Step 1
What Counts as Income?
For a marketplace plan, add up the income on the left for everyone in your household. Leave out everything on the right.
Counts
- Wages and tips (after pre-tax deductions)
- Self-employment profit
- Unemployment
- Social Security, including SSDI
- Pensions and traditional IRA or 401(k) withdrawals
- Rental income (after expenses)
- Interest, dividends, and capital gains
- Alimony from a divorce finalized before 2019
Doesn't count
- Child support
- Gifts
- Supplemental Security Income (SSI)
- Veterans' disability payments
- Workers' compensation
- Loans, including student loans
- Qualified Roth IRA withdrawals
- Alimony from a divorce finalized in 2019 or later
Shortcut: for most people, this is close to the adjusted gross income (AGI) on line 11 of your federal tax return. Add back any tax-free Social Security and tax-exempt interest.
Step 2
Do I Qualify for Medicaid?
Find your household size. If your yearly income is at or below the number, you likely qualify for Medicaid instead of a marketplace plan. Oregon calls it the Oregon Health Plan. Washington calls it Apple Health.
At or below the number: you likely qualify for free Medicaid coverage.
Above the number: look at a marketplace plan. You may still get help paying for it.
For adults 19 through 64 who are not on Medicare. Larger household? Add $7,848 per extra person. These are 2026 limits. Medicaid checks monthly income, so a year with uneven pay can count differently.