Medicaid is a joint federal and state program that pays for medical care for people with low income

Medicaid is not a single national program. The federal government sets basic rules, but each state runs its own Medicaid program and decides who it covers, what services it pays for, and how much it reimburses doctors and hospitals. This means what Medicaid covers in California is different from what it covers in Texas or New York.

Medicaid pays doctors, hospitals, and other providers directly when you receive care. You do not pay a premium each month the way you would with private insurance, though some states charge small copays when you visit a doctor or fill a prescription. If you have Medicaid and go to a provider who accepts it, you show your Medicaid card and the program handles the bill.

Medicaid is funded by both federal tax dollars and state tax dollars. The federal government requires states to cover certain groups — pregnant people, children under 19, and people over 65 — but states can choose to cover other groups too. Some states have expanded Medicaid to cover more working-age adults; others have not.

Key Takeaways

  • Medicaid is run by your state, not the federal government, so coverage and rules differ significantly depending on where you live.
  • You do not pay a monthly premium for Medicaid, though some states charge small copays when you use services.
  • Medicaid covers doctor visits, hospital care, prescription drugs, and other medical services, but the exact list varies by state.
  • Income limits for Medicaid differ by state and by family size, and some states have expanded coverage while others have not.

Who Medicaid covers depends on your state and your income

Every state must cover children under 19 whose family income is below a certain level, pregnant people, and people over 65 with very low income. Beyond those groups, states have choices. Some states have expanded Medicaid to cover working-age adults earning up to 138 percent of the federal poverty line. Other states have not expanded, so a working adult might earn too much to may have access to even if they cannot afford insurance.

Income limits are set by your state and change based on family size. A single person might have a different income limit than a family of four. Some states also count assets — savings, property, or other things you own — when deciding whether you may have access to. Others only look at income. You can find your state's specific rules by contacting your state Medicaid office or looking it up on your state health department website.

Medicaid also covers people who are blind, disabled, or over 65 with very low income, regardless of whether they work. The rules for these groups are federal, so they are the same in every state.

What Medicaid pays for varies by state

Every state Medicaid program must cover certain services: doctor visits, hospital stays, lab tests, X-rays, and prescription drugs. Most states also cover dental care, vision care, and mental health services, though the scope varies. Some states cover physical therapy and rehabilitation; others do not. Some cover hearing aids; others do not.

Long-term care — nursing home or home health services for people who need ongoing help — is covered by Medicaid in every state, but the rules about how long you can stay and what you have to pay are different in each state. Medicaid is actually the largest payer for nursing home care in the United States.

To find out exactly what your state Medicaid program covers, contact your state Medicaid office directly or visit your state health department website. Many states publish a handbook that lists covered services.

How to learn about you might be covered

The first step is to contact your state Medicaid office. You can find the phone number and website by searching "[your state] Medicaid" or by calling 211, which is a free referral line that connects you to local health and human services programs. When you call, have your income information and family size ready.

Some states also use a federal website called Healthcare.gov where you can enter your information and see what programs you might be able to use. If your state has expanded Medicaid, you may also be able to use that website to learn whether you may have access to.

You do not have to guess whether you may have access to. Your state Medicaid office can tell you based on your income and family size. If you do not may have access to for Medicaid, they can usually tell you about other programs that might help, such as subsidized private insurance through the marketplace.

How Medicaid differs from Medicare

Medicare and Medicaid are often confused because of their similar names, but they are completely different programs. Medicare is a federal program run by the Social Security Administration. It is based on age or disability, not income. If you are 65 or older, you are usually may be able to access for Medicare regardless of how much money you have.

Medicaid is based on income and is run by states. You can be on both programs at the same time — this is called being "dual may be able to access" — if you are over 65 and have low income. But they serve different purposes and have different rules.

What happens after you are covered

Once you are enrolled in Medicaid, you receive a card that you show to doctors and hospitals. Some states assign you to a primary care doctor who coordinates your care; others let you choose any doctor who accepts Medicaid. When you receive care, the provider bills Medicaid directly. You do not have to file paperwork or wait for reimbursement the way you might with private insurance.

Your Medicaid coverage can change if your income changes, your family size changes, or your state changes its program rules. Some states require you to recertify your income once a year; others recertify more often. If your circumstances change, tell your state Medicaid office so your coverage stays accurate.

If you move to a different state, your Medicaid coverage does not move with you. You will need to apply for Medicaid in your new state, and the rules and covered services may be different.

Frequently Asked Questions

Does Medicaid cover dental and vision care?

Most states cover some dental and vision services through Medicaid, but the scope varies widely. Some states cover routine cleanings and eye exams; others cover only emergency dental care. Contact your state Medicaid office to find out what your state covers.

Can I have Medicaid and private insurance at the same time?

Yes. If you have both, Medicaid usually pays second, after your private insurance pays its share. This is called coordination of benefits. Tell both programs about each other so they coordinate correctly.

What if my income goes up after I am enrolled?

Your coverage may end if your income exceeds your state's limit. Most states require you to report income changes, and some have a grace period before coverage stops. Contact your state Medicaid office if your income changes so you know whether you still may have access to.

Do I have to pay anything for Medicaid?

You do not pay a monthly premium, but some states charge small copays — usually a few dollars — when you visit a doctor or fill a prescription. Copays vary by state and by service. Emergency room visits and preventive care are usually free.

How long does it take to learn about I may have access to?

Most states make a decision within 30 days of receiving your information, though some decide faster. If you are pregnant or a child, some states prioritize your application and decide within days. Ask your state Medicaid office how long the process usually takes.