What is Medicaid
Medicaid is a joint federal-state health insurance program that provides free or low-cost coverage to eligible low-income individuals, families, pregnant women, elderly adults, and people with disabilities.
Medicaid is a public health insurance program jointly funded by the federal government and individual states that provides health coverage to people with low incomes. It is the largest source of health coverage in the United States, covering more than 80 million Americans as of 2025. Eligibility, benefits, and administration vary by state, but federal rules establish minimum requirements and funding commitments.
Medicaid is distinct from Medicare — Medicaid is income-based and serves people of all ages; Medicare is primarily age-based (65+) and tied to work history.
Who Qualifies for Medicaid
Eligibility varies by state, but under the ACA Medicaid expansion (adopted in most states), coverage generally extends to:
| Population | Income Threshold (Federal Poverty Level) |
|---|---|
| Adults under 65 (expansion states) | Up to 138% FPL (~$20,800/individual in 2025) |
| Children (CHIP) | Up to 200–300% FPL (varies by state) |
| Pregnant women | Up to 138–200% FPL (varies) |
| Elderly/disabled | Determined by asset and income tests |
As of 2025, all but a handful of states have expanded Medicaid under the ACA. In non-expansion states, income thresholds are significantly lower, leaving many low-income working adults in a "coverage gap."
What Medicaid Covers
Federal law requires Medicaid to cover:
- Inpatient and outpatient hospital services
- Physician and specialist services
- Laboratory and imaging services
- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) for children
- Family planning services
- Nursing facility services
States can (and most do) expand coverage to include dental, vision, mental health, substance use treatment, prescription drugs, and transportation.
Cost-Sharing Under Medicaid
Medicaid has minimal cost-sharing:
- Premiums: Generally $0 for most beneficiaries (small premiums for some in higher-income brackets)
- Copays: Limited by federal rules — typically $0–$4 for most services
- No deductible in most state programs
This makes Medicaid dramatically more affordable than private insurance options like COBRA or marketplace plans.
Medicaid vs. Medicare vs. Marketplace
| Program | Who It Serves | Cost to Member |
|---|---|---|
| Medicaid | Low-income individuals, all ages | Free or very low |
| Medicare | Seniors (65+) and certain disabled | Premiums + cost-sharing |
| ACA Marketplace | Anyone not otherwise covered | Premiums (subsidies available) |
Some people qualify for both Medicaid and Medicare — they're called "dual eligibles" and receive the most comprehensive benefits.
How to Apply for Medicaid
You can apply through:
- Healthcare.gov — income verification triggers automatic review for Medicaid eligibility
- Your state's Medicaid agency — many have online applications
- In person at local social services offices
Medicaid eligibility is based on current monthly income, not annual income — so major life events like job loss can create immediate eligibility, even mid-year.
Medicaid Renewal and Continuous Eligibility
After the COVID-19 pandemic's continuous enrollment protections ended in 2023, states resumed annual Medicaid eligibility reviews. Beneficiaries must update their income information annually to maintain coverage. Many people lost Medicaid not because they became ineligible, but because of failed redetermination processes — keeping contact information updated with your state Medicaid agency is critical.