Medicaid is the single largest insurer in the United States, offering free or low-cost medical benefits to 71 million low-income Americans or those with disabilities. But despite its widespread use, many people still aren’t familiar with the program — and even confuse it with Medicare.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296068be80-dcbb-480d-a52a-2bfb25567360e60dc2a1-f33c-4a05-9b50-8e3e8e597629267df347-8b13-4e85-b1e8-01cd9919f492 “People tend to use the terms interchangeably, but they are not at all the same,” says Josh Hodges , the chief customer officer at the National Council on Aging. Unlike Medicare, which is funded by the federal government and is primarily for people age 65 and older, Medicaid is jointly funded by both the state and federal government. That means each state determines who qualifies, which nonmandatory services are covered, and how care is delivered. This state-by-state variation even extends to program names — for instance, it’s called Medi-Cal in California and SoonerCare in Oklahoma.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fc90debf-cc4b-46d8-95a5-478b35dbbbe4 One thing is the same, though: For millions of families, Medicaid provides a critical safety net that makes healthcare accessible to people who would not be able to afford it otherwise. Here’s what you need to know.
How Does Medicaid Work? How Does Medicaid Work? Despite variations across the country, all Medicaid programs must cover these core services:e60dc2a1-f33c-4a05-9b50-8e3e8e5976291bb3b21b-300d-4361-ace3-4357e6651d60 Doctors’ visits and hospital care Preventive care like checkups and vaccines Lab tests and X-rays Prenatal and maternity care Prescription drugs Mental health services Transportation to medical appointments Emergency services Certain aspects of Medicaid vary from state to state, though, including:e60dc2a1-f33c-4a05-9b50-8e3e8e597629f5bc96ca-3b91-45c4-8218-a14fa1466d3a Eligibility rules Application processes Additional services such as dental care and physical therapy Provider reimbursement rates Coverage can start from the date you apply and may even cover medical bills from up to three months before your application if you qualified during that time.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ed776178-8c36-41d6-9127-e182c067722d
Who Qualifies for Medicaid? Who Qualifies? Medicaid provides free or low-cost health coverage to millions of Americans with diverse needs. Here’s who may be eligible. Financial Eligibility Most people qualify for Medicaid because of their income, which is evaluated according to taxable income and household size. (The formula for calculating Medicaid eligibility is called Modified Adjusted Gross Income, or MAGI .) All states must cover families with incomes up to certain levels. In states that have expanded Medicaid (which includes 40 states and the District of Columbia), a family of four would qualify if they earn $44,367 per year or less (that’s 138 percent of the Federal Poverty Level in 2025).e60dc2a1-f33c-4a05-9b50-8e3e8e59762948cada5f-154a-48d9-bd06-2c8c7bdbebd9 That said, children still can qualify for Medicaid in most states, even if their families have higher income levels.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292e29d794-37f2-4a2c-a844-e0e575fcb0c2 If you’re at least 65 years old or have a disability, you can also qualify for Medicaid if your income and assets are low, even if you’re on Medicare.e60dc2a1-f33c-4a05-9b50-8e3e8e59762986111c3e-a582-441d-bef3-c741724d93b4 Medicaid reviews income and household size, plus assets/savings (except in California), and verifies age or disability status when applicable. In addition to the income guidelines, most states require proof that assets fall within limits.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297d606612-b5f5-45cd-a9e0-e5fbeba9257e Medical Eligibility If you have very expensive medical bills, but your income is higher than the Medicaid requirements, you may still qualify for the program if your healthcare expenses exceed a certain amount, called the medically needy income limit. For example, if you have an $800 monthly income and a $500 medically needy income limit, you must “spend down” $300 to qualify for Medicaid.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ad9fb391-e823-4047-8d6c-807114b08d52e60dc2a1-f33c-4a05-9b50-8e3e8e597629c1cc9b50-ba3a-4fc1-a246-f19c2adab453 Special Circumstances Eligibility Some people can qualify for Medicaid through other means. For example, former foster youth can be eligible up until the age of 26, and people who’ve been diagnosed with breast or cervical cancer through a Centers for Disease and Control (CDC) screening program can have their cancer care paid for by Medicaid.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296db9b920-f702-4e4b-bbc4-43d220a6bc6ce60dc2a1-f33c-4a05-9b50-8e3e8e59762949de423a-4286-4fcd-bd74-fe77776ec985
Are There Different Types of Medicaid? Are There Different Types? While Medicaid is often discussed as a single program, there are, in fact, different types, each of which provides coverage through different pathways. Traditional Medicaid This program exists in every state, plus DC and all U.S. territories . It covers children, pregnant women, parents with dependents, adults 65 and older, and people with disabilities based on their income and household size.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294c5b85e3-fbab-4134-ba4b-f0b71bc8a12a Expansion Medicaid This program covers adults under the age of 65 in 40 states and DC who have an income that’s no more than 138 percent of the Federal Poverty Level . In 2025, that amount is $21,597 annually for a single person and $44,367 for a household of four. Long-Term Care Medicaid Even though more than 60 percent of all nursing home residentse60dc2a1-f33c-4a05-9b50-8e3e8e59762980e5ba2e-f5a9-4913-a627-0f46cb246887 are covered by Medicaid, most Americanse60dc2a1-f33c-4a05-9b50-8e3e8e597629ea814cf7-9ad0-416c-a812-b15a0e02f1a3 are unaware that Medicaid covers this type of care. Beyond nursing homes, Medicaid helps pay for home care and other extended care needs, known as long-term services and supports (LTSS).e60dc2a1-f33c-4a05-9b50-8e3e8e5976294b689836-2906-47c6-81ef-c575ce533b2a These services assist people who need help with daily activities like eating or bathing. While all states cover nursing home care for those who meet income and asset requirements, home and community-based service coverage varies by state.e60dc2a1-f33c-4a05-9b50-8e3e8e597629988eea85-f3e7-4fd1-a3b2-3c1e39c26a5a
How Do I Know if I’m Eligible? Am I Eligible? You can determine your eligibility for Medicaid by entering your state and household size on HealthCare.gov or contacting your state Medicaid agency directly.
