Understanding whether you qualify for Medicaid in Illinois can be confusing. The Illinois Medicaid Eligibility Calculator simplifies this process by helping you determine if you or your family members are eligible for Medicaid coverage based on income, household size, age, disability status, and more.
What Is the Illinois Medicaid Program?
Illinois Medicaid is a state-run health insurance program for low-income individuals, families, seniors, and people with disabilities. It offers coverage for doctor visits, hospital stays, medications, long-term care, and more. Eligibility is based primarily on Modified Adjusted Gross Income (MAGI), household size, and specific qualifying conditions.
What Is the Illinois Medicaid Eligibility Calculator?
The Illinois Medicaid Eligibility Calculator is an online tool that estimates whether you may qualify for Medicaid based on the financial and personal information you enter. It follows the current federal poverty level (FPL) guidelines and Illinois Department of Healthcare and Family Services rules to estimate eligibility.
How to Use the Illinois Medicaid Eligibility Calculator
Here’s a step-by-step guide:
- Open the calculator on your device.
- Enter your household size – Count yourself and everyone living with you (including dependents).
- Input your monthly or annual income – This should be your gross (pre-tax) income.
- Select your age group – Under 19, 19–64, or 65+.
- Select if you’re pregnant, disabled, or a parent/caretaker – These can affect eligibility.
- Click Calculate – The tool will instantly display whether you’re likely eligible or not.
Formula Used in the Calculator
The calculator checks if your income falls below the Medicaid limit for your household size, based on percentages of the Federal Poverty Level (FPL).
General Formula:
iniCopyEditEligibility = (Household Income / FPL for Household Size) * 100 If the result is:
- ≤ 138% of FPL – Eligible for most adults aged 19–64.
- ≤ 213% of FPL – Eligible for pregnant women.
- ≤ 142% of FPL – Children under age 19 may qualify.
- ≤ 100% of FPL – Parents/caretakers and aged/blind/disabled adults may qualify.
Example Calculations
Example 1: Adult without children
- Household Size: 1
- Annual Income: $19,000
- 138% FPL for 1 person (2025): ~$20,783
iniCopyEditEligibility = ($19,000 / $20,783) * 100 = 91.4% ✅ Eligible (under 138% FPL)
Example 2: Family of 3 with children
- Household Size: 3
- Annual Income: $40,000
- 142% FPL for 3: ~$37,814
- 213% FPL for pregnant woman: ~$56,725
iniCopyEditEligibility = ($40,000 / $37,814) * 100 = 105.8% ❌ Children may qualify, but parent likely ineligible
Who Can Use the Calculator?
This calculator is useful for:
- Low-income adults aged 19–64
- Parents or caretakers
- Pregnant women
- Children under age 19
- Seniors aged 65+
- Disabled individuals
Note: Final eligibility is always determined by the Illinois Department of Healthcare and Family Services.
Benefits of Using the Calculator
- ✅ Fast – Results in seconds
- ✅ Free – No cost to use
- ✅ Private – No personal data is stored
- ✅ Current – Uses up-to-date income thresholds
- ✅ Reliable – Based on official Medicaid rules
Additional Information About Illinois Medicaid
Income Limits for 2025 (Estimated)
| Household Size | 138% FPL (Adults 19–64) | 213% FPL (Pregnant Women) | 142% FPL (Children) |
|---|---|---|---|
| 1 | $20,783 | N/A | N/A |
| 2 | $28,208 | $43,496 | $29,417 |
| 3 | $35,633 | $54,309 | $37,814 |
| 4 | $43,058 | $65,122 | $46,211 |
Covered Services
- Preventive and primary care
- Emergency room visits
- Prescriptions
- Mental health services
- Dental and vision (in some cases)
- Long-term care (for eligible adults)
- Maternity and newborn care
20 Frequently Asked Questions (FAQs)
1. What is Medicaid?
Medicaid is a government health insurance program for low-income individuals and families.
2. Who runs Medicaid in Illinois?
The Illinois Department of Healthcare and Family Services (HFS) administers it.
3. What is FPL?
FPL stands for Federal Poverty Level, a measure used to determine financial eligibility.
4. Does everyone under 138% of FPL qualify?
Generally yes, if you’re aged 19–64, not on Medicare, and a resident of Illinois.
5. Can children qualify separately from adults?
Yes, children may qualify even if parents don’t.
6. Can I still qualify if I have some assets?
MAGI-based eligibility focuses on income, not assets (except for seniors and disabled applicants).
7. Does the calculator guarantee eligibility?
No, it’s an estimator. Final decisions are made by the HFS after reviewing documentation.
8. Can pregnant women qualify with higher income?
Yes, up to 213% of FPL.
9. What if my income fluctuates?
Use an average monthly income or your latest annual estimate.
10. Does Illinois Medicaid cover dental?
Yes, for children and some adults, depending on the plan.
11. Do seniors over 65 qualify?
Yes, but through a different Medicaid pathway based on age and assets.
12. Can I apply if I’m unemployed?
Yes, especially if your income is low or you receive unemployment benefits.
13. Can I apply for someone else?
Yes, you can apply for children, elderly parents, or dependents.
14. What if I’m denied?
You can appeal the decision or reapply if circumstances change.
15. Is there a deadline for applying?
You can apply anytime during the year.
16. Is the calculator available in Spanish?
Some versions may offer multilingual support depending on the website.
17. Does the calculator store my data?
No, it doesn’t store or share your information.
18. How often are the income limits updated?
Annually, based on federal updates to the FPL.
19. What documents are needed to apply?
Proof of identity, income, residence, and Social Security numbers.
20. Where can I apply for Illinois Medicaid?
Visit the official Illinois ABE website to start your application.
Conclusion
The Illinois Medicaid Eligibility Calculator is a valuable tool to assess your chances of qualifying for state-sponsored health coverage. While it doesn’t guarantee enrollment, it can save you time and uncertainty by providing a quick and accurate assessment. With healthcare costs on the rise, ensuring your eligibility for assistance like Medicaid can be a vital step in protecting your health and financial well-being.