Medicaid Eligibility Guide 2025: Income Limits, Application Process, and Coverage
Medicaid is a joint federal and state program that provides health coverage to millions of low-income Americans. This comprehensive guide covers everything you need to know about Medicaid eligibility, income limits, application process, and covered services for 2025.
Table of Contents
What is Medicaid?
Medicaid is a government-sponsored health insurance program that provides free or low-cost health coverage to eligible low-income individuals and families. It's the largest source of health coverage in the United States, covering over 90 million people.
Unlike Medicare, which is primarily for seniors, Medicaid serves people of all ages who meet certain income and other requirements. The program is jointly funded by the federal government and individual states, with each state administering its own Medicaid program within federal guidelines.
Medicaid Eligibility Requirements
Medicaid eligibility is based on several factors, including income, household size, age, disability status, and pregnancy. Here are the main eligibility categories:
Eligibility Categories
- Low-income adults: In expansion states, adults under 65 with income up to 138% of the federal poverty level
- Children: Children under 19 in families with income up to 200% of the federal poverty level
- Pregnant women: Pregnant women with income up to 200% of the federal poverty level
- Disabled individuals: People with disabilities who meet income and asset requirements
- Seniors: Adults 65 and older with limited income and resources
Important Note
Medicaid eligibility rules vary by state. Some states have expanded Medicaid coverage, while others have more restrictive requirements. Always check with your state's Medicaid office for the most accurate information.
Income Limits for 2025
Medicaid income limits are based on the federal poverty level (FPL) and vary by household size and state. For 2025, the federal poverty level guidelines are:
| Household Size | Federal Poverty Level (2025) | Medicaid Limit (138% FPL) |
|---|---|---|
| 1 | $15,060 | $20,783 |
| 2 | $20,440 | $28,207 |
| 3 | $25,820 | $35,632 |
| 4 | $31,200 | $43,056 |
| 5 | $36,580 | $50,480 |
| 6 | $41,960 | $57,905 |
Note: These are the limits for Medicaid expansion states. Non-expansion states may have lower income limits, and some states have different limits for different eligibility categories.
Medicaid Expansion States
As of 2025, 40 states and the District of Columbia have expanded Medicaid coverage under the Affordable Care Act. This expansion allows adults under 65 with income up to 138% of the federal poverty level to qualify for Medicaid.
States That Have Expanded Medicaid
These states offer Medicaid to adults with income up to 138% of the federal poverty level:
- Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming
States That Have NOT Expanded Medicaid
These states have more restrictive Medicaid eligibility:
- Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wyoming
Check Your State
Use our Medicaid Eligibility Calculator to check your eligibility based on your state and income.
How to Apply for Medicaid
The Medicaid application process varies by state, but generally follows these steps:
Step 1: Gather Required Documents
- • Proof of identity (driver's license, birth certificate, etc.)
- • Social Security numbers for all household members
- • Proof of income (pay stubs, tax returns, etc.)
- • Proof of citizenship or legal residency
- • Proof of address (utility bills, lease agreement, etc.)
- • Information about other health insurance coverage
Step 2: Submit Your Application
You can apply for Medicaid in several ways:
- • Online: Most states offer online applications through their websites
- • In Person: Visit your local Medicaid office
- • By Mail: Request an application form and mail it back
- • By Phone: Call your state's Medicaid hotline
- • Through Healthcare.gov: If your state uses the federal marketplace
Step 3: Complete the Interview
After submitting your application, you may need to complete an interview with a caseworker. This can be done:
- • In person at the Medicaid office
- • Over the phone
- • Sometimes waived for certain households
Step 4: Receive Your Decision
You should receive a decision within 45 days of your application date. If you're approved, you'll receive a Medicaid card in the mail with your coverage information.
What Services Does Medicaid Cover?
Medicaid provides comprehensive health coverage, including:
Medical Services
- • Doctor visits and specialist care
- • Hospital stays and emergency care
- • Laboratory tests and X-rays
- • Prescription medications
- • Mental health services
- • Substance abuse treatment
- • Physical therapy and rehabilitation
- • Medical equipment and supplies
Preventive Care
- • Annual check-ups and physicals
- • Vaccinations and immunizations
- • Screenings for various conditions
- • Family planning services
- • Prenatal and postnatal care
- • Dental care (for children)
- • Vision care and eyeglasses
- • Hearing aids and services
Cost Sharing
Most Medicaid services are provided at no cost to beneficiaries. However, some states may require small copayments for certain services, such as prescription drugs or non-emergency visits to the emergency room.
Medicaid vs Medicare
While both Medicaid and Medicare are government health insurance programs, they serve different populations and have different eligibility requirements:
| Feature | Medicaid | Medicare |
|---|---|---|
| Eligibility | Based on income and other factors | Age 65+ or disabled |
| Cost | Free or very low cost | Premiums, deductibles, copays |
| Coverage | Comprehensive health coverage | Hospital, medical, and prescription drug coverage |
| Administration | State-administered | Federal program |
Important: Some people may be eligible for both Medicaid and Medicare (known as "dual eligible"). In these cases, Medicaid typically helps pay for Medicare premiums, deductibles, and copayments.
Renewing Your Medicaid Coverage
Medicaid coverage is not permanent and must be renewed periodically. The renewal process helps ensure that you still meet the eligibility requirements.
Renewal Process
- Renewal Notice: You'll receive a renewal notice in the mail before your coverage expires
- Update Information: Provide updated information about your income, household size, and other relevant details
- Submit Renewal: Complete and submit your renewal application by the deadline
- Verification: Your state may verify the information you provided
- Decision: You'll receive a decision about your continued eligibility
Important Tips
- • Respond to renewal notices promptly to avoid a gap in coverage
- • Keep your contact information updated with your Medicaid office
- • Report any changes in income, household size, or other circumstances
- • Keep copies of all documents you submit
Check Your Medicaid Eligibility
Use our free Medicaid eligibility calculator to see if you qualify for coverage in your state.
Check My Medicaid Eligibility