Federal Poverty Level (FPL)

The Federal Poverty Level (FPL) is an income threshold updated annually by the U.S. Department of Health and Human Services and used as the reference income for determining eligibility for many federal benefit programs — including Medicaid, ACA marketplace premium subsidies, and CHIP. FPL is expressed both as a dollar amount by household size and as a percentage (a household at "200% of FPL" earns twice the poverty level for their household size).

The 2024 FPL for a single-person household is $15,060; for a family of four it's $31,200. For ACA marketplace subsidies, households up to 400 percent of FPL (temporarily uncapped through 2025) qualify for the Advance Premium Tax Credit, and households from 100 to 250 percent of FPL also qualify for Cost Sharing Reductions on Silver-tier plans. For Medicaid, eligibility varies by state — the ACA expanded Medicaid to 138 percent of FPL in states that adopted expansion, but Texas has not adopted expansion, so Medicaid eligibility for adults in Texas remains extremely restrictive (essentially only pregnant women, custodial parents at very low income, and people with disabilities qualify). This creates the "coverage gap" in Texas and other non-expansion states where households too poor for marketplace subsidies (under 100 percent FPL) and too high-income for Medicaid have no realistic coverage option — the ACA didn't anticipate the Supreme Court's ruling making Medicaid expansion optional. Alaska and Hawaii have separately calculated FPL amounts because of higher cost of living.

The takeaway: when helping someone understand their coverage options, always calculate their household income as a percentage of FPL first — that number determines Medicaid eligibility, APTC eligibility, and CSR eligibility all at once. In Texas specifically, watch the 100-138 percent FPL band carefully because those households often fall into the coverage gap.