Medicaid is the largest health insurance program in the United States, covering over 90 million Americans. It provides free or very low-cost healthcare to people with limited incomes, and it covers everything from doctor visits and hospital stays to prescriptions and mental health care.
If you're struggling to afford health insurance or medical care, Medicaid might be the answer — and you might qualify even if you think you don't. This guide walks you through eligibility rules, income limits, and exactly how to apply.
What Medicaid Covers
Medicaid covers a comprehensive set of healthcare services. While exact coverage varies by state, all Medicaid programs must cover:
- Doctor visits — primary care and specialists
- Hospital stays — inpatient and outpatient
- Emergency services
- Prescription drugs
- Lab tests and X-rays
- Mental health services — therapy, psychiatric care, substance abuse treatment
- Preventive care — screenings, vaccines, wellness visits
- Maternity and newborn care
- Pediatric services — including dental and vision for children
Many states also cover additional services like dental care for adults, vision, physical therapy, and long-term care.
Cost to you: Most Medicaid beneficiaries pay $0 in premiums and minimal copays (often $1–$4 per service). There are no deductibles, and out-of-pocket costs are capped at 5% of your household income.
Who Qualifies for Medicaid in 2026
Medicaid eligibility depends primarily on your income and household size, though rules vary significantly by state.
In Medicaid Expansion States (41 states + D.C.)
If your state expanded Medicaid under the ACA, eligibility is straightforward:
- Adults under 65: Household income at or below 138% of the Federal Poverty Level (FPL)
- Children: Generally covered at higher income levels (up to 200–300% FPL in many states)
- Pregnant women: Often covered at higher income levels (up to 200% FPL or more)
2026 Income Limits (138% FPL) for Medicaid Expansion:
| Household Size | Annual Income Limit | Monthly Income Limit |
|---|---|---|
| 1 person | $20,783 | $1,732 |
| 2 people | $28,208 | $2,351 |
| 3 people | $35,633 | $2,969 |
| 4 people | $43,056 | $3,588 |
| 5 people | $50,481 | $4,207 |
In Non-Expansion States
A handful of states have not expanded Medicaid. In these states, eligibility is more limited:
- Parents/caregivers: Income limits vary, sometimes as low as 17–50% FPL
- Childless adults: Often not eligible regardless of income (the "coverage gap")
- Children and pregnant women: Still covered at higher income levels
If you're in a non-expansion state and earn too much for Medicaid but too little for marketplace subsidies, you're in what's called the coverage gap. Check if your state has announced expansion plans, and look into community health centers for affordable care in the meantime.
Special Eligibility Groups
Some groups qualify for Medicaid regardless of the expansion status:
- Pregnant women — most states cover up to 200% FPL
- Children under 19 — through Medicaid or CHIP, often up to 200–300% FPL
- Seniors 65+ — who meet income and asset tests (often alongside Medicare)
- People with disabilities — who receive SSI or meet state disability criteria
- Former foster care youth — covered until age 26
How to Apply: Step by Step
Step 1: Gather Your Documents
Before you start, collect:
- Proof of identity: Driver's license, state ID, passport, or birth certificate
- Social Security numbers for everyone in your household applying
- Proof of income: Recent pay stubs, tax return, W-2, or letter from employer. If self-employed, profit/loss statement
- Proof of residency: Utility bill, lease agreement, or bank statement with your address
- Immigration documents (if applicable): Green card, work permit, or other status documentation
- Information about current insurance (if any)
Don't let missing documents stop you from applying. You can submit the application and provide documentation later. The key is to get the application in — eligibility can be retroactive up to 3 months before your application date.
