medicaid or a marketplace plan in Idaho?
Medicaid (Idaho Medicaid) provides free or very low-cost coverage with no premiums. Marketplace plans in Idaho average $440/month before subsidies — relatively affordable compared to other states. If you're right at the Medicaid income boundary, subsidized marketplace Silver plans with cost-sharing reductions can offer solid coverage.
Medicaid Eligibility in Nearby States
- Montana Medicaid Eligibility — Expansion state
- Nevada Medicaid Eligibility — Expansion state
- Oregon Medicaid Eligibility — Expansion state
- Utah Medicaid Eligibility — Expansion state