Medicaid Eligibility in Illinois: Income Limits & How to Apply
Medicaid Eligibility in Illinois
Illinois has expanded Medicaid under the Affordable Care Act. This means adults aged 19-64 with household income at or below 138% of the federal poverty level (FPL) qualify for Medical Card / Illinois Medicaid. This is approximately $21,597 per year for an individual or $44,367 per year for a family of four in 2026.
Key threshold: If your income is below $21,597 (individual) or $44,367 (family of 4), you likely qualify for Medical Card / Illinois Medicaid with free or very low-cost coverage. No premiums, no deductibles.
Medicaid expansion in Illinois covers:
- 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 Medical Card / Illinois Medicaid
In Illinois, the Medical Card, also known as Illinois Medicaid, provides vital health coverage to millions. You may qualify if your household income is at or under 138% of the Federal Poverty Level (FPL). For an individual, this means an annual income of about $21,597, and for a family of four, it's around $44,367. However, income limits are higher for certain groups: children under 18 can qualify with household incomes up to 318% FPL (around $102,237 for a family of four), and pregnant women up to 213% FPL (approximately $68,480 for a family of four). In 2024, approximately 3.4 million Illinoisans received healthcare coverage through Medicaid, demonstrating it's a large and active program.
If your income is just above the Medical Card cutoff, you'll likely transition to the HealthCare.gov marketplace, where you can access subsidies to help pay for your plan. These subsidies can significantly reduce your monthly premiums. For example, with a moderate benchmark Silver plan costing around $465 per month, your actual payment could be much lower depending on your income. It's important to remember that your eligibility for either program can change with your income, so if your financial situation shifts, you might move between Medical Card and marketplace coverage. Illinois recently disenrolled almost 700,000 people from Medicaid who no longer qualified after the continuous enrollment provision ended, but if you've lost coverage, you can reapply at any time if you believe you now meet the eligibility requirements.
With the Medical Card, you receive comprehensive health benefits with little to no cost-sharing. This means you generally won't have co-pays for doctor visits, prescriptions, or emergency room use when it's a true emergency. Illinois also offers various Home and Community-Based Services (HCBS) waivers, which can provide crucial support for specific populations, such as seniors at risk of nursing home placement, individuals with disabilities, or those with brain injuries or HIV/AIDS, allowing them to receive care in their homes or communities. These waivers aim to help you maintain independence and avoid institutional care. Additionally, Illinois Medicaid has continued telehealth flexibilities beyond the COVID-19 public health emergency, and as of January 1, 2024, community-based mental health and substance use treatment via telehealth became a permanent benefit, reimbursed at the same rate as in-person care.
Be aware that processing delays can sometimes occur when applying for or renewing your Medical Card, so submitting documentation promptly is key. While there are generally no asset tests for income-based Medicaid, different rules apply for adults who are disabled, blind, or over 65, where asset limits of $17,500 for an individual may apply, excluding your home and one car. If you were among those who lost coverage during the recent redetermination period, don't assume you're permanently ineligible; your circumstances may have changed, or you might now qualify for marketplace subsidies. Your concrete action step is to visit the Illinois Department of Healthcare and Family Services (HFS) website or contact an All Kids Application Agent to review the most current income guidelines and begin your application or reapplication process.
Illinois Medicaid Income Limits 2026
The following table shows the key income thresholds for Illinois 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 Medical Card / Illinois Medicaid. If your income is between 138% and 400% FPL, you qualify for ACA marketplace subsidies to help pay for private insurance.
Illinois's average benchmark premium of $465/month is near the national midpoint. For residents earning between 100-400% FPL, premium tax credits offset most of this cost.
Marketplace Insurance in Illinois
Illinois 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 Illinois costs approximately $465/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 Illinois 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.
Residents of Illinois shop for marketplace insurance through HealthCare.gov, the federal exchange. The application process screens for Medicaid eligibility first, so you'll be directed to Illinois's program if you qualify.
Illinois adopted Medicaid expansion, bringing Medical Card / Illinois Medicaid coverage to low-income adults who previously had no affordable option. The transition between Medicaid and marketplace coverage is handled through HealthCare.gov.
How to Apply for Medical Card / Illinois Medicaid
- Start online at HealthCare.gov — the application automatically screens for Medical Card / Illinois Medicaid eligibility based on your household income.
- Go through the state directly — Illinois's Medicaid office accepts applications year-round with no enrollment window.
- Get phone support — Illinois's Medicaid hotline can walk you through the process and verify eligibility.
- In-person options — Local social services offices and community health navigators can assist with your application.
You will need to provide proof of income (pay stubs, tax returns), proof of Illinois residency, Social Security numbers for household members, and information about any current health coverage.
Calculate Your Subsidy in Illinois
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in Illinois.
Check Your Eligibility →Frequently Asked Questions
How much can I earn and still qualify for Medical Card / Illinois Medicaid?
In 2026, the Medicaid income limit in Illinois 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.
Has Illinois expanded Medicaid under the ACA?
Yes, Illinois has expanded Medicaid under the ACA. Adults aged 19-64 earning up to 138% of the federal poverty level qualify for Medical Card / Illinois Medicaid.
How do I get help paying for health insurance in Illinois?
Yes. Illinois 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 HealthCare.gov.
What is the Illinois Medicaid program called?
Illinois's Medicaid program is known as Medical Card / Illinois Medicaid. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and adults up to 138% FPL.
What should I do if my Medical Card / Illinois Medicaid coverage is ending?
If your Medical Card / Illinois 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.
Am I eligible for Medical Card / Illinois Medicaid if I'm employed?
Yes. Medicaid eligibility in Illinois 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 Medical Card / Illinois Medicaid even if you work full-time. Many Medical Card / Illinois Medicaid enrollees are working adults.
What's the difference between Medicaid and marketplace insurance in Illinois?
Medicaid (Medical Card / Illinois Medicaid) is free or near-free with no premiums or deductibles. Marketplace plans in Illinois average $465/month before subsidies. If you qualify for Medicaid, it's the more affordable option. If your income puts you just above the cutoff, subsidized Silver plans with cost-sharing reductions are the next best thing.
Medicaid Eligibility in Nearby States
- Indiana Medicaid Eligibility — Expansion state
- Iowa Medicaid Eligibility — Expansion state
- Kentucky Medicaid Eligibility — Expansion state
- Missouri Medicaid Eligibility — Expansion state