Most Medicaid programs do not charge premiums, but some states require them for certain groups

In most states, Medicaid is free — you pay no monthly premium. However, about half of all states charge premiums to some Medicaid members, usually those with higher incomes or those enrolled in specific programs. The amount varies widely by state, from a few dollars a month to over $100, depending on your income and which Medicaid program you are in.

Whether you pay a premium depends on three things: which state you live in, your income level, and which Medicaid category you fall into (such as parent, child, elderly, or disabled). A parent earning $20,000 a year might pay nothing in one state and $50 a month in another. The only way to know what you will owe is to check your specific state's rules.

Key Takeaways

  • Most Medicaid members pay no premium at all, but about half of states do charge premiums to some groups of enrollees.
  • Premium amounts and who pays them vary by state and by income level, so you must check your state's Medicaid program directly.
  • Even if you pay a premium, Medicaid typically has much lower out-of-pocket costs than private insurance.
  • If you cannot afford a premium, some states allow you to request a hardship exemption or reduction.

Which states charge Medicaid premiums and how much

States that do charge premiums typically set them based on your household income as a percentage of the federal poverty level. For example, a state might charge $10 a month for someone earning 100% to 150% of poverty, and $25 a month for someone earning 150% to 200% of poverty. A few states charge a flat fee regardless of income.

Premium amounts are usually small — often between $5 and $50 per month for an individual — but some states charge more for families or for people with higher incomes. A handful of states have experimented with higher premiums tied to income, though federal rules limit how much states can charge. Your state's Medicaid office publishes its premium schedule, and you can find it by searching "[your state] Medicaid premiums" or calling your state's Medicaid hotline.

What counts as income for premium calculations

States count income differently depending on which Medicaid program you are in. For most adult and parent programs, income includes wages, self-employment earnings, Social Security, unemployment benefits, and child support. Some states count unearned income like interest or rental income; others do not.

The key detail is that most states use modified adjusted gross income (MAGI) to calculate Medicaid income, which is simpler than the old method but can include income that does not feel like "real" money to you. For example, some states count the value of food or housing you receive as income. If you are unsure whether something counts, ask your state's Medicaid office before you report your income — getting this wrong can mean paying the wrong premium or losing coverage.

Premiums for different Medicaid groups

Children almost never have premiums in any state. Parents and pregnant people may have premiums in some states, usually only if their income is above a certain threshold. Elderly people and people with disabilities have premiums in fewer states, and when they do, the amounts are often lower or waived for those with very low incomes.

Some states run special programs — like Medicaid expansion for adults without children — that have different premium rules than traditional Medicaid. If you are not sure which program you are in, your Medicaid notice will say. If you do not have a notice, call your state's Medicaid office and give them your case number or Social Security number; they can tell you which program covers you and whether a premium applies.

What happens if you cannot pay a premium

If you receive a premium bill and cannot pay it, do not ignore it. Contact your state's Medicaid office and ask about a hardship exemption or reduction. Many states will waive or reduce premiums for people facing financial hardship, though you usually have to request it in writing and explain your situation.

If you do not pay a premium by the deadline, your coverage may be suspended or terminated. However, most states give you a grace period — usually 30 to 90 days — before they actually end your coverage. During that time, you can still use your Medicaid card, but you should contact your state immediately to work out a payment plan or request a waiver. Waiting until after your coverage ends is much harder to fix.

How Medicaid premiums compare to other costs

Even if you pay a Medicaid premium, your total out-of-pocket costs are usually far lower than private insurance. Medicaid typically has no deductible, low or no copays for doctor visits, and capped out-of-pocket maximums. A $20 monthly premium plus a $3 copay per visit is still much cheaper than a private plan with a $1,500 deductible and 20% coinsurance.

Some states also charge small copays for office visits, emergency room visits, or prescriptions — usually $1 to $5 per visit or prescription. These copays are separate from premiums and are capped by federal law so they do not become unaffordable. If you are enrolled in Medicaid, your welcome letter or coverage documents will list both premiums and copays so you know what to expect.

How to learn about you will pay a premium

The fastest way is to contact your state's Medicaid office directly. You can find the number by searching "[your state] Medicaid" or by calling 211, which connects you to local health and human services. Have your Social Security number or case number ready. Tell them your household income and ask whether a premium applies to you and how much it will be.

You can also check your state's Medicaid website, which usually has a chart showing premium amounts by income level and program type. Some states have online tools where you can enter your income and see what you would owe. If you are already enrolled in Medicaid, your approval notice will state whether you have a premium and when it is due.

Frequently Asked Questions

Can Medicaid premiums change after I enroll?

Yes. If your income changes, your premium may change at your next renewal or when you report the change. States also sometimes adjust premium amounts from year to year. You will receive a new notice if your premium changes, so read it carefully and contact your state if you think the amount is wrong.

Do I have to pay a premium if I am on disability or Social Security?

It depends on your state and your income level. People receiving SSI (Supplemental Security Income) usually pay no premium because SSI income is very low. People receiving SSDI (Social Security Disability Insurance) may have a premium if their SSDI payment pushes them above your state's income threshold. Check with your state's Medicaid office to be sure.

What if I disagree with the premium amount I was charged?

Contact your state's Medicaid office and ask them to review your case. Bring proof of your actual income — pay stubs, tax returns, or benefit statements. If you think they made a mistake, you have the right to request a hearing. Your state's Medicaid office will explain how to file an appeal in your notice.

Do Medicaid premiums count toward my deductible?

No. Premiums and deductibles are separate. Medicaid premiums are what you pay to stay enrolled; deductibles (if your state charges them) are what you pay before Medicaid starts covering care. Most Medicaid programs have no deductible, so premiums are usually your only regular out-of-pocket cost.

Can I get Medicaid without paying a premium?

In most states, yes — either because your state does not charge premiums at all, or because your income is low enough that you fall below the premium threshold. If you live in a state that does charge premiums, you may still be able to request a hardship exemption. Contact your state's Medicaid office to learn your options.