Medicaid is a joint federal and state health insurance program for people with low income

Medicaid pays for medical care — doctor visits, hospital stays, prescription drugs, mental health treatment, and other services — for people who meet income and other requirements set by their state. It is not a loan. You do not pay it back. The federal government funds part of it; your state funds and runs the rest. This means the program looks different depending on which state you live in: what it covers, who qualifies, and how much you pay out of pocket all vary.

Medicaid is the largest source of health insurance for people under 65 with low income in the United States. It covers roughly 70 million people. Unlike Medicare, which is federal and based on age or disability, Medicaid is state-run and based mainly on income. You apply through your state, not through a national office.

Key Takeaways

  • Medicaid is health insurance for people with low income, run by your state with federal funding, and you do not repay it.
  • Income limits, covered services, and out-of-pocket costs differ by state, so what qualifies you in one state may not in another.
  • You apply through your state's Medicaid office or health department, not through a federal agency.
  • Medicaid covers doctor visits, hospital care, prescription drugs, mental health services, and many other medical needs, though the exact list varies by state.
  • Some people may have access to based on income alone; others must also be pregnant, disabled, a child, or a parent or caregiver of a child.

Who Medicaid covers

Medicaid covers people in specific groups: children, pregnant people, parents and caregivers of children, people over 65, and people with disabilities. Within each group, there is an income limit. The limit varies by state and by which group you fall into. For example, a state might cover children in households earning up to 200% of the federal poverty line but cover parents only up to 100% of the poverty line.

Some states also cover people with low income who do not fit into one of those groups — this is called Medicaid expansion, and it was optional under federal law starting in 2014. Expansion states cover adults earning up to a certain income (usually around 138% of the federal poverty line) regardless of whether they are parents, disabled, or in another category. Non-expansion states do not. This is why a single adult with the same income might have Medicaid in one state and not in another.

Your state's Medicaid office publishes its income limits and covered groups on its website. You can also call 211 or visit your state health department to ask whether you likely may have access to.

What Medicaid pays for

Medicaid must cover certain services in every state: doctor visits, hospital inpatient and outpatient care, lab tests, X-rays, and nursing home care for people over 21. Beyond that, states choose what else to cover. Most states cover prescription drugs, mental health and substance use treatment, dental care for children, and vision care. Some cover dental and vision for adults; some do not. Some cover physical therapy, hearing aids, or other services; others do not.

When you enroll in Medicaid in your state, you will receive a handbook or summary that lists what is covered. Read it or ask your state's Medicaid office what services matter to you — whether that is dental work, mental health visits, or prescription medications — before you assume they are included.

How much Medicaid costs

Medicaid is free or very low-cost. Most people pay nothing for coverage itself. Some states charge a small monthly premium (usually a few dollars) for certain groups, and some charge copayments when you use a service — for example, $3 for a doctor visit or $1 for a prescription. These copayments are capped by federal law so they do not become a barrier to care. Pregnant people, children under 18, and emergency services are usually free with no copayment.

If you cannot afford even a small copayment, tell the provider or the Medicaid office. Many providers will waive it, and Medicaid rules allow for hardship exceptions.

How to apply for Medicaid

You apply through your state's Medicaid office, which is usually part of the state health department or department of human services. You can apply online, by mail, by phone, or in person. The state's website lists all the ways to apply and what documents you need to bring — usually proof of income (a recent pay stub or tax return), proof of residency (a utility bill or lease), and proof of citizenship or immigration status.

The application asks for your income, household size, citizenship, and which group you fall into (child, parent, pregnant person, disabled person, or adult in an expansion state). Be honest about your income. Medicaid uses your household income, not just your own, and it counts income from all household members.

After you submit your application, the state has a deadline to make a decision — usually 30 to 45 days. You will receive a notice in the mail or email telling you whether you are covered, what your coverage includes, and when it starts. If you are denied, the notice will explain why and how to appeal.

Medicaid and other health insurance

If you have another health insurance plan — through an employer, a spouse's job, or the marketplace — you can still have Medicaid. Medicaid will be your secondary insurance and will cover costs that your primary insurance does not. This is called coordination of benefits.

If you are offered health insurance through your job, you do not have to turn it down to keep Medicaid. However, some states have rules about whether you can have both. Ask your state's Medicaid office if you are unsure.

How long Medicaid coverage lasts

Medicaid coverage lasts as long as you remain in your state and continue to meet the income and other requirements. You must renew your coverage periodically — usually once a year, though some states renew more often. Your state will send you a renewal form in the mail or email. If you do not return it by the deadline, your coverage may end.

If your income increases above the limit, you will lose Medicaid. If you move to another state, your coverage ends in your old state, and you must apply in your new state. Some states have different rules, so contact your new state's Medicaid office as soon as you move.

Frequently Asked Questions

Is Medicaid the same as Medicare?

No. Medicaid is for people with low income and is run by states. Medicare is for people 65 and older and for some younger people with disabilities, and it is run by the federal government. You do not pay into Medicare during your working years to earn it; instead, it is based on age or disability status.

Can I have Medicaid if I work?

Yes. Medicaid is based on income, not on whether you work. If your job pays low wages and your household income is below your state's limit, you can have Medicaid while working. Some states have work requirements, meaning you must work or be in school to stay covered, but most do not.

What happens to my Medicaid if I get a raise?

If your income rises above your state's Medicaid limit, you will lose coverage. However, some states have a grace period or allow you to keep coverage for a few months after your income increases. Contact your state's Medicaid office to ask about your state's rules.

Can I use my Medicaid card in another state?

No. Medicaid is state-specific. If you travel or move, your coverage ends when you leave your state. You must apply for Medicaid in your new state. Some states process applications quickly, so you may be covered within days of moving.

Do I have to choose a doctor with Medicaid?

It depends on your state and your plan. Some states require you to pick a primary care doctor who coordinates your care. Others let you see any doctor who accepts Medicaid. Your state's Medicaid office or your coverage documents will tell you which applies to you.