The BasicsIs it Right for You?What it CoversWhat You PayHow to Sign UpFAQsPitfallsNext Steps

Income-Based NC Medicaid

Try It

    Income-Based NC Medicaid

    Is it Right for You?

    Almost everyone should be able to get health coverage. The question is, which plan is right for you and your family?

    This page looks at whether you might qualify for NC Medicaid based on your family's income. If you do, it is your best choice and you won’t qualify for subsidized individual coverage. You can see if you qualify for income-based NC Medicaid at North Carolina ePASS or HealthCare.gov. Note: On the ePASS website, NC Medicaid is called "Medical Assistance."

    If you don’t qualify for NC Medicaid, consider other options we will introduce, including Medicare and private health insurance.

    Different ways to qualify for NC Medicaid if you have a disability

    If the Social Security Administration (SSA) says you are disabled, you may have additional ways of qualifying for NC Medicaid, depending on your situation. Read DB101’s Disability-Based NC Medicaid article.

    Income-Based NC Medicaid Basic Eligibility Requirements

    To qualify for income-based NC Medicaid, most people must meet several basic requirements:

    • Be under 65 years old
      • You can be 65 or older if you are the parent or caretaker of a child
    • Not be eligible for Medicare
      • You can be on Medicare if you are the parent or caretaker of a child or are pregnant
    • Be a U.S. citizen or meet specific noncitizen requirements, and
    • Have income below certain limits

    Under Age 65

    Income-based NC Medicaid is usually for people under age 65. However, seniors may qualify for disability-based NC Medicaid. If you are 65 years old or older and have low income, talk to your local Department of Social Services (DSS) office about whether you qualify for NC Medicaid.

    Exception: If you are 65 or older and are the parent or caretaker of a child, you may be able to get income-based NC Medicaid.

    If you are under 65, continue reading this article.

    Not Eligible for Medicare

    NC Medicaid’s eligibility rules are different for most people who are eligible for or enrolled in Medicare. If you are eligible for or getting Medicare, read DB101’s Medicare article or contact your local Department of Social Services (DSS) office.

    Exception: If you are enrolled in Medicare and are the parent or caretaker of a child or are pregnant, you may be able to get income-based NC Medicaid.

    If you are not on Medicare, keep reading this article.

    Citizenship or Residency

    You must be a U.S. citizen or meet specific noncitizen requirements to be eligible for NC Medicaid.

    If you are legally in the United States, but do not qualify for NC Medicaid, you may qualify for subsidized private insurance through HealthCare.gov.

    If you are an undocumented immigrant, you may qualify for NC Medicaid coverage for emergencies only. To learn more about this, contact your local Department of Social Services (DSS) office.

    If you are a U.S. citizen or meet the noncitizen requirements for NC Medicaid, continue reading this article.

    Income

    Income-based NC Medicaid is for people with low incomes. These are the two main rules:

    1. If your family’s income is at or below 138% of the Federal Poverty Guidelines (FPG) ($1,800 per month for an individual in 2025, $3,697 for a family of four), you may qualify for income-based NC Medicaid.
    2. Children under 19 may get NC Medicaid for children coverage if their family's income is 216% of FPG or less ($5,787 per month or less for a family of four). Pregnant women may get NC Medicaid if their family's income is 201% of FPG or less. (For the purposes of calculating a pregnant woman’s family income, the unborn baby is counted as a family member.)

    Income-based NC Medicaid counts most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect income-based NC Medicaid eligibility.

    There are no limits to how much money or other resources you can have for income-based NC Medicaid. Other ways to qualify for NC Medicaid, such as disability-based NC Medicaid, do have resource limits.

    Is NC Medicaid’s income limit 133% or 138% of FPG?

    You may see the income limit for income-based NC Medicaid listed as 133% of the Federal Poverty Guidelines (FPG) in some places. However, when NC Medicaid counts your income, they’ll knock 5% of FPG off your income if you make more than 133% of FPG. That's why we show the limit as 138% of FPG, because it more accurately shows how much you could make and still get NC Medicaid.

