You do not pay premiums, copays, or deductibles for Medicaid in most states
Medicaid is free or nearly free for people who meet income and asset limits. You will not receive a bill for coverage itself, and in most cases you will not pay when you visit a doctor, fill a prescription, or go to the hospital. The program is funded by federal and state taxes, not by monthly payments from members.
Some states do charge small copays — usually $1 to $3 per doctor visit or prescription — but these are rare and apply only to certain services. Even when copays exist, they are optional for people with disabilities or serious illnesses, and the state cannot deny you care if you cannot pay them.
The only cost you might face is if you have resources (savings, property, or investments) above your state's limit. In that case, you may have to spend down those assets before Medicaid covers long-term care in a nursing home. This does not apply to regular medical care — only to institutional care lasting more than 30 days.
Key Takeaways
- Medicaid covers doctor visits, hospital care, prescriptions, and preventive services at no cost to you in most states.
- You do not pay monthly premiums or annual deductibles, and copays are rare and usually $1 to $3 when they exist.
- If you have significant savings or property, you may need to use those resources before Medicaid covers nursing home care.
- Your state determines the exact rules about copays and asset limits, so costs vary by location.
When Medicaid does charge copays
A handful of states charge small copays for certain services. These typically apply to doctor visits, emergency room visits, and prescription drugs. The copay is usually $1 to $3 per service, and it is capped — meaning you will not pay more than a set amount per month or year.
Copays are waived for children under 18, pregnant women, people receiving emergency care, and people with disabilities or chronic illnesses. If you cannot afford the copay, you can still receive the service — the state cannot turn you away or reduce your coverage because you cannot pay it.
Not every state charges copays. Some states cover all services completely free. Contact your state Medicaid office to find out whether your state charges them and for which services.
Asset limits and long-term care spending
Medicaid has different rules for regular medical care and for long-term institutional care (nursing homes, assisted living facilities, or inpatient psychiatric hospitals). For doctor visits, hospital stays, and prescriptions, there are no asset limits — you can have any amount of savings and still receive free coverage.
For nursing home care lasting more than 30 days, most states require you to spend down assets above a certain limit before Medicaid pays. The limit varies by state but is often around $2,000 to $3,000 in countable resources. Your home, one vehicle, and personal items do not count toward this limit. Money in a revocable trust, stocks, bonds, and bank accounts do count.
If you are facing a long nursing home stay and have significant assets, you may want to speak with an elder law attorney about legal ways to protect some resources. Some strategies, like irrevocable trusts or Medicaid planning, can help — but they must be done before you need care, and rules vary by state.
How Medicaid is different from Medicare
Medicaid and Medicare are separate programs with different costs. Medicare is for people 65 and older, regardless of income. It charges monthly premiums (usually deducted from Social Security), copays, and deductibles. Medicaid is for people with low income or disabilities and is free or nearly free.
Some people may have access to for both programs — called "dual may be able to access." If you are dual may be able to access, Medicare is your primary insurance and Medicaid fills in gaps, covering copays and deductibles that Medicare does not pay. You still do not pay Medicaid directly.
What services are covered at no cost
Medicaid covers a broad range of services without charging you. These include doctor visits, hospital stays, emergency room care, lab tests, X-rays, prescription drugs, mental health services, and substance use treatment. Preventive care like vaccinations, cancer screenings, and annual checkups are covered. Dental and vision care vary by state — some states cover them for adults, others only for children.
Long-term services like nursing home care, home health aide services, and adult day care are covered if you meet your state's medical and financial criteria. Medicaid also covers some services that private insurance often does not, such as transportation to medical appointments and personal care assistance.
Your state determines the exact list of covered services. Some states cover more than others. You can find your state's coverage list on your state Medicaid website or by calling your local Medicaid office.
What happens if your income changes
If your income rises above your state's Medicaid limit, you will lose coverage. There is no gradual phase-out — coverage ends on a specific date, usually the last day of the month in which you became ineligible. You should report income changes to your Medicaid office right away so the end date is accurate and you have time to find other coverage.
If your income drops again, you can reapply for Medicaid. Some states have continuous enrollment periods that allow you to reapply quickly. Others require you to wait until the next open enrollment period. Contact your state Medicaid office to learn the rules in your state.
If you lose Medicaid because of income, you may be able to buy coverage through the health insurance marketplace. You might also may have access to for subsidies that lower the cost of marketplace plans based on your income.
Medicaid expansion and income thresholds by state
The income limit for Medicaid varies significantly by state. Some states expanded Medicaid under the Affordable Care Act and cover adults earning up to 138% of the federal poverty level. Other states have not expanded and cover only certain groups — typically children, pregnant women, parents, and people with disabilities — at much lower income limits.
In non-expansion states, a single adult with no children may not may have access to for Medicaid at all, even with very low income. In expansion states, the same person would may have access to. This means the cost to you (zero) is the same everywhere, but whether you can get Medicaid depends on where you live.
Your state Medicaid office can tell you the exact income limit for your situation. You can also check your state's Medicaid website or call 211 for a referral to local resources.
Frequently Asked Questions
Do I have to pay Medicaid back if my situation improves?
No. Medicaid is not a loan. You do not have to repay the cost of services you received, even if your income later rises above the limit. The only exception is if you received long-term care in a nursing home and you have an estate when you die — your state may try to recover costs from your estate, but only in limited circumstances and only if you have significant assets.
What if I cannot afford the copay?
You cannot be denied care because you cannot pay a copay. Tell the provider or pharmacy that you cannot afford it. The copay is optional, not a requirement to receive the service. If your state charges copays, it must have a process for waiving them when you cannot pay.
Does Medicaid cover dental work and glasses?
Dental and vision coverage varies by state. Most states cover dental and vision care for children under 18. For adults, coverage depends on your state — some cover routine cleanings and exams, others cover only emergency dental care, and some cover nothing. Contact your state Medicaid office or check your coverage documents to find out what your state covers.
Will I lose Medicaid if I get a job?
Not immediately. You must report the income change to your Medicaid office. Your coverage will end when your income exceeds your state's limit, usually at the end of that month. Some states have work incentive programs that let you keep Medicaid for a few months after you start working, even if your income is above the limit. Ask your Medicaid office about work incentives in your state.
Can I use Medicaid at any hospital or doctor?
Most doctors and hospitals accept Medicaid, but not all. Some providers do not take Medicaid because the payment rates are lower than private insurance. Before scheduling an appointment, call the provider's office and ask whether they accept your Medicaid plan. If you use an out-of-network provider, you may have to pay out of pocket.