ACA Note: Defining FPL Categories in the Affordable Care Act

August 22, 2011

August 22, 2011: The federal Affordable Care Act (ACA) establishes several income-based eligibility categories for its public coverage and premium subsidy options. These income categories are each defined by specific upper and lower bounds of the federal poverty level (FPL).

But where, precisely, do these boundaries fall? It turns out that each eligibility category starts at the point “greater than” (but not equal to) the lower bound and is capped at the point “less than or equal to” the upper bound.

Here’s the breakdown:

ACA Coverage Type	Range of Federal Poverty Level*	Equivalent Income for Family of Four*
Medicaid	≤ 138% FPL	≤ $30,843
Basic Health Plan (if state opts to create one)	˃ 138% FPL to ≤ 200% FPL	˃ $30,843 to ≤ $44,700
Exchange-Based Premium Subsidies with Basic Health Plan	˃ 200% FPL to ≤ 400% FPL	˃ $44,700 to ≤ $89,400
Exchange-based Premium Subsidies without Basic Health Plan	˃ 138% FPL to ≤ 400% FPL	˃ $30,843 to ≤ $89,400

*Amounts here reflect the 2011 FPL for the continental United States, which is $22,350; in Alaska and Hawaii, the base FPL for a family of four is $27,940 and $25,710, respectively.

For background on why Medicaid is capped at 138 percent FPL rather than 133 percent FPL, click here.