Medicaid is a government health insurance program that covers medical costs for people with limited income. Unlike Medicare, which is based on age and work history, Medicaid eligibility is primarily based on income and household size. It is jointly funded by the federal government and each state, which means the specific benefits and income limits vary depending on where you live.
For millions of Americans — including seniors, adults with disabilities, parents, and children — Medicaid is how they access healthcare. Understanding who qualifies and how to apply can make a significant difference in your out-of-pocket costs.
Who Qualifies for Medicaid
Medicaid eligibility depends on your state, household size, and income. In states that expanded Medicaid under the Affordable Care Act, most adults with incomes at or below 138 percent of the federal poverty level qualify. For 2026, that is approximately $20,783 per year for a single person.
As of 2026, 41 states and the District of Columbia have expanded Medicaid. In non-expansion states, eligibility is generally more limited and often tied to specific categories such as pregnancy, disability, or having dependent children. You can check your state’s rules through your state Medicaid agency or at healthcare.gov.
Certain groups have broader pathways to Medicaid regardless of standard income limits:
- Seniors and people with disabilities — may qualify through SSI eligibility or specific Medicaid programs
- Pregnant women — most states set higher income thresholds during pregnancy
- Children — covered through Medicaid or CHIP in most households
- Dual-eligible individuals — seniors or people with disabilities who qualify for both Medicaid and Medicare
What Medicaid Covers
Federal law requires all state Medicaid programs to cover a core set of services. These include inpatient and outpatient hospital care, physician visits, laboratory tests, nursing facility care, home health services, and prescription drugs in most states. Many states go further and also cover dental care, vision, mental health services, and transportation to medical appointments.
Medicaid typically has no monthly premiums and very low or no cost-sharing for covered services. For people who qualify, it is one of the most comprehensive low-cost health coverage options available.
Medicaid and Medicare Together
If you are 65 or older with limited income, you may qualify for both Medicare and Medicaid. People in this situation are called “dual eligible.” Medicaid can help cover Medicare premiums, deductibles, and copays that would otherwise come out of pocket. It may also cover services Medicare does not, such as long-term nursing home care.
Medicare Savings Programs are a related option — they help pay Medicare costs for people who do not qualify for full Medicaid but still have limited income. If you are on Medicare and struggling with healthcare costs, it is worth checking both programs.
How to Apply
You can apply for Medicaid in several ways:
- Online: At healthcare.gov or your state’s Medicaid website
- By phone: Call your state Medicaid agency directly
- In person: At a local Department of Social Services or community health center
- With free assistance: Navigators and benefits counselors can help at no cost in most areas
You will typically need to provide proof of identity, residency, income, and household size. If your situation is urgent — such as a hospital stay — applications can sometimes be processed quickly.
If You Are Not Sure Whether You Qualify
Eligibility rules are complex, and many people who qualify never apply. If your income is modest or you fall into a specific category — senior, disabled, pregnant, parent of a minor child — it is worth checking. Applying costs nothing, and approval can cover thousands of dollars in medical expenses.
Use our Benefits Finder tool to check what programs you may be eligible for, including Medicaid and other assistance programs.
Money Instructor does not provide tax, legal, or investment advice. This material has been prepared for educational and informational purposes only. You should consult your own advisors regarding your own financial situation.
