Medicaid: Starting Out

Medicaid is health insurance run by state governments. It covers people and families with low income. Unlike Medicare (which is for people 65 and over), Medicaid can cover anyone — children, adults, seniors, and people with disabilities. This guide explains what Medicaid is, how it differs from Medicare, who qualifies, and what happens when you apply.

What Is Medicaid?

Medicaid is a health insurance program funded by both the federal government and the states. It pays for hospital care, doctor visits, prescription drugs, and other services. But here's the key thing: each state runs its own Medicaid program with its own rules.

This means one person might qualify for Medicaid in one state but not in another state with the same income. Benefits can also be different — one state might cover dental work, while another doesn't. So when you're thinking about Medicaid, you need to check your own state's program.

Medicaid vs. Medicare: They Are Different

Many people get Medicaid and Medicare confused because the names sound alike. They are completely separate programs.

Medicare is for people 65 and older (and some younger people with disabilities or end-stage kidney disease). You earn it by paying Medicare taxes through work. It's run by the federal government.

Medicaid is for people and families with low income. You don't have to earn it or pay taxes — you apply based on your income and household size. Each state runs it.

Important: you can have both programs. When you do, it's called "dual eligible." Your Medicare covers some services, and your Medicaid fills in gaps and pays for things Medicare doesn't cover. See Dual Eligible: Medicare and Medicaid for more on how both programs work together.

Who Qualifies for Medicaid?

Medicaid covers several groups of people. Your income, age, family size, and whether you have a disability all matter. But remember: each state sets its own income limits.

Children and Families

States cover children in low-income families. The income limit is different in each state — it's often higher than you'd expect. Many families who work full-time still qualify. There's also a program called CHIP (Children's Health Insurance Program) that covers children whose families earn too much for Medicaid but not enough to afford private insurance.

Pregnant People and Postpartum Coverage

If you're pregnant or just gave birth, you can apply for Medicaid based on income. Many states have higher income limits for pregnant people than for other adults. Coverage usually includes prenatal care, delivery, hospital stays, and care in the months after birth.

Low-Income Adults

In states that expanded Medicaid (most states have), adults without children can qualify if their income is low enough. In states that didn't expand, the income limits for adults without children are much stricter. Check your state's program to see if you qualify.

Seniors and People with Disabilities

If you're 65 or older, or if you receive disability payments, you might qualify for Medicaid based on both your income and your assets (money and things you own). Each state has its own limits. And remember: you can have both Medicare and Medicaid at the same time.

Medicaid Covers These Services

Medicaid covers the basics:

• Hospital care (emergency and non-emergency stays)
• Doctor visits (primary care, specialists)
• Prescription medications
• X-rays and lab tests
• Mental health and substance-abuse treatment
• Preventive care (checkups, vaccines, screenings)

But some services vary by state. Dental care, vision, hearing aids, and long-term care (nursing home or home health services) might or might not be covered depending on where you live. Always check your state's Medicaid program to know what's included.

How to Apply for Medicaid

Applying is free and usually takes a few minutes.

Three Ways to Apply

1. Apply through your state Medicaid office directly. Go to our State Medicaid Directory to find your state's website and phone number. You can apply online, by phone, by mail, or in person.
2. Apply through Healthcare.gov (the federal Marketplace). Go to Healthcare.gov, enter your ZIP code, and apply. The site will route you to your state's Medicaid program automatically if you qualify. You don't need to create a new account if you already have one.
3. Go to your local benefits office in person. Most counties have a social services or benefits office where you can apply face-to-face and get help filling out the forms.

What You'll Need to Apply

Have these ready when you apply:

• Social Security numbers for everyone in your household
• Proof of income (recent pay stubs, tax returns, or a letter from your employer)
• Proof of where you live (lease, utility bill, or mortgage statement)
• Information about any other health coverage you have
• Citizenship or immigration status information

Apply Any Time (No Deadline)

Unlike Medicare, which has enrollment windows, you can apply for Medicaid anytime. There's no deadline. If you're approved, coverage usually starts right away or at the first of the next month.

What Happens After You Apply

The Decision Letter

You'll get a letter telling you if you were approved or denied. If approved, it tells you when your coverage starts and what plan you're in (if your state uses managed care). Save this letter. You might need it to show doctors, pharmacies, or your employer.

Getting Your Medicaid Card

If approved, you'll get a Medicaid card in the mail. This card has your member number on it. Some states send the card right away; others take a few weeks. You can use a temporary number for prescriptions and appointments while you wait for the physical card.

Choosing a Plan or Provider (Varies by State)

In many states, Medicaid covers you through a managed-care plan (a health insurance company that Medicaid partners with). Your state might assign you to a plan automatically, or you might get to choose. You might also need to pick a primary-care doctor. Check your approval letter or call your state Medicaid office to find out what your state does.

Reporting Changes

Your Medicaid coverage stays as long as you stay eligible. But if your situation changes — your income goes up or down, you move, or your household size changes — you must report it to Medicaid. Some changes can happen anytime; others have a deadline. Report changes quickly to keep your coverage active.

Renewal: Keeping Your Coverage

Your Medicaid doesn't last forever. Your state will ask you regularly (usually once a year) to confirm that you still qualify. This is called a renewal. Medicaid will send you paperwork or ask you to update your information online. You must respond by the deadline they give you, or your coverage ends.

Make sure Medicaid has your current address and phone number so you don't miss a renewal notice. If you lose your coverage because you missed a deadline, you can usually reapply right away.

If You're Denied

If your application is denied, you get a letter explaining why. You have the right to appeal. To appeal:

1. Read the denial letter carefully — it tells you the reason, your appeal deadline, and exactly which appeal path applies to you.
2. Follow the path in the letter. If a managed-care plan denied care, you usually appeal to the plan first. If the state denied your application or coverage, you can ask for a state fair hearing — a review by someone who didn't make the first decision.
3. Keep copies of everything and note every deadline. You can ask for free help at any step.

Your state must decide on your appeal within a certain time frame. For help, call your state Medicaid office or a local legal-aid office.

Medicaid Managed Care Plans

In most states, Medicaid members get coverage through a managed-care plan. The plan acts as a middleman between you, the doctors, and the state. You get an ID card from the plan and may need to choose a primary-care doctor. The plan coordinates your care and pays doctors.

Different plans might have different doctors, hospitals, and drug lists. If you want to switch plans, you usually can change once a year. Ask your state about open enrollment or when you can make changes.

Do You Have Both Medicare and Medicaid?

If you're 65 or older, have a disability, or have end-stage kidney disease, you might qualify for both. When you have both, Medicare is your primary insurance (it pays first), and Medicaid fills in gaps. Medicaid can help pay your Medicare premiums and cover services Medicare doesn't, like long-term care.

Dual-eligible people have special options. See Dual Eligible: Medicare and Medicaid for the details and programs you might qualify for.

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