Medicaid has no monthly premium for most people
Most adults and children covered by Medicaid pay nothing each month. There is no monthly fee, no insurance premium, and no enrollment cost. Medicaid is funded by federal and state taxes, not by charges to the people it covers.
Some states have introduced small monthly premiums for certain groups — usually working adults without dependent children — but even these are rare and typically under $20 per month. If your state does charge a premium, you would learn about it during the enrollment process, and the amount would be spelled out in writing before coverage begins.
Key Takeaways
- Most Medicaid members pay zero dollars per month; there is no premium, enrollment fee, or monthly charge.
- A handful of states charge premiums to working adults, typically $5 to $20 per month, and you are told the amount before you enroll.
- You may pay a small copay when you visit a doctor or fill a prescription, but this is separate from any monthly cost and often waived for preventive care.
- If you stop meeting income or other requirements, your coverage ends; you do not owe back premiums.
- The amount you pay depends on your state and your category of coverage, so check your state Medicaid office for specifics.
Which states charge monthly premiums and how much
As of 2024, fewer than 10 states have active premium requirements, and most of those apply only to adults earning above a certain income threshold. Indiana, Iowa, Kentucky, and a few others have experimented with premiums, but the amounts and who pays vary widely. Some states have suspended or eliminated their premiums in recent years.
The most common scenario is a state charging $5 to $20 per month to working adults without dependent children whose income is above the poverty line. Parents and children almost never face premiums. Pregnant people and people over 65 are typically exempt. If your state does charge a premium and you do not pay it, your coverage may be suspended, though you can usually restore it by paying what you owe.
Because state rules change and vary significantly, the only way to know what you would pay in your state is to contact your state Medicaid office directly or check their website. A 211 call can also connect you to your state program.
Copays and other costs you might see at the doctor
Even though there is no monthly premium, Medicaid may require you to pay a small amount when you use a service. This is called a copay. A typical copay might be $1 to $5 for a doctor visit or prescription, though some services are free.
Preventive care — like annual checkups, vaccinations, and cancer screenings — is almost always free with no copay. Emergency room visits and inpatient hospital stays usually have no copay or a small one. Mental health visits and substance use treatment often have no copay as well.
Some states waive copays entirely for people with very low incomes. Others charge copays only for certain services. Your Medicaid card or member handbook will list what copays apply to you, or you can call the number on your card to ask before you go to an appointment.
What happens if you cannot pay a premium
If your state charges a premium and you miss a payment, your coverage is usually suspended — not canceled. This means you lose coverage temporarily, but you can restore it by paying the amount owed, often within 30 to 90 days.
During the suspension period, you are not covered and would have to pay out of pocket for medical care. However, if you go to an emergency room, you will still receive care; the hospital cannot turn you away, though you may receive a bill afterward.
If you are having trouble paying a premium, contact your state Medicaid office immediately. Some states have hardship exemptions or payment plans. Explaining your situation before you miss a payment is better than waiting until coverage is suspended.
Income limits and how they affect what you pay
Medicaid is a program for people with low income. The income limit varies by state and by category — parents, children, pregnant people, elderly people, and people with disabilities all have different thresholds. In most states, if your income is below 138% of the federal poverty line, you may be covered at no premium.
If your income is above that threshold but your state has expanded Medicaid, you might still be covered, but your state may charge a premium. The higher your income within the covered range, the more likely a premium applies — though again, this is rare and state-specific.
Your income is checked when you enroll and then once per year. If your income rises above your state's limit, your coverage ends. You do not owe back premiums or bills; you simply lose coverage and would need to find another option, such as a marketplace plan.
Medicaid for children and pregnant people
Children covered by Medicaid almost never have a monthly premium, regardless of state. The same is true for pregnant people. These groups are protected from premium charges under federal rules, even in states that charge premiums to other adults.
Children may have small copays for some services, but preventive care is free. Pregnant people have no copays for prenatal care, delivery, or postpartum care. If you are pregnant or caring for a child on Medicaid, you should not see a monthly bill.
Frequently Asked Questions
Do I have to pay Medicaid back if I move to a different state?
No. Medicaid coverage ends when you move and your new state's residency requirement is met, but you do not owe money for the coverage you received. Your new state will have its own Medicaid program with its own rules and income limits. You will need to enroll in your new state's program if you want to continue coverage.
What if I earn too much for Medicaid but cannot afford insurance?
You may be able to buy a plan through the Health Insurance Marketplace, where you might receive a tax credit or subsidy to lower your monthly premium. You can also contact 211 or your state insurance commissioner's office to learn about other low-cost options in your area.
Can my employer charge me to enroll in Medicaid?
No. Medicaid is a government program, not an employer benefit. Your employer cannot charge you to enroll or deduct Medicaid premiums from your paycheck. If someone claims otherwise, contact your state Medicaid office or your state labor department.
Will I owe money if my Medicaid coverage is terminated?
No. If your coverage ends because your income rose or you moved, you do not owe back premiums or medical bills for care you received while covered. However, if you missed a premium payment in a state that charges premiums, you may owe that specific amount to restore coverage.
How do I find out what my state charges?
Contact your state Medicaid office directly — the phone number is on the Medicaid website for your state. You can also call 211 and ask to be connected to your state program. They can tell you the exact premium, if any, and who is required to pay it.