If your income is on the lower end, you may qualify for Medicaid rather than — or instead of — a marketplace plan. Understanding the boundary between these two programs is important, because choosing the wrong one (or missing Medicaid eligibility) has real financial consequences.
What Is Medicaid?
Medicaid is a joint federal-state program that provides health coverage to low-income individuals and families. In states that expanded Medicaid under the ACA (which includes New Jersey), adults with incomes up to 138% of the Federal Poverty Level qualify for Medicaid. In 2026, that’s roughly $20,782 for a single person or $42,622 for a family of four.
Medicaid vs. Marketplace: The Key Differences
- Cost: Medicaid is free or very low cost for most enrollees. Marketplace plans require premium payments, even after subsidies.
- Networks: Medicaid networks are often more limited than marketplace plan networks. Access to specialists and certain facilities varies by state and managed care plan.
- Enrollment timing: Medicaid enrollment is open year-round — there’s no open enrollment window. If you qualify, you can enroll any time.
- Income changes: If your income increases above the Medicaid threshold during the year, you lose eligibility and can transition to a marketplace plan with a Special Enrollment Period.
New Jersey Specifics
New Jersey expanded Medicaid under the ACA and operates its marketplace through GetCoveredNJ (GetCovered.NJ.gov). NJ Medicaid (NJ FamilyCare) covers adults, children, pregnant women, and people with disabilities at varying income thresholds.
What If You’re Near the Boundary?
If your income is close to the Medicaid cutoff, a small change in income could shift you from Medicaid to marketplace eligibility. Understanding this boundary — and planning around it — is important for self-employed individuals whose income fluctuates.
Not sure which program you qualify for? Garden State Benefits can help you determine eligibility and find the right path.