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How Health Benefits Work

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    How Health Benefits Work

    Income-Based Medicaid

    Look at Medicaid based on income if:

    • You are less than 65 years old

    • You don’t qualify for SSI or Medicare

    • You are a U.S. citizen or eligible immigrant, and

    • Your household has low to moderate income.

    Is It Right for You?

    Medicaid is government-funded health coverage for people in certain situations. You may qualify if you:

    Answer the questions on this page to see if you might qualify for Medicaid based on having low to moderate income. If so, it’s probably your best health coverage option because it doesn’t have a premium, the copayments for services are generally lower than copayments required by private plans, and Medicaid covers more services than most private plans. Also, if you qualify for Medicaid, you cannot get government help paying for an individual plan on Nevada Health Link.

    Do You Meet the Basic Requirements for Income-Based Medicaid?

    To qualify for Medicaid based on having low to moderate income, you must:

    • Be under 65 years old
    • Not qualify for Medicare
      • You can be on Medicare if you are pregnant.
    • Be a U.S. citizen or meet specific noncitizen requirements

    Note: If you are 65 or older or are eligible for Medicare and are the parent or caretaker of a child, you may still qualify for income-based Medicaid, but the income limit is lower than the limits shown on this page. If you're in this situation, talk to your local Division of Social Services (DSS) office to see how you may qualify.

    If you are under 65, do not qualify for Medicare, and are either a U.S. citizen or a noncitizen who qualifies, income-based Medicaid might cover you.

    Medicaid Rules for Immigrants:

    • Undocumented immigrants do not qualify for full Medicaid coverage, but they may qualify for some coverage if they need emergency medical services.
    • Immigrants who have been lawfully present for five years or longer and some other noncitizens who meet specific noncitizen requirements may qualify for Medicaid or other Nevada health programs.

    Is Your Income Low Enough for Income-Based Medicaid?

    These are the main income rules for getting Medicaid based on having low to moderate income:

    • If your family’s income is at or under 138% of the Federal Poverty Guidelines (FPG) ($1,835 per month or less for a person, $3,795 or less for a family of four), you may qualify.
    • If you are 18 or younger and your family’s income is at or under 205% of FPG ($5,638 per month for a family of four), you may qualify for Nevada Check Up (NCU).
    • If you are pregnant and your family’s income is at or under 205% of FPG ($5,638 per month for a family of four), you may qualify. The unborn baby is counted as a family member.

    This way of qualifying for Medicaid, sometimes called "Medicaid expansion," is based on your Modified Adjusted Gross Income (MAGI), which includes most earned and unearned income. However, some income is not counted, including Supplemental Security Income (SSI) benefits, growth of the investments in an ABLE account, and some contributions to retirement accounts. Learn more about what types of income affect income-based Medicaid eligibility.

    Note: There are no limits to how much you can have in resources for income-based Medicaid and you do not need to have a disability.

    Health Coverage Income Limits for Your Family

    If your income is low enough and you meet all other requirements, you should sign up for Medicaid or Nevada Check Up (NCU).

    More Ways to Qualify for Medicaid if You Have a Disability

    There are other ways to qualify for Medicaid if you have a disability. You might qualify for Medicaid based on having a disability if:

    • You get Supplemental Security Income (SSI) benefits or used to get SSI and now have SSI 1619(b) status. People who get SSI benefits qualify for Medicaid, but need to apply for Medicaid separately.
    • You make more money at work than income-based Medicaid allows. In that case, you could apply for Health Insurance for Work Advancement (HIWA).
    • You also get Medicare. Usually, Medicaid doesn’t cover people getting Medicare, but disability-based Medicaid does.
    • You are 65 years old or older.

    You might qualify for income-based Medicaid, even though you have a disability, if:

    • Your disability does not meet Social Security’s definition of disability. Disability-based Medicaid is only for people who have disabilities meeting this standard and seniors who are 65 or older.
    • You have more resources than are allowed by disability-based Medicaid and do not work.

    Learn more about disability-based Medicaid and HIWA.

    How to Sign Up

    You can apply for Medicaid and Nevada Check Up (NCU):

    Staying on Medicaid

    Usually, once approved for Medicaid, you continue to qualify as long as your situation doesn’t change. If your income, immigration status, residency, or household size changes, let your Division of Social Services (DSS) office as soon as possible. You can do this in person, by phone, or by email. Or, you can update your information online using Access Nevada. If you have income-based Medicaid, you must report any change by the fifth day of the month after the change happened.

    When you report your changes, the county or website tells you whether you continue to get Medicaid or if you have new health coverage options, like individual coverage with subsidies or Health Insurance for Work Advancement (HIWA).

    Learn more

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