Keep Factually independent
Whether you agree or disagree with our analysis, these conversations matter for democracy. We don't take money from political groups - even a $5 donation helps us keep it that way.
My husband and i are not insured because we make too much money for florida medicaid and too little for obamacare, what is the government doing for us
Executive Summary
You and your husband likely fall into Florida’s well-documented “coverage gap”: you earn too much for Medicaid but may not qualify for Affordable Care Act (ACA) subsidy rules depending on exact income and whether enhanced subsidies persist. Federal and state actions differ: the federal marketplace can provide premium tax credits for many in the 100–400% FPL band, but Florida’s non-expansion of Medicaid and the uncertain future of enhanced subsidies leave significant gaps and short-term fixes [1] [2] [3].
1. Why you’re being squeezed — the coverage gap explained with numbers that matter
Florida sets Medicaid income and asset limits that exclude many working families, creating a clear income band where neither program covers you. State guidance documents list monthly Medicaid eligibility ceilings — for example cited limits of roughly $2,742 for individuals and $5,484 for married couples as a 2024 benchmark — and legal workarounds like Qualified Income Trusts are used in narrow long‑term care contexts, but these do not address broader marketplace eligibility [1] [4]. Advocates estimate this state policy leaves hundreds of thousands exposed; one advocacy analysis highlights parents of three with incomes between $6,936 and $23,030 annually being ineligible for Medicaid, demonstrating the practical scale of the gap [3]. This mismatch is structural: Medicaid is state‑administered with strict limits in Florida, while ACA subsidies are federally tethered to income bands that do not always align with state eligibility decisions [5] [3].
2. What the federal government is doing — subsidies, but with limits and timelines
The federal marketplace provides premium tax credits and cost-sharing reductions for many households whose incomes fall between defined percentages of the federal poverty level; analysis notes eligibility between 100% and 400% FPL and points to calculators and open enrollment timelines to estimate assistance [2] [6]. However, analysts warn that the temporary enhancement of subsidies could expire, restoring a stricter 400% cliff and raising premiums for those who currently benefit; models show many Floridians on ACA plans could face steep increases if enhanced federal subsidies are not extended [6] [7]. The federal program therefore offers relief for many but depends on legislative decisions and annual enrollment mechanics, creating uncertainty for households whose incomes hover near thresholds [6].
3. What Florida state policy adds — no Medicaid expansion and local pressures
Florida’s refusal to expand Medicaid under the ACA is a key driver of the coverage gap. Multiple analyses emphasize that because Florida has not adopted expansion, the optional adult eligibility group that would have covered many low‑income adults is not available, leaving a policy-created hole for those who earn too much for traditional Medicaid but too little to be comfortably insured in the ACA marketplace [3] [8]. Advocacy groups like Florida Voices for Health are pressing the state legislature to close this gap, arguing the status quo leaves nearly half a million lower‑income and disabled Floridians exposed [3]. State political choices thus directly shape whether your income qualifies you for public coverage or not.
4. Short-term fixes and market workarounds — limited and imperfect
Where neither Medicaid nor ACA subsidies fully help, advisers point to short-term health plans and hospital- or employer-offered alternatives as stopgaps; these plans often exclude pre-existing conditions and comprehensive benefits like maternity care, and enrollment may require medical questionnaires [9]. Some hospitals and health systems have explored offering plans on the ACA marketplace to stabilize costs for local populations, but these are piecemeal solutions unlikely to match comprehensive coverage or systemic policy reform [7] [9]. Legal financial strategies exist for specific Medicaid categories (Qualified Income Trusts, spend‑down), but they apply narrowly—mainly for long‑term care—rather than serving working families seeking routine coverage [1].
5. What you can do now — practical steps and realistic expectations
Begin by calculating your exact household income against federal poverty levels and the 100–400% bands to see if you qualify for ACA subsidies this year; marketplace calculators and brokers can estimate subsidies and enrollment windows [6] [2]. If your income falls under expanded subsidy thresholds today, enrolling during open or special enrollment can materially reduce premiums; if not, expect to evaluate short‑term plans or employer options while monitoring federal policy decisions on extending enhanced subsidies and Florida legislative activity on Medicaid expansion [2] [3] [9]. Engage a licensed broker or navigator to model scenarios and flag any state programs or hospital plans that might offer targeted relief, recognizing these are temporary or limited compared with comprehensive Medicaid coverage [8] [9].