Yes, Medicaid is government information for health care costs

Medicaid is a joint federal and state program that pays for medical care for people with low income. The federal government sets basic rules, but each state runs its own Medicaid program and decides who is covered and what services are paid for. This means Medicaid in one state may look different from Medicaid in another state — the income limits, covered services, and process process all vary.

Medicaid is not the same as Medicare. Medicare is a federal program for people 65 and older, regardless of income. Medicaid is for people of any age who meet income and other requirements set by their state.

The program pays doctors, hospitals, and pharmacies directly for your care. You do not receive a check or cash benefit. Instead, when you go to a doctor who accepts Medicaid, that doctor bills Medicaid for the visit, and Medicaid pays the bill.

Key Takeaways

  • Medicaid is run by your state, not by the federal government, so income limits and covered services differ by state.
  • The program pays health care providers directly, not you — you show your Medicaid card at the doctor's office.
  • Income limits vary widely; some states cover people earning up to 138 percent of the federal poverty line, while others set lower thresholds.
  • You must live in the state where you are explore and meet that state's specific rules for income, citizenship, and other factors.

How Medicaid differs from other government health programs

Medicaid is one of several government programs that help pay for health care, but each one covers a different group of people. Medicare covers people 65 and older and some younger people with disabilities or end-stage renal disease. The Children's Health Insurance Program (CHIP) covers children in families with income too high for Medicaid but too low to afford private insurance. Veterans may be covered through the VA health system. Medicaid is the largest program and covers the most people overall.

Unlike private health insurance, which you buy from an insurance company, Medicaid is paid for with tax dollars. You do not pay a monthly premium for Medicaid in most cases, though some states charge small copayments when you use services. Medicaid also covers services that private insurance often does not, such as nursing home care and long-term care services.

Who Medicaid covers in your state

Each state decides its own income limits for Medicaid. Some states use the federal poverty line as a starting point — for example, a state might cover people earning up to 138 percent of the federal poverty line. Other states set their own limits that are lower or higher. A few states have not expanded Medicaid at all, meaning fewer people are covered.

Beyond income, your state may require you to be a U.S. citizen or may have access to immigrant, to live in that state, and to be a resident of the United States. Some states cover pregnant people, parents, children, people with disabilities, and elderly people. Other states have different categories. The only way to know what your state covers is to check your state's Medicaid website or call your state Medicaid office.

Your income is measured as a percentage of the federal poverty line. For 2024, the federal poverty line for a single person is about $14,600 per year. A state that covers people at 138 percent of the poverty line would cover a single person earning up to about $20,100 per year. If you have dependents, the income limit is higher.

How to learn about your state's Medicaid covers you

The fastest way to learn whether you may be covered is to contact your state Medicaid office directly. You can find your state office through the Centers for Medicare and Medicaid Services (CMS) website, which lists every state program. Your state Medicaid office can tell you the current income limits, what documents you need to provide, and how long the process takes.

You can also call 211, a free helpline run by the United Way. Dial 2-1-1 from any phone, and a counselor will tell you what programs your state offers and help you understand the next steps. The counselor can also answer questions about other programs you might be covered by.

When you contact your state Medicaid office, have ready your Social Security number, proof of income (such as recent pay stubs or tax returns), and proof of residency (such as a utility bill or lease). Different states ask for different documents, so ask what you need before you gather everything.

What Medicaid pays for

Federal law requires all state Medicaid programs to cover certain services: doctor visits, hospital stays, emergency care, lab tests, X-rays, nursing home care, and family planning services. States may also cover dental care, vision care, hearing aids, mental health services, and substance use treatment. Some states cover more services than others.

Medicaid covers prescription drugs, though each state has a list of drugs it will pay for. If your doctor prescribes a drug not on the list, you may have to pay for it yourself or ask your doctor to prescribe a different drug that is covered. Medicaid also covers preventive care like vaccines and cancer screenings at no cost to you.

Medicaid and work or income changes

If you are covered by Medicaid and your income increases, you may lose coverage. The income limit varies by state, but in most states, if you earn more than the limit, you are no longer covered. Some states have a grace period where you stay covered for a few months after your income goes over the limit, but this is not true everywhere.

If your income drops again, you can reapply. You should report any major change in income, family size, or living situation to your state Medicaid office, because your coverage may change. Many states now allow you to report changes online or by phone rather than in person.

Medicaid expansion and coverage gaps

In 2014, the federal government gave states the option to expand Medicaid to cover more people with low income. Some states took this option, and others did not. States that expanded Medicaid now cover people earning up to 138 percent of the federal poverty line. States that did not expand have lower income limits, which means some people fall into a coverage gap — they earn too much for Medicaid but too little to afford private insurance or subsidies for private insurance.

If you live in a state that has not expanded Medicaid, you may still be covered if you are pregnant, a parent, elderly, or have a disability. But if you are a childless adult with low income, you may not be covered. Check your state's specific rules to be sure.

Frequently Asked Questions

Does Medicaid cost money?

In most states, Medicaid does not charge a monthly premium. Some states charge small copayments — usually $1 to $5 — when you visit a doctor or fill a prescription. A few states charge premiums for certain groups of people. Contact your state Medicaid office to learn what, if anything, you would pay.

Can I use Medicaid at any doctor?

No. You can only use Medicaid at doctors, hospitals, and pharmacies that accept Medicaid. Most do, but some private practices do not. When you get your Medicaid card, your state will send you a list of providers in your area, or you can search online for providers near you.

What happens if I move to a different state?

Medicaid is state-based, so your coverage ends when you move. You must explore for Medicaid in your new state. The income limits, covered services, and process process may be different. Contact your new state's Medicaid office as soon as you move to find out what you need to do.

Can I have both Medicaid and private insurance?

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

How long does it take to get Medicaid?

Most states aim to process Medicaid applications within 30 days, though some take longer. Emergency Medicaid, which covers emergency hospital care only, may be approved faster. Ask your state office how long the process typically takes and whether you can check the status of your process online.