Step 2: Choose Your Application Method
Online (fastest):
- Visit Healthcare.gov — when you apply for coverage, they'll automatically check if you qualify for Medicaid
- Or go directly to your state's Medicaid website — search "[your state] Medicaid application"
By phone:
- Call the Health Insurance Marketplace at 1-800-318-2596 (24/7)
- Or call your state's Medicaid office directly
In person:
- Visit your local Department of Social Services or Department of Health office
- Many community health centers have enrollment assistors who can help you apply
By mail:
- Download and print the application from your state's Medicaid website or request one by phone
Step 3: Fill Out the Application
The application asks about:
- Your household members and their ages
- Your income from all sources
- Your current insurance status
- Whether you're pregnant, disabled, or have other qualifying conditions
- Your citizenship or immigration status
Tips for a smooth application:
- Report your current monthly income, not your annual income (Medicaid uses Modified Adjusted Gross Income — MAGI)
- Include all household members, even those not applying for Medicaid — household size affects the income limit
- Be honest and thorough — incomplete applications cause delays
Step 4: Submit and Wait
After submitting:
- Your state must process the application within 45 days (90 days if you're applying based on disability)
- You may receive a request for additional documentation — respond promptly
- If approved, your coverage may be retroactive to the first day of the month you applied — and sometimes up to 3 months prior
Step 5: If You're Denied
If your application is denied, you have the right to appeal. The denial letter will explain how. Common reasons for denial and what to do:
- Income too high: Double-check their calculation. Medicaid uses MAGI, which may differ from your gross income. Also check if you qualify for CHIP (for children) or marketplace subsidies instead.
- Missing documentation: Submit the requested documents and ask for reconsideration.
- Not in an eligible category: Check if there are other Medicaid programs you might qualify for (aged, blind, disabled, pregnant, etc.).
Medicaid and Employment
A common misconception: you can work and still qualify for Medicaid. The program is based on income, not employment status. Plenty of working people — especially those in part-time, gig, or low-wage jobs — qualify.
If you get a raise or new job that pushes you over the income limit, you won't lose coverage immediately. Most states provide a transition period, and you can move to a marketplace plan with subsidies.
Medicaid vs. Other Programs
- Medicaid vs. Medicare: Medicaid is for low income; Medicare is for people 65+ or with disabilities. Some people qualify for both ("dual eligible"). Read our comparison guide.
- Medicaid vs. CHIP: CHIP (Children's Health Insurance Program) covers children in families that earn too much for Medicaid but can't afford private insurance. You apply through the same process — the system routes you automatically.
- Medicaid vs. Marketplace plans: If you earn too much for Medicaid, you may qualify for subsidized marketplace plans. Here's how to choose one.
Important Things to Know
You Can Apply Year-Round
Unlike marketplace insurance, Medicaid has no open enrollment period. You can apply any time of year. If you qualify, you qualify — there's no waiting for a special window.
Retroactive Coverage
Medicaid can cover medical expenses from up to 3 months before your application date, as long as you would have been eligible during that time. If you have unpaid medical bills from recent months, applying for Medicaid might help cover them.
No Asset Test in Most Cases
For most adults in expansion states, Medicaid eligibility is based solely on income — not assets. You can own a home and a car and still qualify. Asset tests typically only apply to seniors and people with disabilities applying for long-term care coverage.
Immigration Status
Eligibility for immigrants varies:
- U.S. citizens and nationals: Fully eligible
- Lawful permanent residents (green card holders): Eligible after 5 years in most states, though some states cover them sooner
- Refugees and asylees: Immediately eligible
- Undocumented immigrants: Generally not eligible for full Medicaid, but may qualify for emergency Medicaid and some state-funded programs
- Children and pregnant women: Some states cover regardless of immigration status through state-funded programs
Renewal
Medicaid isn't permanent — you'll need to renew annually. Your state will send a renewal form. Fill it out promptly or you risk losing coverage. Many states now do automatic renewals using data matching, but don't count on it — respond to any mail from your Medicaid office.
The Bottom Line
If you earn under about $20,800 as an individual or $43,000 for a family of four, you may qualify for Medicaid. It's comprehensive coverage with minimal costs, and you can apply any time.
Don't let the paperwork intimidate you. The application takes about 15–30 minutes online, and free help is available through community health centers, navigators, and the marketplace call center.
If you're currently uninsured and waiting on your application, community health centers can provide affordable care while you wait. And for any planned procedures, use Taven's Compare Care tool to find the best prices in your area.