Where and How Do I Sign Up? Signing Up “Even though rules vary by state, generally people applying for Medicaid should be ready to provide documentation of all sources of income, as well as assets like bank accounts and any trusts,” says Kata Kertesz , the managing policy attorney for the Center for Medicare Advocacy. Unlike Medicare, with its specified enrollment periods, you can sign up for Medicaid at any time in a few different ways:e60dc2a1-f33c-4a05-9b50-8e3e8e597629efee7969-4470-4415-b094-c950acad375a State Medicaid Agency Apply online, by phone, or in person in your state’s Medicaid office . Healthcare.gov Go to Healthcare.gov to apply. If you qualify, your application will be forwarded to your state Medicaid agency. Automatic Enrollment In 34 states and DC, SSI recipients are automatically enrolled.
How Much Will It Cost Me? Costs With Medicaid, costs are minimal — usually small copays , if anything.e60dc2a1-f33c-4a05-9b50-8e3e8e597629155e38fb-932a-4750-94f1-bb36965bfca6 For instance, you might pay $1 to $5 for a doctor’s visit or prescription, while services like emergency care, pregnancy-related services, hospice, and preventive care for children are exempt from copays.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298a794560-c074-4076-895f-4651da36b32f For nursing home care and home-based care services (HCBS), Medicaid covers 100 percent of the costs — including rooming, meals, and medical supplies. But you’ll need to contribute nearly all your income toward these costs first, keeping only a small personal needs allowance (PNA), which varies by state. “Individuals with Medicaid coverage are also eligible for ‘ Extra Help ,’ a Medicare program that reduces drug costs,” notes Kertesz.
How Do I Know Which Doctors Accept Medicaid? Which Doctors Take Medicaid? Not all doctors accept Medicaid. In fact, research shows that roughly 20 percent of physicians do not accept new Medicaid patients. To find a provider, contact your state Medicaid agency or visit Medicaid.gov for state-specific details.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290acd8174-c930-470e-8a92-63ab68618ac5
What Do I Do if I Lose My Benefits? What if I Lose My Benefits? It can feel overwhelming to lose Medicaid coverage, but there are steps you can take to reinstate it.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295b66110b-29a3-4963-8abd-b4ff039ca974 Understand why you lost coverage. States regularly check your eligibility for Medicaid. If your income (or other factors) make you ineligible, your coverage may end. If you’ve received a notice or request from your state, don’t ignore it — respond quickly to avoid losing coverage unnecessarily. Reapply for Medicaid. If you believe there was a mistake, reapply — you can do so anytime your income or circumstances change. Apply for Marketplace coverage. Plans on the Health Insurance Marketplace, a government-run platform for finding health insurance, offer low-cost options for those transitioning off Medicaid. You can apply up to 60 days before Medicaid ends or within 90 days after it ends, with coverage starting the next month. Get free help. Marketplace assisters can explain your health coverage options and help you apply for free. Visit HealthCare.gov to find local help or contact the Marketplace Call Center at 800-318-2596.
Can I Have Medicaid and Private Insurance? Medicaid and Private Insurance Yes, Medicaid can work alongside other health coverage you may have.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a0f9e06f-8839-4f1c-b6be-230d584a38da For instance, 12 million people are enrolled in both Medicaid and Medicare right now. Medicaid works with:e60dc2a1-f33c-4a05-9b50-8e3e8e597629b18ea479-ba7e-454a-8876-df0facde1bf2 Private health insurance Medicare Employer-sponsored plans Workers’ compensation Court-ordered health coverage When you have Medicaid plus another form of health coverage, know that: Medicaid pays last. Medicaid acts as a secondary payer, covering what your other plan doesn’t, including copays, deductibles, or remaining balances. So if you’re on Medicare, too, “Medicaid will pick up your Medicare deductible and copays,” says Sandy Kemp , a registered Social Security analyst in Las Vegas. Medicaid coordinates with other coverage. If your other insurance is responsible for part of a medical bill, Medicaid works directly with that insurer to make sure your providers are paid. Drug coverage may shift. If you have both Medicare and Medicaid, you’ll be automatically enrolled in a Medicare drug plan that covers your medication costs instead of Medicaid.e60dc2a1-f33c-4a05-9b50-8e3e8e597629bf9931fc-d893-49aa-b7bb-bdfcaa70882e
The Takeaway Medicaid provides free or low-cost health coverage to millions of low-income individuals, families, seniors, and people with disabilities. Program eligibility and benefits vary by state, so it’s important to check with your state Medicaid office to understand what’s available to you. Medicaid covers essential services like doctor visits, hospital care, and preventive care, and may also help cover long-term care services for those who qualify. If you lose Medicaid coverage, you may qualify for low-cost health insurance through the Health Insurance Marketplace.
Resources We Trust Medicaid.gov: Eligibility PolicyNational Council on Aging: Why Is Medically Needy Medicaid Good for Long-Term Care?HealthCare.gov: Staying Covered if You Lose Medicaid or CHIP USA.gov: How to Apply for Medicaid and CHIP
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