Medicaid Eligibility: Do You Qualify for Free Health Insurance?

Medicaid provides free or low-cost health coverage to millions of Americans. With expanded eligibility in many states, more people qualify than ever before. Here is how to find out if you are eligible.

Who Qualifies for Medicaid?

Medicaid eligibility varies by state, but you may qualify if you are:

• A low-income adult (in expansion states, up to 138% of poverty level)
• Pregnant
• A parent or caretaker of dependent children
• Elderly (65+) with limited income
• Disabled
• A child in a low-income family

What Medicaid Covers

Medicaid provides comprehensive coverage including:

• Doctor visits and hospital care
• Prescription medications
• Mental health services
• Dental care (varies by state)
• Vision care
• Lab tests and X-rays
• Transportation to medical appointments

How to Apply

Apply online at Healthcare.gov, through your state Medicaid office, or by calling Healthcare.gov. You can apply any time of year – there is no enrollment period for Medicaid. Gather proof of income, identification, and Social Security numbers before starting your application.

Even if you think you make too much money, apply anyway. Many people are surprised to learn they qualify, especially for their children through CHIP.

Medicaid Expansion and What It Means for You

The Affordable Care Act expanded Medicaid eligibility to all adults with incomes up to 138 percent of the federal poverty level. As of 2024, 40 states plus the District of Columbia have adopted Medicaid expansion. In expansion states, single adults without children can qualify for Medicaid for the first time, and income limits are more generous for families. If you live in an expansion state, you may qualify with an income of approximately $20,783 per year for an individual or $43,056 for a family of four.

In states that have not expanded Medicaid, eligibility is more limited. Adults without children may not qualify regardless of income, and parents typically must have very low incomes to be eligible. However, children in all states can qualify for Medicaid or the Children’s Health Insurance Program (CHIP) at higher income levels than adults. In most states, children in families earning up to 200 percent or more of the poverty level qualify for coverage.

What Medicaid Covers

Medicaid provides comprehensive health coverage that rivals many private insurance plans. All state Medicaid programs must cover hospital stays, doctor visits, lab tests, X-rays, prenatal care, and nursing home care. Most states also cover prescription drugs, dental care, vision services, physical therapy, and mental health treatment. Preventive care including screenings, immunizations, and wellness visits are always covered with no out-of-pocket costs to you.

Children enrolled in Medicaid receive an especially broad set of benefits through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. This requires states to provide any medically necessary service to children under 21, even services that are not covered for adults in that state. This includes vision care, dental treatment, hearing aids, speech therapy, and mental health services.

The Application Process Step by Step

Applying for Medicaid is free and can be done in several ways. The fastest option is usually online through your state’s Medicaid website or through HealthCare.gov. You can also apply by phone, by mail, or in person at your local Department of Social Services office. When you apply, you will need to provide your Social Security number, proof of citizenship or legal residency, proof of income, and basic household information.

Most states process Medicaid applications within 45 days, though some applications are approved much faster. If you are pregnant or have a disability, your application may be expedited. Once approved, your coverage can be effective retroactively for up to three months before your application date if you had eligible medical expenses during that time. If you are denied, you have the right to appeal the decision. Many people who are initially denied are approved on appeal, especially with the help of a patient advocate or legal aid attorney.

Medicaid Expansion and What It Means for You

The Affordable Care Act expanded Medicaid eligibility to all adults with incomes up to 138 percent of the federal poverty level. As of 2024, 40 states plus the District of Columbia have adopted Medicaid expansion. In expansion states, single adults without children can qualify for Medicaid for the first time, and income limits are more generous for families. If you live in an expansion state, you may qualify with an income of approximately $20,783 per year for an individual or $43,056 for a family of four.

In states that have not expanded Medicaid, eligibility is more limited. Adults without children may not qualify regardless of income, and parents typically must have very low incomes to be eligible. However, children in all states can qualify for Medicaid or the Children’s Health Insurance Program (CHIP) at higher income levels than adults. In most states, children in families earning up to 200 percent or more of the poverty level qualify for coverage.

What Medicaid Covers

Medicaid provides comprehensive health coverage that rivals many private insurance plans. All state Medicaid programs must cover hospital stays, doctor visits, lab tests, X-rays, prenatal care, and nursing home care. Most states also cover prescription drugs, dental care, vision services, physical therapy, and mental health treatment. Preventive care including screenings, immunizations, and wellness visits are always covered with no out-of-pocket costs to you.

Children enrolled in Medicaid receive an especially broad set of benefits through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. This requires states to provide any medically necessary service to children under 21, even services that are not covered for adults in that state. This includes vision care, dental treatment, hearing aids, speech therapy, and mental health services.

The Application Process Step by Step

Applying for Medicaid is free and can be done in several ways. The fastest option is usually online through your state’s Medicaid website or through HealthCare.gov. You can also apply by phone, by mail, or in person at your local Department of Social Services office. When you apply, you will need to provide your Social Security number, proof of citizenship or legal residency, proof of income, and basic household information.

Most states process Medicaid applications within 45 days, though some applications are approved much faster. If you are pregnant or have a disability, your application may be expedited. Once approved, your coverage can be effective retroactively for up to three months before your application date if you had eligible medical expenses during that time. If you are denied, you have the right to appeal the decision. Many people who are initially denied are approved on appeal, especially with the help of a patient advocate or legal aid attorney.