What Is MAGI Medicaid? 2026 Income Limits and Household Rules

MAGI Medicaid is the income-based eligibility method the Affordable Care Act created for most Medicaid applicants under 65. It uses your Modified Adjusted Gross Income, the same figure that drives your federal tax return, to decide whether you qualify. There is no asset test. In states that expanded Medicaid, a single adult earning roughly $22,000 or less per year in 2026 will generally qualify.

What MAGI Actually Measures

MAGI stands for Modified Adjusted Gross Income. The ACA introduced it as a single, standardized income measure to replace the patchwork of state-by-state Medicaid rules that used to count wages, deductions, and household size differently. Under MAGI, Medicaid borrows the tax code’s basic income formula, so the number that matters is closely related to what you report on your Form 1040.¹

The MAGI method also eliminated asset tests for the groups it covers. Medicaid will not look at your savings, your car, or whether you own a home. The only financial question is whether your household income falls below the threshold for your group.²

Who Qualifies Under MAGI Rules

MAGI-based eligibility applies to four broad groups:

Children under 19. Every state must cover children in families with income up to at least 133 percent of the federal poverty level (FPL), and most states set the cutoff considerably higher.
Pregnant individuals. States must cover pregnant women up to at least 185 percent of FPL if they offer separate CHIP coverage for children, and many states go well above that floor.³
Parents and caretaker relatives. Income limits vary by state but are determined using MAGI.
Adults aged 19 to 64 in expansion states. The ACA gave states the option to extend Medicaid to adults under 65 who are not pregnant and do not have Medicare, with income up to 133 percent of FPL (effectively 138 percent after a built-in income disregard).⁴

Expansion Is Not Nationwide

Roughly 40 states and Washington, D.C., have adopted the ACA’s Medicaid expansion for adults. About ten states have not. In non-expansion states, childless adults generally cannot qualify for Medicaid regardless of how low their income is. If you live in one of those states and earn too little for marketplace subsidies, you may fall into what is often called the coverage gap. Your state Medicaid agency’s website or HealthCare.gov will tell you where your state stands.

Immigration Status

U.S. citizens and most lawful permanent residents can qualify for MAGI Medicaid if they meet the income requirements. A federal rule imposes a five-year waiting period on many qualified noncitizens, running from the date you receive your qualifying immigration status rather than when you first entered the country.⁵ Some groups are exempt, including certain long-term green card holders. States also have the option to cover lawfully present children and pregnant women during the five-year wait, and many have taken it.

Who Does Not Use MAGI Rules

Certain groups qualify for Medicaid through a different, older set of rules that still count assets alongside income. MAGI does not apply to you if you are:

65 or older
Applying based on a disability (including SSI recipients)
Seeking coverage in a long-term care facility
Applying through a medically needy pathway

For these groups, the state will typically examine bank accounts, property, and other resources in addition to income. Spousal asset protections and transfer-of-asset restrictions often apply.⁶ If you are 65 or older or applying based on disability, the income-only approach described here does not govern your case.

2026 Income Limits

Income limits are pegged to the federal poverty level, which updates every year. For adults in expansion states, the effective threshold is 138 percent of FPL. The statutory cutoff is 133 percent, but a built-in 5-percent income disregard raises the effective limit to 138 percent for every MAGI group.⁷

At 138 percent of FPL for the 48 contiguous states (Alaska and Hawaii have higher limits), the 2026 numbers are:⁸

1 person: $22,025 per year ($1,835 per month)
2 people: $29,863 per year ($2,489 per month)
3 people: $37,702 per year ($3,142 per month)
4 people: $45,540 per year ($3,795 per month)

Children and pregnant women often qualify at higher income levels because federal law and state choices push those thresholds above 138 percent of FPL. Many states cover children through Medicaid or CHIP at incomes up to 200 to 400 percent of FPL, and pregnant women are covered up to at least 185 percent of FPL in most states.³ Check your state’s Medicaid website for the exact limits that apply to your household.

How Your Income Is Calculated

Your MAGI starts with your adjusted gross income, the number on line 11 of IRS Form 1040. For most people, MAGI and AGI are identical or very close.¹ AGI already reflects most of what people earn: wages, salary, tips, self-employment income, unemployment compensation, taxable Social Security benefits, dividends, capital gains, and rental income.

