Virginia Medicaid income limits help people get free or low cost health insurance. The income limits based on your family size, age, pregnancy, disability, and other factors. Most adults ages 19 to 64 can qualify through Medicaid expansion if their income is within the allowed limit.
Learning these rules can help you know if you qualify for coverage.
What Is Virginia Medicaid income limits?
Virginia Medicaid is a health insurance program funded by the state and federal government. It is managed by the Virginia Department of Medical Assistance Services (DMAS).
Medicaid can help pay for:
- Doctor visits
- Hospital care
- Emergency services
- Prescription medicines
- Mental health care
- Preventive care
- Pregnancy care
- Long-term care
People across Virginia, including Richmond, Virginia Beach, Norfolk, Fairfax, Arlington, Roanoke, and other cities, can apply.
Who Qualifies for Medicaid in Virginia?
Different groups may qualify for Medicaid.
Adults Ages 19 to 64
Low-income adults may qualify through Medicaid expansion.
Children
Children can get Medicaid or FAMIS coverage.
Pregnant Women
Pregnant women may qualify for special Medicaid benefits.
Seniors
People age 65 and older may qualify under ABD Medicaid.
Individuals With Disabilities
People with disabilities may qualify through special programs.
People Needing Long Term Care
Virginia also offers long-term care Medicaid programs.
Virginia Medicaid Income Limits for Adults
Income limits are based on household size and the Federal Poverty Level.
Monthly and Annual Income Limits
| Household Size | Monthly Income | Annual Income |
|---|---|---|
| 1 | $1,836 | $22,025 |
| 2 | $2,489 | $29,864 |
| 3 | $3,143 | $37,702 |
| 4 | $3,795 | $45,540 |
| 5 | $4,449 | $53,378 |
| 6 | $5,101 | $61,217 |
Larger families usually have higher income limits.
How to Determine Whether You Qualify
You can check your eligibility by following these steps.
Step 1: Determine Household Size
Include:
- Yourself
- Your spouse
- Your dependents
Step 2: Calculate Monthly Income
Income may include:
- Wages
- Salary
- Self-employment income
- Unemployment benefits
- Social Security benefits
- Pension income
Step 3: Identify Your Category
Different rules apply to:
- Adults
- Children
- Pregnant women
- Seniors
- Disabled adults
Step 4: Compare Your Income With Virginia Guidelines
Check if your income is below the limit.
Step 5: Apply Through Cover Virginia
You can apply online, by phone, or in person.
Virginia Medicaid Expansion
Virginia expanded Medicaid under the Affordable Care Act.
Because of this, more people can qualify, including:
- Adults without children
- Working adults
- Self-employed people
- Part-time workers
- People who recently lost their jobs
This gives more Virginians access to affordable health coverage.
Medicaid for Children and Families
Children often have higher income limits than adults.
Programs include:
Medicaid for Children
Benefits may include:
- Checkups
- Vaccines
- Vision care
- Dental care
- Hospital services
FAMIS
FAMIS stands for Family Access to Medical Insurance Security.
It helps families who make too much for Medicaid but still need affordable health insurance.
Medicaid Coverage for Pregnant Women
Pregnant women may qualify under different income rules.
Benefits include:
- Prenatal care
- Doctor visits
- Ultrasounds
- Hospital care
- Labor and delivery
- Postpartum care
It is best to apply as early as possible.
Seniors and Disabled Adults
People age 65 or older and individuals with disabilities may qualify through ABD Medicaid.
These programs have different income and asset rules.
Typical Resource Limits
| Category | Asset Limit |
|---|---|
| Individual | $2,000 |
| Couple | $3,000 |
Some assets are not counted, such as:
- One vehicle
- Personal items
- Household goods
- Primary home
Long-term care Medicaid may have extra requirements.
What Income Counts for Medicaid?
Virginia uses Modified Adjusted Gross Income (MAGI) for many programs.
Income that may count includes:
- Job income
- Self-employment income
- Social Security benefits
- Pension payments
- Rental income
- Unemployment benefits
Example
A family of three earning $3,000 each month may qualify because their income is below the limit for three people.
Common Situations
I Lost My Job
Lower income may help you qualify for Medicaid.
