MO – ACA vs Medicaid confusion, transgender healthcare

Hello, I am trying to apply for health insurance and am feeling more confused and panicked the more I try. Sorry if this gets a bit long. And I didn’t know which flair to use, since this is about the ACA and Medicaid.

My job doesn’t have super consistent hours, so my income is very uncertain. Like, somewhere between $15,000 and $22,000 next year. I can probably influence that a bit and push for a bit more, but I also feel uncertain how my health will hold out.

I also expect a lot of health expenses in the coming year. I’m transgender and plan on top surgery, plus hormone costs. Therapy, general health issues I’m hoping don’t turn into something worse.

Here’s what I’ve done so far:

I applied on the ACA Marketplace on 11/2. I went with the lower income estimate of 15,000/year and an estimated $1280 for this month (it’s one of my slower months). I was told I didn’t qualify for a tax credit but may be eligible for Medicaid.

The next day I tried adjusting my yearly income to 19,000, since I was guessing anyway and had gone low. Same result.

A few days later, after talking to someone from a phone number on the ACA website, I adjusted it again based on their suggestion to 22,500/year and an updated 1440 for this month. Same results.

I have two main concerns.

I worry that my annual income will put me in a dead area between the tax credit and Medicaid and I’ll end up without insurance or a $600/month insurance

I worry that Medicaid won’t cover a lot of my health expenses. I’ve heard in several places that transgender specific health care isn’t covered by MO Medicaid. Surgery for sure, hormones I really wouldn’t count on.

I tried contacting a local place for assistance. They referred me to https://mydss.mo.gov to chat with someone about Medicaid. That person gave me a phone number to ask about Medicaid coverage. That phone number took me to what sounded like a call center focused on selling medical alert buttons. Plus, the person in the chat said I needed to apply for Medicaid and the ACA said I need to wait to hear from them.

Does anyone have any advice on this? Is there anything I can do to better qualify for an ACA tax credit? Does anyone have advice on Medicaid? Would I be better off paying full price for insurance or just paying out of pocket for medical expenses?

Thanks in advance for any advice.