Medicaid pays for medical care for people with low income, and the specific services it covers depend on which state you live in

Medicaid is a joint federal and state program that covers doctor visits, hospital stays, prescription drugs, and other medical services for people who meet income limits. Unlike Medicare, which is based on age or disability status, Medicaid is based on how much money you make. Each state runs its own Medicaid program within federal guidelines, so what Medicaid covers in one state may differ from another.

The program pays the provider directly — your doctor, hospital, or pharmacy — rather than giving you money to pay them yourself. You typically pay little or nothing out of pocket for covered services, though some states charge small copayments for certain visits or prescriptions.

Key Takeaways

  • Medicaid covers doctor visits, hospital care, emergency services, prescription drugs, and preventive care for people with low income, but the exact services vary by state.
  • You do not pay Medicaid directly; the program pays providers on your behalf, and you usually pay nothing or a small copayment per visit.
  • Medicaid is different from Medicare — Medicaid is income-based, while Medicare is for people 65 and older or with certain disabilities.
  • Each state sets its own income limits and decides which additional services to cover beyond the federal minimum.
  • You must be a U.S. citizen or may have access to immigrant and meet your state's income and asset rules to be covered.

What Medicaid covers in every state

Federal law requires all state Medicaid programs to cover certain core services. These include doctor office visits, hospital inpatient and outpatient care, emergency room visits, lab tests and X-rays, family planning services, and preventive care like vaccinations and screenings. Prescription drugs are also covered, though the specific medications available and any copayments vary by state.

Medicaid also covers long-term care services in some situations, including nursing home care and home health services for people who need ongoing medical support. Mental health and substance use treatment are covered services as well, though the range of providers and types of therapy available depends on your state's program.

Services that vary by state

Beyond the federal minimum, states can choose to cover additional services with their Medicaid funds. Some states cover dental care, vision care, and hearing aids; others do not. Physical therapy, occupational therapy, and speech therapy coverage also differs. Some states cover transportation to medical appointments, while others leave that to you.

Your state's Medicaid program publishes a list of covered services, usually on its health department website. If you are unsure whether a specific service or medication is covered, contact your state Medicaid office or your Medicaid managed care plan directly — they can tell you before you receive the service and avoid unexpected bills.

How Medicaid pays providers

When you see a doctor or go to a hospital that accepts Medicaid, you show your Medicaid card and the provider bills Medicaid directly. The program pays the provider a set rate for that service, which is usually lower than what private insurance pays. Providers agree to accept Medicaid's payment as full payment for covered services, so you cannot be billed for the difference.

Not all providers accept Medicaid. Some doctors, dentists, and specialists do not participate in the program because the payment rates are lower than private insurance. Before scheduling an appointment, ask whether the provider accepts your Medicaid plan. If you are in a Medicaid managed care plan, you may be limited to in-network providers, similar to how private insurance works.

Income limits and who qualifies

Medicaid covers people with low income, but the income limit varies significantly by state. Some states cover people earning up to 138% of the federal poverty level; others have lower limits. Your state's Medicaid office publishes its current income limits, and they change each year based on federal poverty guidelines.

You must also be a U.S. citizen or a may have access to immigrant to receive Medicaid. Some states have additional requirements, such as residency in that state or limits on assets you can own. Medicaid is not based on immigration status alone — even if you are a citizen, you must meet your state's income and other rules.

Medicaid versus Medicare

Medicaid and Medicare are separate programs that serve different groups. Medicare is primarily for people 65 and older, regardless of income, and for some younger people with disabilities or end-stage renal disease. Medicaid is for people with low income of any age. Some people may have access to for both programs — they are called "dual may be able to access" — and in that case both programs work together to cover costs.

If you are not yet 65 and do not have Medicare, Medicaid is your main option for government health coverage based on income. If you are 65 or older, you are automatically covered by Medicare Part A (hospital insurance) and should also check whether you may have access to for Medicaid to help pay your Medicare premiums and out-of-pocket costs.

How to find out what your state covers

Each state Medicaid program has a website listing covered services, income limits, and how to contact the program. You can find your state's Medicaid office by searching "[your state] Medicaid" or by visiting the federal Centers for Medicare and Medicaid Services website, which links to every state program.

If you already have Medicaid, your state sends you a handbook or member guide that lists covered services and explains how to use your benefits. If you are considering Medicaid, your state's website usually has a tool to check whether you meet the income limit before you formally submit information. Many states also have a phone line where staff can answer questions about coverage and may be able to access rules.

Frequently Asked Questions

Does Medicaid cover dental and vision care?

It depends on your state. Some state Medicaid programs cover routine dental care, cleanings, and fillings; others cover only emergency dental work. Vision coverage varies similarly — some states cover eye exams and glasses, others do not. Check your state's Medicaid website or call your state Medicaid office to learn what is covered where you live.

Can I use Medicaid at any doctor or hospital?

Not all providers accept Medicaid. Some doctors and specialists do not participate because Medicaid payment rates are lower than private insurance. If you are in a Medicaid managed care plan, you are usually limited to in-network providers. Always call ahead to confirm a provider accepts your Medicaid plan before scheduling an appointment.

What happens to my Medicaid if my income goes up?

If your income rises above your state's Medicaid limit, you will lose coverage. The timing depends on your state — some programs check income monthly, others quarterly or annually. You should report income changes to your state Medicaid office right away. You may be able to move to a private insurance plan through your employer or the health insurance marketplace.

Does Medicaid cover prescription drugs?

Yes, Medicaid covers prescription medications, but your state decides which drugs are covered and whether you pay a copayment. Some medications require prior approval from Medicaid before the pharmacy will fill them. If your doctor prescribes a drug that is not covered, ask whether a covered alternative exists or whether your state Medicaid program will make an exception.

Is Medicaid the same in every state?

No. While all states must cover certain core services, each state sets its own income limits, decides which additional services to cover, and manages its own program. A service covered by Medicaid in one state may not be covered in another. If you move to a different state, you will need to reapply for Medicaid there and learn what that state's program covers.