Paul Sanchez
In Illinois, Medicaid is a health care program that provides financial assistance to low-income individuals of all ages, including non-elderly adults, children, pregnant women, and people with disabilities. While Medicaid does not have a fixed income limit, eligibility is generally determined by income levels relative to the federal poverty level (FPL) and varies based on factors such as age, marital status, and household size. As of 2025, adults with income up to 138% of the FPL are eligible, while children and pregnant women have higher income limits, with specific thresholds depending on factors like family size. Additionally, Illinois offers multiple pathways to qualify for Medicaid, including the Medically Needy Pathway for seniors with income above the Medicaid limit who spend a significant portion of their income on medical expenses.
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What You'll Learn
Income requirements for Medicaid eligibility
To be eligible for Medicaid in Illinois, applicants must meet specific income requirements. The income limits for Medicaid eligibility in Illinois vary depending on the applicant's household size and other factors.
For individuals applying for Medicaid in Illinois, the income limit is generally $1,366 per month or $16,392 per year. For a couple, the income limit is $1,845 per month or $22,140 per year. These income limits are based on the federal poverty level (FPL) guidelines and are typically updated annually.
In addition to the income limits, applicants must also have countable assets of $25,000 or less. Countable assets include bank accounts, savings accounts, motor vehicles, property, stocks, and bonds. However, the value of the applicant's primary home and one motor vehicle is usually exempt from this calculation.
It's important to note that certain types of income may not be counted towards the Medicaid income limits. For example, Supplemental Security Income (SSI) benefits and some contributions to retirement accounts are typically excluded. Additionally, deductions from earned income for lunches, childcare, transportation, uniforms, and special tools may be allowed if the applicant provides proper proof.
For those who do not qualify for Medicaid due to their income exceeding the limits, other options are available. The Illinois Health Insurance Marketplace, also known as the Marketplace, is an online platform where individuals can compare health insurance plans and receive financial assistance from the government to help pay for insurance costs. Alternatively, individuals can explore purchasing an individual health plan through Get Covered Illinois/HealthCare.gov, where they may be eligible for government subsidies to help with the cost of coverage.
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Income rules for Medicare
Illinois has expanded Medicaid to cover more adults, and the public can apply through the Application for Benefits Eligibility (ABE). Illinois residents between 19 and 64 years of age, who are U.S. citizens or have legal status, and who have a monthly income below a certain threshold, are eligible for Medicaid. Specifically, the income limit is $1,366 for an individual and $1,845 for a couple.
Illinois also offers a spend-down program for seniors with income over the Medicaid limit. This program allows individuals to become income-eligible for Medicaid services by spending most of their income on medical expenses. Effective April 2025–March 2026, the medically needy income limit (MNIL) is $1,304.17 per month for an individual and $1,762.50 per month for a couple.
Illinois has a Medicare Savings Program (MSP) to help beneficiaries struggling to afford the cost of coverage. The Qualified Medicare Beneficiary (QMB) program has an income limit of $1,240 a month for singles and $1,668 a month for married couples. The Specified Low-Income Medicare Beneficiary (SLMB) program has an income limit of $1,483 a month for singles and $1,997 a month for married couples. The Qualified Individuals (QI) program has an income limit of $1,665 a month for singles and $2,244 a month for married couples.
Additionally, Illinois has a program called Aid to the Aged, Blind, and Disabled (AABD), with an income limit of $1,133 a month for singles and $1,526 a month for married couples. Medicare beneficiaries with Medicaid, an MSP, or Supplemental Security Income (SSI) can receive Extra Help to lower their Medicare Part D prescription drug costs. The income limit for this program is $1,843 a month for singles and $2,485 a month for couples.
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Income and assets for health insurance
Income and assets are essential factors in determining eligibility for health insurance in Illinois. The state offers various programs and options to ensure that individuals and families have access to affordable healthcare coverage.
The Affordable Care Act (ACA) and IL Public Act 98-104 have expanded Medicaid eligibility in Illinois, making it more accessible to low-income individuals and families. To qualify for Medicaid, applicants must meet specific income requirements. For instance, individuals with a monthly income of less than $1,366 and couples with a monthly income of less than $1,845 are eligible for Medicaid under the "ACA Adult" category. Additionally, families with an annual income at or below 138% of the Federal Poverty Guidelines (FPG) ($21,597 for an individual and $44,367 for a family of four) may also qualify for Medicaid.
