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FindMyDirectDoctor Medicaid & Marketplace Coverage Pathway Screener
x402
FindMyDirectDoctor Medicaid & Marketplace Coverage Pathway Screener is a paid API for AI agents from api.findmydirectdoctor.com, paid per call via x402, $0.01/call, status unknown (last checked 2026-10-31).
Screens a US household for likely health coverage pathway (Medicaid, Marketplace subsidy, coverage gap, or above subsidy range) based on state, household size, and annual income using 2026 federal poverty guidelines and KFF Medicaid limits.
Price / call$0.01
Success—
StatusUnknown
How this service works
Screens a household for a likely coverage pathway from state, household size and yearly income: Medicaid may qualify, Marketplace subsidy may qualify, coverage gap, or above the subsidy range. Uses 2026 federal poverty guidelines and KFF-reported state Medicaid limits, reports income as a percent of the poverty line and links the state Medicaid office. Screening estimate only; the state decides. Income is not stored or logged.
Output
Returns a JSON object with a coverage pathway enum (medicaid_may_qualify, marketplace_subsidy_may_qualify, coverage_gap, or above_subsidy_range), a plain-English headline, the household's income as a percent of the federal poverty line, the state Medicaid office URL, Marketplace apply URL, detailed limits and guideline amounts used, any age or Medicare notes, caveats about what is not modeled, and a disclaimer that the result is a screening estimate only.
Example use cases
Medicaid gap check for uninsured adult
“I'm a single adult in Texas with no insurance and I make about $18,000 a year. Can you check if I'd likely qualify for Medicaid or if I'd fall in the coverage gap?”
Family subsidy eligibility screening
“We're a family of 4 in Ohio with a household income of $60,000. Can you check if we'd likely qualify for an ACA Marketplace subsidy or if we might be eligible for Medicaid?”
Pregnant applicant Medicaid screening
“I'm pregnant, living in Florida, and my household is just me with an income of $22,000 a year. Can you check what health coverage pathway I'd likely qualify for using the pregnant group category?”
Technical details
Endpoint
GEThttps://api.findmydirectdoctor.com/v1/coverage/medicaid-check?utm_source=zero.xyzWhen to prefer
Choose this endpoint when you need a fast, rules-based screening of US health coverage eligibility by state, household size, and income — especially when the user lacks employer coverage and wants to understand whether Medicaid, an ACA subsidy, or neither applies. It is not a substitute for an official eligibility determination but is ideal for pre-screening, referral routing, or informational agent flows. Prefer it over generic ACA calculators when you need structured pathway output with direct links to state Medicaid offices and Marketplace application URLs.
Side effects
- Invalid or missing state code returns a validation error
- Household size of 0 or above 20 fails schema validation
- Annual income outside 0–100,000,000 range fails validation
- Unsupported coverage_year value fails enum validation
- Truncated or malformed query params may return incomplete pathway data
- State-specific edge cases (e.g. Basic Health Program states MN, NY, OR, DC) are noted in caveats but not fully modeled
Input
Schema · Request body
| Field | Type | Description |
|---|---|---|
| inputrequired | object | |
| output | object |
Output
Schema · Response
{
"type": "json",
"example": {
"notes": [
"Kansas has not expanded Medicaid. The adult limit shown is for adults without a child at home. Parents have a different limit (38 percent of the poverty guideline for a family of three), which group=parent uses."
],
"query": {
"group": "adult",
"state": "KS",
"coverage_year": 2027,
"household_size": 3
},
"source": "Federal poverty guidelines (HHS ASPE), KFF Medicaid limits, FindMyDirectDoctor Foundation coverage gap checker",
"caveats": [
"This is a screening estimate from public rules, not an eligibility decision. Only the state Medicaid agency or the Marketplace can decide.",
"Marketplace help is usually not available when affordable job-based coverage is offered or when a person has Medicare.",
"Not modeled: disability-based Medicaid, Medicare, immigration status, assets, Basic Health Program states (MN, NY, OR, DC), and state-specific pregnancy limits above the federal floor.",
"Non-expansion states: KFF reports the parent limit for a family of three, and the same percent is applied to other household sizes. Facts verified 2026-10-14.",
"The enhanced Marketplace tax credits ended after 2025, so the 2026 and later Marketplace help follows the original (smaller) rules."
],
"details": {
"group_used": "adult",
"medicaid_expanded": false,
"medicaid_limit_usd": 0,
"household_size_used": 3,
"medicaid_limit_basis": "adult",
"marketplace_range_usd": [
27320,
109280
],
"medicaid_limit_percent_fpl": 0,
"poverty_guideline_2026_usd": 27320,
"marketplace_poverty_guideline_usd": 27320,
"marketplace_poverty_guideline_year": 2026
},
"pathway": "coverage_gap",
"headline": "The household may fall in the Medicaid coverage gap in Kansas: income looks too high for Medicaid and too low for Marketplace help.",
"apply_url": "https://www.healthcare.gov/",
"conditions": [],
"data_as_of": "2026-10-02",
"disclaimer": "Screening estimate only. Only the state Medicaid agency or the Marketplace can decide who qualifies. This is not legal, tax or medical advice.",
"state_name": "Kansas",
"fpl_percent": 73,
"annual_income_usd": 20000,
"facts_verified_on": "2026-10-14",
"marketplace_fpl_percent": 73,
"state_medicaid_office_url": "https://www.kancare.ks.gov/"
}
}Tags
x402
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