I Am Self-Employed
Self-employment income can still count.
I Receive Social Security
Some Social Security benefits are counted.
I Am a Student
Students with low income may qualify.
I Make Too Much for Medicaid
You may still get help through Marketplace insurance.
Medicaid vs Marketplace Insurance
| Feature | Medicaid | Marketplace Plans |
|---|---|---|
| Premiums | Usually $0 | Varies |
| Deductibles | Low | Higher |
| Enrollment | Year-round | Open enrollment periods |
| Eligibility | Income-based | Subsidies available |
| Out-of-pocket Costs | Lower | Higher |
Marketplace plans may be a good option if your income is above the Medicaid limit.
Common Mistakes to Avoid
Many people make simple mistakes when applying.
Using Net Income Instead of Gross Income
Medicaid usually looks at gross income.
Reporting the Wrong Household Size
Household size affects your eligibility.
Ignoring Special Programs
Children and pregnant women may qualify under different rules.
Forgetting to Report Income Changes
Always report changes in income.
Missing Renewal Deadlines
Renew on time to keep your coverage.
How to Apply for Virginia Medicaid
There are several ways to apply.
Online
Apply through Cover Virginia.
Phone
Call the Cover Virginia Call Center.
Local Departments of Social Services
People in Richmond, Virginia Beach, Norfolk, Fairfax, Arlington, Alexandria, Roanoke, and other areas can get in-person help.
Hospitals and Community Health Centers
Some hospitals and clinics can help you apply.
Renewal Process
You must renew your Medicaid coverage when required.
To avoid losing benefits:
- Reply to notices quickly.
- Update your income information.
- Report family changes.
- Keep your contact information up to date.
Why Virginia Medicaid Matters
Healthcare can be expensive.
Virginia Medicaid helps people get important medical services like:
- Preventive care
- Doctor visits
- Specialist care
- Prescription drugs
- Emergency services
- Mental health treatment
For many families, Medicaid makes healthcare more affordable.
Helpful Resources
- Cover Virginia -Apply for Medicaid and check eligibility.
- Virginia DMAS – Official Virginia Medicaid program information.
- State-by-State Medicaid Eligibility Charts – Medicaid Income Limits by State (All 50 States)
FAQs ( Virginia Medicaid income limits)
What is the income limit for Medicaid in Virginia for one person?
For most adults ages 19 to 64, the limit is about $1,836 per month or $22,025 per year.
Does Virginia have Medicaid expansion?
Yes, Virginia expanded Medicaid under the Affordable Care Act. Because of this, more adults can qualify based on their income.
Can adults without children qualify?
Yes, adults without children may still qualify for Virginia Medicaid if their income is within the allowed limits.
Does Virginia Medicaid have asset limits?
Most adults under Medicaid expansion do not have asset limits. However, seniors and people with disabilities who qualify through ABD Medicaid may have resource limits.
Does Social Security count as income?
Yes. Some Social Security benefits may count when Virginia Medicaid checks your eligibility.
What if my income is too high?
If your income is above the Medicaid limit, you may still qualify for financial help through Health Insurance Marketplace plans.
Can pregnant women receive Medicaid?
Yes, pregnant women may qualify under special income guidelines and receive coverage for prenatal care, delivery, and postpartum care.
Can seniors qualify for Medicaid?
Yes, seniors age 65 and older may qualify through ABD Medicaid or long-term care Medicaid programs.
What income is counted for Medicaid?
Income that may count includes:
- Wages and salary
- Self-employment income
- Social Security benefits
- Pension income
- Rental income
- Unemployment benefits
Can I apply for Virginia Medicaid online?
Yes, you can apply online through Cover Virginia. You can also apply by phone or visit your local Department of Social Services office.
Conclusion
Virginia Medicaid income limits are depends on household size and the type of program you qualify for. Most adults ages 19 to 64 can qualify through Medicaid expansion if their income is below the limits. Kids, pregnant women, seniors, and people with disabilities may have different rules and may qualify under special programs.
If you think you might qualify, check your household income, compare it with the current Virginia Medicaid guidelines, and apply through Cover Virginia. Even if your income is too high for Medicaid, Marketplace insurance plans may still help you get affordable health coverage.