    If you cannot get NC Medicaid because your income is too high, consider buying an individual plan through HealthCare.gov. See DB101’s article about Buying Health Coverage on HealthCare.gov.

    Health Coverage Income Limits for Your Family

    The bottom line: If you meet the four main requirements described here, NC Medicaid is a great program that you should sign up for. We explain how to sign up later in this article.

    More ways to qualify for NC Medicaid if you have a disability

    If you have a disability, you may qualify for NC Medicaid in more than one way. The good thing is that when you apply for NC Medicaid, the people reviewing your application will automatically figure out which NC Medicaid eligibility rules are right for you.

    Reasons you might qualify for disability-based NC Medicaid instead of income-based NC Medicaid:

    • Your income is higher than the 138% of FPG limit. Disability-based NC Medicaid doesn't count all of your earned income, so you may make more and still qualify. Furthermore, people with disabilities who work and have higher income may qualify through Health Coverage for Workers with Disabilities (HCWD).
    • You also get Medicare. Usually, income-based NC Medicaid isn’t available to most people getting Medicare, but disability-based NC Medicaid is. It may even help pay your monthly Medicare premiums.

    Reasons you might qualify for income-based NC Medicaid, even if you have a disability:

    • Your disability does not meet Social Security’s definition of disability. Disability-based NC Medicaid is only for people who have disabilities meeting this standard.
    • Your resources are greater than disability-based NC Medicaid allows. Disability-based NC Medicaid has a resource limit, meaning that if you have too much money in the bank or in any other type of account, you do not qualify.

    To learn more, read DB101’s articles about disability-based NC Medicaid and Health Coverage for Workers with Disabilities (HCWD), or contact your local Department of Social Services (DSS) office.

    NC Medicaid and Private Health Coverage

    If you qualify for NC Medicaid, you should sign up for it. Here we will look at what signing up for NC Medicaid might mean if you have or want private coverage.

    NC Medicaid and Employer-Sponsored Health Coverage

    If you qualify for NC Medicaid, it will always be your best choice, even if your employer offers health insurance. That’s because NC Medicaid has no monthly premium and the copayments for services are usually much lower than copayments required by employer-sponsored plans. Also, NC Medicaid may cover some services that your employer-sponsored coverage does not pay for.

    However, there are a couple of advantages to having NC Medicaid and employer-sponsored coverage at the same time:

    • Private insurance may cover some benefits that NC Medicaid doesn’t or the other way around.
    • Private coverage may let you choose from more doctors.

    If you are eligible for NC Medicaid and have insurance through an employer, NC Medicaid may help pay your employer-sponsored coverage premiums, if NC Medicaid would save money by doing so. In order to qualify for help paying your premiums, you must have a high-risk illness and not be able to afford your premiums.

    Example

    Nelson is a single father living on his own with his two daughters. He makes $15 an hour repairing shoes and works 30 hours a week, so he makes a total of about $2,000 a month. Because he works 30 hours a week, his employer offers him and his daughters health insurance, but to get it, he would have to pay a $400 premium each month.

    Nelson decides to go to his local Department of Social Services (DSS) office to see if his family would qualify for NC Medicaid, because he doesn’t have enough money to pay the monthly premium for health coverage offered through his job. The case worker looks at his income and explains that he does qualify for NC Medicaid, because his income is less than 138% of FPG for a family of three. Nelson signs up for NC Medicaid and does not sign up for the plan his job offered.

    NC Medicaid and Individual Plans

    If you are eligible for NC Medicaid, then you will not be eligible to get government help to pay for a private insurance plan. That means the private insurance plan would be expensive for you. If you qualify for NC Medicaid, it will always be a better option for you than paying for an individual plan.

    Learn more

    Buying Health Coverage on HealthCare.gov

    You can get private health coverage on HealthCare.gov. The government may help you pay for it.

    Employer-Sponsored Health Coverage

    Your job, your parent's job, or your spouse's job may offer private health coverage as a benefit.