Three items get added back on top of AGI to reach MAGI:⁹

Untaxed foreign earned income
Non-taxable Social Security benefits
Tax-exempt interest, such as municipal bond interest

Supplemental Security Income (SSI) is not counted in MAGI at all.¹

What Lowers Your MAGI

Because MAGI builds on AGI, anything that reduces your AGI also reduces your MAGI. Pre-tax contributions to a 401(k) or 403(b), contributions to a health savings account or flexible spending account, the student loan interest deduction, deductible IRA contributions, and the deduction for half of your self-employment tax all shrink the income Medicaid counts.

Child Support and Alimony

Child support you receive is never counted as income under MAGI. Alimony is more complicated. If your divorce or separation agreement was finalized after December 31, 2018, alimony you receive is not counted. If the agreement was finalized on or before that date and has not been modified since, alimony still counts as income for MAGI purposes.¹⁰

Household Size Rules

Your income limit depends on your household size, and MAGI uses tax-filing relationships to define who is in your household. Your Medicaid household is not necessarily everyone who lives under your roof.

If you file a tax return (or plan to), your household includes you, your spouse if filing jointly, and anyone you claim as a tax dependent. If someone else claims you as a dependent, your household is generally the same as the tax filer who claims you.¹¹

If you do not file taxes and no one claims you as a dependent, your household includes you, your spouse (if you live together), and your children under 19 who live with you. For a child, the household also includes their parents and siblings living in the home.¹¹

Two details are worth flagging. Children under 19 who are claimed as dependents by a non-custodial parent, or by someone other than a spouse or parent, have their household determined using the non-filer rules instead. And a pregnant woman counts as herself plus the number of children she expects to deliver, which increases the household size and raises the income limit.⁷

Applying and What Comes Next

You can apply online through HealthCare.gov or your state’s Medicaid website, by phone, in person at a local Medicaid office, or by mail. Have your recent pay stubs or tax return, Social Security numbers for everyone in the household, proof of address, and citizenship or immigration documents ready. The state will verify most information electronically and may follow up if it needs more.

Federal rules give states up to 45 days to process a MAGI Medicaid application. Disability-based applications get up to 90 days.¹² Once approved, coverage is effective on the date of your application or the first day of the month you applied, depending on the state. Medicaid can also cover medical bills you incurred up to three months before you applied, as long as you would have been eligible during those months and the services are ones Medicaid covers.¹³ Ask about retroactive coverage when you apply if you have unpaid bills.

Every 12 months, your state will review your eligibility. It must first try to renew you automatically using data it already has. If it cannot, it will mail you a pre-filled renewal form with at least 30 days to respond.¹⁴ Ignoring that envelope is one of the most common reasons people lose coverage while still qualifying.

If you are denied, the state must send you a written notice explaining why and telling you how to appeal. You have the right to request a fair hearing, typically within 30 to 90 days of the denial notice, and if you win, benefits are applied retroactively to your original application date.¹⁵ If the denial was based on income, check the MAGI calculation for items that should not have been counted, such as child support or SSI.

1
HealthCare.gov. Modified Adjusted Gross Income (MAGI) – Glossary
2
Medicaid.gov. Implementation Guide: Medicaid State Plan Eligibility MAGI-based Methodologies
3
Medicaid. CHIP Eligibility and Enrollment
4
MACPAC. Eligibility
5
Centers for Medicare & Medicaid Services. Immigrant Eligibility for Marketplace and Medicaid and CHIP Coverage
6
Medicaid. Streamlined Eligibility and Enrollment for Non-MAGI Populations
7
eCFR. 42 CFR 435.603 – Application of Modified Adjusted Gross Income (MAGI)
8
U.S. Department of Health and Human Services, ASPE. 2026 Poverty Guidelines: 48 Contiguous States
9
Internal Revenue Service. Modified Adjusted Gross Income
10
Centers for Medicare & Medicaid Services. Changes to Modified Adjusted Gross Income (MAGI)-based Income Methodologies
11
CMS. 5 Common Questions for Reviewing Household Composition: PERM Eligibility Reviews – MAGI
12
Centers for Medicare & Medicaid Services. Medicaid and CHIP Determinations at Application
13
Medicaid. Eligibility Policy
14
Medicaid.gov. Medicaid and CHIP Renewals and Redeterminations
15
Medicaid.gov. Understanding Medicaid Fair Hearings