If you’ve ever skipped a doctor’s appointment or delayed filling a prescription because of the cost, you’re not alone. Medical expenses can add up quickly, and for people living on a limited income, even basic healthcare can feel out of reach. That’s where Medicaid comes in.
Medicaid is a public health insurance program that offers free or low-cost healthcare coverage to eligible individuals and families. If you’re not sure whether you qualify or what it covers, this guide is here to help you get the facts.
What Is Medicaid?
Medicaid is a joint federal and state program that helps pay for medical care for low-income people of all ages. While the federal government funds it, each state runs its own program, which means rules, coverage, and benefits can vary depending on where you live.
Medicaid is different from Medicare, which is primarily for people over 65 or with certain disabilities. You don’t have to be elderly or disabled to get Medicaid—many working adults, parents, and children also qualify based on income and need.
What Does Medicaid Cover?
Medicaid offers a broad range of health services, many of which are completely free to the patient. While the exact list can vary by state, there are some core benefits that all state Medicaid programs must provide.
Mandatory Medicaid benefits include:
- Doctor visits (including specialists)
- Hospital stays and surgeries
- Emergency services
- Lab work and X-rays
- Pediatric services for children
- Vaccinations and preventive screenings
- Mental health services
- Nursing facility services
- Prescription medications
- Family planning services
In addition to these, many states also offer optional services, such as:
- Dental care (especially for children)
- Vision care (eye exams and glasses, especially for children)
- Physical therapy and rehab
- Chiropractic care
- Hospice services
- Occupational therapy
Because Medicaid is focused on improving long-term health outcomes, it tends to cover services that help prevent bigger health issues down the road.
Who Can Get Medicaid?
Eligibility depends mostly on income, household size, and specific circumstances (like age, pregnancy, or disability). Each state uses slightly different guidelines, but many follow the federal standards or have expanded Medicaid under the Affordable Care Act (ACA).
You may be able to get Medicaid if you are:
- A child (in some states, up to age 19)
- A pregnant person or a new parent
- A parent or guardian of children
- A low-income adult, even without children (in Medicaid expansion states)
- A senior or a person over 65 with limited income
- A person with a disability or chronic condition
- A recipient of SSI (Supplemental Security Income)
Even if you don’t fall into these categories, you might still qualify based on income alone, especially if your state has expanded Medicaid.
How Much Income Is Too Much?
Each state sets its own income limits for Medicaid, based on the Federal Poverty Level (FPL) and your household size. In non-expansion states, income limits are often lower and may require you to meet other conditions (like being a parent or pregnant).
Tip: The easiest way to find out if you qualify is to apply or use a Medicaid eligibility screening tool on your state’s health department website or healthcare.gov.
How Do You Apply for Medicaid?
The application process is free, and most states allow you to apply online, by phone, by mail, or in person at a local office. To apply, you’ll usually need:
- Proof of identity (such as a driver’s license or ID card)
- Proof of income (pay stubs, tax return, benefit letters)
- Social Security numbers for everyone applying
- Information about your household size
- Immigration documents (if applicable)
Once your application is submitted, you’ll get a notice of approval or denial—often within 30 to 45 days. If approved, your coverage may begin immediately or even be backdated to cover recent medical expenses.
What If You’re Pregnant?
Pregnant people often qualify for Medicaid even if their income is slightly above normal limits. Coverage includes prenatal care, delivery, and postpartum services, and often continues for 12 months after giving birth in most states.
Some states also have Presumptive Eligibility, which allows healthcare providers to grant temporary Medicaid coverage while your full application is being reviewed, so you can get care right away.
Does Medicaid Cover Children?
Yes. In fact, Medicaid provides health coverage to around 37 million children in the U.S. Children can often qualify even if their parents don’t. However, like adult benefits, children’s benefits vary by state. However, children are more likely to receive benefits like dental and vision care.
If children don’t qualify for Medicaid, they may still be eligible for the Children’s Health Insurance Program (CHIP). CHIP provides coverage for children in middle-income households who don’t qualify for Medicaid but can’t afford private insurance.
Can You Have Medicaid and Other Insurance?
Yes. You can be enrolled in Medicaid even if you have other insurance, including Medicare, employer coverage, or private plans. In those cases, Medicaid often acts as secondary insurance. It may cover:
- Services your main insurance doesn’t pay for
- Copays and deductibles
- Out-of-pocket costs that would otherwise fall to you
If you have Medicare and qualify for Medicaid, you’re considered “dual eligible”, which opens up additional help with prescription costs, long-term care, and Medicare premiums.
What Is Dual Eligibility?
If you qualify for both Medicare and Medicaid, you’re considered dually eligible, and that can open up even more benefits.
Medicare typically becomes your primary insurance, covering things like hospital stays, doctor visits, and outpatient care. Medicaid steps in as secondary coverage, helping with copays, deductibles, prescription drug costs, and services Medicare doesn’t fully cover, like long-term care or transportation to medical appointments.
If you’re over 65 or have a disability and think you might be eligible for both, it’s worth checking—dual eligibility can reduce your out-of-pocket costs significantly.
What If You’re Denied Medicaid?
If your application is denied, don’t panic. You may still have options:
- Review the denial letter—it will explain why you were denied and how to appeal.
- Correct any missing or inaccurate information—denials often come from paperwork issues.
- Explore other programs—you may qualify for low-cost insurance through the ACA marketplace.
- Call your local Medicaid office—they may offer help with reapplying or filing an appeal.
You also have the right to request a hearing if you believe the decision was made in error.
What Else Should You Know About Medicaid?
Here are a few more helpful things to keep in mind:
- You can apply at any time—there’s no open enrollment window like private insurance plans.
- You must renew coverage annually—your state will contact you with instructions to verify your income and household info.
- Coverage can be retroactive—if you’ve had medical bills in the past 3 months and were eligible, Medicaid may help cover them.
- Your privacy is protected—your personal and immigration information isn’t shared with law enforcement.
Medicaid Is Here to Help
Healthcare shouldn’t be a luxury, and if you’re living on a limited income, Medicaid can provide real peace of mind. Whether you’re raising kids, managing a chronic condition, or just trying to afford a check-up, this program exists to help you stay healthy without going into debt.
Don’t assume you won’t qualify. The rules are more flexible than many people realize, and applying is always free. Even if you’re unsure, it’s worth taking a look—because everyone deserves access to care.