For those who do not qualify for Medicaid, the Illinois Health Insurance Marketplace, also known as the Marketplace, offers an online platform to compare health insurance plans and receive financial assistance from the government to help pay for insurance costs. The Marketplace allows individuals and families to shop for plans that fit their income levels and provides an opportunity to obtain coverage outside of the standard open enrollment period through Special Enrollment Periods.
When applying for health insurance, applicants must provide proof of their income and assets. This includes information about bank accounts, savings accounts, motor vehicles, property, stocks, and bonds. Deductions from earned income for expenses such as lunches, childcare, transportation, uniforms, and special tools may be allowed if the applicant provides valid proof. Additionally, certain types of income, such as Supplemental Security Income (SSI) benefits and some retirement contributions, are not counted towards the income limit for Medicaid qualification.
It is important to note that income is not the sole factor in determining eligibility for health insurance in Illinois. Other factors, such as age, citizenship or legal status, disability status, and family size, also come into play. Applicants must meet the eligibility criteria set by the respective health insurance programs, such as Medicaid, Medicare, or individual coverage plans, to obtain the coverage they need.
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Income and citizenship
To qualify for Medicaid in Illinois, applicants must meet specific income and citizenship requirements. Firstly, concerning income, applicants must have a countable income equal to or less than 350% of the Federal Poverty Level (FPL) for their family size. This includes income from various sources, such as employment wages, alimony payments, pension payments, Social Security Disability Income, and stock dividends. For context, in 2025, adults with income up to 138% of the FPL were eligible for Medicaid. Children aged 0-18 with family income levels up to 142% of the FPL and pregnant women with family income up to 208% of the FPL also qualified for Medicaid.
Additionally, applicants for Medicaid in Illinois must be residents of the state, and there is no minimum length of time required for residency. In terms of citizenship, applicants must be citizens of the United States or immigrants legally admitted for permanent residence. However, immigrants admitted after August 21, 1996, are ineligible for the first five years following their entry into the country.
It is important to note that Medicaid applicants in Illinois must provide proof of their income and deductions, and they may be required to pay monthly premiums before receiving their medical card. The application process can be complex, and incorrect submissions may result in delays or denials of benefits. Therefore, applicants should ensure they meet all eligibility requirements and carefully follow the application instructions.
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Income and age
Medicaid:
Medicaid is a government-funded health program designed for individuals and families with low incomes. In Illinois, residents between the ages of 19 and 64 who are U.S. citizens or have legal status and have a monthly income below a certain threshold are eligible for Medicaid. Specifically, an individual with a monthly income of less than $1,366 or a couple with a combined monthly income of less than $1,845 can qualify for Medicaid through the "ACA Adult" category. Additionally, individuals aged 65 or older may be eligible for Aid to the Aged, Blind, and Disabled (AABD) Medicaid, which caters to those with disabilities, low resources, and specific income requirements.
Federal Health Insurance Marketplace:
The Federal Health Insurance Marketplace, also known as the Marketplace, is an online platform where uninsured Illinois residents who do not qualify for Medicaid can compare health insurance plans and receive financial assistance from the government to help pay for insurance costs. This platform enables individuals and families to find more affordable health coverage options. The income threshold for receiving financial assistance through the Marketplace is based on a percentage of the Federal Poverty Level (FPL) for the family size. Applicants must provide proof of their income and may also be required to disclose information about their assets, such as bank accounts, vehicles, and property.
Other Considerations:
It is important to note that income thresholds and eligibility criteria may vary depending on specific circumstances, such as disabilities or special circumstances like pregnancy or caring for dependent children. Additionally, individuals seeking medical insurance in Illinois must meet other requirements, such as residency, citizenship or legal immigrant status, and age eligibility (generally between 16 and 65 years old). Furthermore, applicants may need to provide information about other existing health insurance coverage and disclose details about responsible relatives, especially if they are married but not living with their spouse or if they are a minor.
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Frequently asked questions
Adults with an income up to 138% of the federal poverty level are eligible for Medicaid. Children who live in households with an income of up to 318% of the federal poverty level are eligible, and women who have recently given birth with incomes up to 213% of the federal poverty level are eligible for up to 12 months after giving birth.
Short-term health insurance plans are available in Illinois, but the rules vary from state to state. Some insurance companies will automatically disqualify you if you have a coverage gap.
Medical programs available in Illinois include the State Children's Health Insurance Program (SCHIP), Veterans Care, and the State Hemophilia Program.
Children are eligible for SCHIP if their household income is up to 318% of the federal poverty level.
The State Hemophilia Program is available to any non-Medicaid eligible resident of Illinois with a bleeding or clotting disorder. Participation fees are determined by the individual’s family income and family size.
