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Navigating Subsidies for the Self-Employed Caught in the 'Coverage Gap'

Navigating Subsidies for the Self-Employed Caught in the 'Coverage Gap'
Photograph by Andrew Roesler/Getty Images

Question: I am a self-employer farmer and would qualify for Medicaid under the Obamacare expansion, except I live in North Carolina, which has chosen not to expand Medicaid. If I have a really good year, I could get above the poverty line and qualify for a lot of subsidies. What if I overestimate my 2014 income, get the subsidies, and end up making less and fall back into the poverty/Medicaid bracket. Would I have to pay the subsidies back? Whom would I owe if I did, the government or the insurance company?

Answer: Unfortunately, you find yourself in a situation that health-reform experts are calling the “coverage gap.” You make too little to be eligible for Obamacare and too much to be eligible for Medicaid, as defined by your state. You’re not alone: In your state of North Carolina, more than 300,000 people fall into this gap, according to data compiled by the Kaiser Family Foundation.