Expansion of Coverage Under the Affordable Care Act (ACA)

Access to quality healthcare for you and your family is influenced by a number of factors that include your insurance status, income, race, gender, age, and where you live. The Affordable Care Act (ACA) attempts to address inequities or special considerations in these areas to make comprehensive and affordable health insurance coverage available to more people.

To accomplish this goal, provisions of the ACA were written to expand coverage to more Americans by doing the following:

  • Increasing the number of people covered by Medicaid
  • Creating a competitive marketplace for comparing and buying coverage
  • Raising the age limit to 26 for adults covered by their parents' insurance plans

Medicaid expansion

Medicaid is a state-administered assistance program that uses federal and state funds to reduce or pay medical bills for eligible low-income people. Eligibility is based on an individual’s or family’s income as a percentage of the Federal Poverty Level (FPL), a benchmark that’s updated every year. Before the passage of the ACA, Medicaid assisted the following eligible, low-income individuals:

  • Pregnant individuals
  • Children under 19
  • People over 65
  • Those who are blind, disabled, or who need nursing home care

In addition to these groups, the ACA increases the number of people eligible for Medicaid by including adults without children and raising the maximum income for eligibility. But not all states have approved this expansion. Find out if your state is expanding coverage. The Supreme Court ruled that each state can decide if it will expand its Medicaid programs.

If you live in a state that’s expanding coverage, Medicaid covers adults under age 65 who make less than 133% of the FPL. ( In 2023, the FPL for an individual was $14,580 and $30,000 for a family of four.) Find out if you might qualify for Medicaid based on your income and family size. But keep in mind the cost of coverage can still vary from state to state based on how the coverage is provided.

If you live in a state that hasn't expanded Medicaid coverage and you’re not already receiving benefits, you may still want to apply in case you qualify in your state under the existing rules. Your state may also opt to expand Medicaid in the future.

If you apply for health insurance at HealthCare.gov, you’ll find out if you qualify for Medicaid. You can also contact your state Medicaid office.

Health insurance marketplace

Another way the ACA makes health insurance available to more people is through federal and state marketplaces, where private insurance companies can compete for your business. The marketplaces allow you to review and compare plans, incentivizing insurance companies to keep premiums low and more competitive with other plans, including group plans.

Some states have their marketplace, while the federal government runs others. Learn more about the health insurance marketplace and how it works. If you aren't already covered by insurance through your employer, Medicare, or Medicaid—for example, you are self-employed or between jobs—the marketplace is intended to help you find affordable, comprehensive coverage that includes preventive care. To visit the health insurance marketplace, go to HealthCare.gov.

Tax credits and subsidies

Some people have too much income to qualify for Medicaid but not enough to manage the premium payments available from plans purchased through the exchange. The ACA provides subsidies and tax credits for this group to help them afford coverage.

You may qualify if your family income is between 100% and 400% of the FPL. These tax credits will lower your total tax bill but can also be used before tax time to reduce your premium payments, copayments, coinsurance, and deductibles.

You may be eligible for sliding scale subsidies if you cannot afford coverage. The Henry J. Kaiser Family Foundation offers a handy tool for calculating your subsidy eligibility based on income level, age, family size, and regional costs.

Coverage for children

Before the passage of the ACA, most health insurance policies covered children on their family's health insurance policies until they turned 18 or 19, or 22 or 23 if the child went on to attend full-time college after high school.

The ACA expanded coverage for these adults, including children, stepchildren, adopted children, and foster children, by allowing them to join or remain on the family policy or group plan until age 26. Your child doesn’t have to be in school, live at home, be single, or qualify as a dependent. In fact, your children may even stay on your policy if they can get health insurance through their employer.

Finding the right coverage for you and your family

Visit HealthCare.gov to learn more about your options for coverage under the ACA and to enroll in plans offered in the health insurance marketplace. If your state has its own website for its health insurance marketplace, the federal website will redirect you to your state website.