- US. How much are the IRMAA brackets for a single person in 2025? These are the amounts
- US. What is the 2025 federal poverty level for Medicare benefits? The eligibility standards
Each year, the U.S. Department of Health and Human Services (HHS) updates the Federal Poverty Level (FPL), a critical tool used to determine eligibility for Medicaid and other assistance programs. For 2025, the poverty guidelines have increased slightly to reflect changes in the cost of living.
These updates impact who qualifies for public health insurance programs and how much income individuals and families can earn while still being eligible for benefits.
Medicaid is a state-istered, federally ed program that provides healthcare coverage to low-income individuals, families, children, seniors, and people with disabilities.
Eligibility is based on a combination of factors, but income is the most significant. Each state uses the FPL as a baseline, applying percentage thresholds to determine who qualifies under their specific Medicaid criteria.
For residents of the 48 contiguous states and Washington, D.C., the FPL in 2025 for a single individual is $15,650 annually. For a household of two, the limit is $21,150. A family of three must earn less than $26,650 to be at 100% of the FPL, and for a family of four, the income cap is $32,150. For larger families, the limit increases by $5,500 for each additional household member.
The thresholds are higher in Alaska and Hawaii due to their elevated cost of living. In Alaska, the poverty guideline for a single person is $19,550, while in Hawaii it is $17,990. Each additional person adds $6,880 in Alaska and $6,330 in Hawaii.
How Medicaid expansion and state policies affect eligibility
Under the Affordable Care Act (ACA), states were given the option to expand Medicaid to cover more low-income adults. Many states chose to do so, setting income eligibility at up to 138% of the FPL.
In 2025, this means a single adult earning up to $21,597 could qualify for Medicaid in an expansion state. For a two-person household, that threshold would be $29,187.
However, not all states have adopted Medicaid expansion. In those that have not, eligibility is often more limited. Adults without dependent children, for example, may not qualify for Medicaid at all in non-expansion states, regardless of how low their income is. In such cases, coverage may be restricted to specific groups, such as pregnant women, seniors, or individuals with disabilities.
Some states offer a "Medically Needy" program, which allows individuals to qualify for Medicaid even if their income is technically too high-if they incur significant medical expenses.
Applying for Medicaid typically involves submitting an application through your state's health department or Medicaid portal. Many states allow online applications, and you may also apply by phone, mail, or in person.