Medicaid: Free or Low-Cost Health Insurance — Who Qualifies & How to Apply

Who qualifies for Medicaid?

Medicaid eligibility is determined by your state, but federal rules set minimum standards. The Affordable Care Act (ACA) expanded eligibility in most states starting in 2014.

Expansion states (38 states + D.C. as of 2025)

Adults with household income up to 138% of the federal poverty level (FPL) qualify, regardless of assets, family status, or whether they have a disability. Approximate 2025 income limits:

• 1-person household: approximately $20,120/year ($1,677/month)
• 2-person household: approximately $27,214/year ($2,268/month)
• 4-person household: approximately $41,400/year ($3,450/month)

Non-expansion states

If your state has not expanded Medicaid, eligibility for adults without children is much more restrictive. Coverage typically focuses on:

• Pregnant women (income up to 133–200% FPL in most non-expansion states)
• Children and teens (covered through CHIP, see below)
• Parents and caretaker relatives with very low income (thresholds vary widely — sometimes below 20–40% FPL)
• Adults with disabilities (if receiving SSI or meeting separate state criteria)
• Adults age 65 and older with low income

Children's Health Insurance Program (CHIP)

Children in families with higher incomes that still cannot afford private insurance may qualify for CHIP. Most states cover children up to 200–300% of the federal poverty level — and some states higher. CHIP is separate from Medicaid but administered together.

What does Medicaid cover?

Federal law requires states to cover certain services. Most states also cover optional services. Standard Medicaid coverage includes:

• Doctor visits and preventive care
• Hospital stays (inpatient and outpatient)
• Emergency services
• Lab tests and X-rays
• Prescription drugs
• Mental health services
• Substance use disorder treatment
• Pregnancy and maternity care
• Long-term care and nursing home care (for those who meet criteria)

Premiums are generally $0. Co-pays, if any, are very low — typically $1–$3 per service for adults above certain income thresholds.

How to apply for Medicaid

1. Check if your state expanded Medicaid. Visit healthcare.gov/medicaid-chip to see your state's expansion status and income thresholds.
2. Apply through healthcare.gov. The federal marketplace at healthcare.gov screens for Medicaid and CHIP automatically when you apply. If you qualify, your application is forwarded to your state Medicaid agency.
3. Apply directly with your state. Most states have their own Medicaid portal. Visit medicaid.gov/contact-us to find your state's agency and online application.
4. Apply via benefits.gov. benefits.gov lists Medicaid and CHIP and links to state applications.
5. Gather documents. You will typically need: proof of identity, Social Security numbers for household members, proof of income, proof of residency, and immigration status if applicable.
6. Enrollment is year-round. Unlike Marketplace insurance, there is no open enrollment period for Medicaid — you can apply any time of year.

Official resources

• Federal Medicaid program — medicaid.gov
• Medicaid and CHIP info — healthcare.gov/medicaid-chip
• Medicaid on benefits.gov — benefits.gov/benefit/1044
• State Medicaid agency directory — medicaid.gov/contact-us