Medicaid Eligibility Calculator 2025

Check if you qualify for free or low-cost health coverage

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2025 updated

Check Your Medicaid Eligibility

Fill out the form below to see if you qualify for Medicaid coverage.

Medicaid rules vary significantly by state

Include all people who live together and share income/resources

Include wages, Social Security, pensions, and other income sources

Age affects eligibility for different Medicaid categories

Disability status can affect income limits and eligibility

Pregnant women often have higher income limits

Your information is never stored or shared

Medicaid Eligibility 2026: Complete Guide to Free Health Insurance

Medicaid is a joint federal and state program that provides free or low-cost health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Because each state manages its own Medicaid program within federal guidelines, the rules can vary significantly depending on where you live.

Medicaid Expansion vs. Non-Expansion States

The Affordable Care Act (ACA) allowed states to "expand" their Medicaid programs to cover all adults whose income is below 138% of the Federal Poverty Level (FPL), regardless of whether they have children or a disability. Currently, the vast majority of US states have expanded Medicaid.

If you live in an Expansion State:

You automatically qualify for Medicaid based solely on income. For 2026, a single adult making up to roughly $20,783 per year qualifies. A family of four making up to $43,056 per year qualifies.

What Does Medicaid Cover?

Federal law requires states to provide certain "mandatory" benefits. Most states also choose to provide "optional" benefits. Standard mandatory benefits include:

  • Inpatient and outpatient hospital services
  • Physician services
  • Laboratory and x-ray services
  • Home health services

How to Apply for Medicaid

You can apply for Medicaid at any time of the year—there is no Open Enrollment period for Medicaid. You can apply through Healthcare.gov (the Health Insurance Marketplace) or directly through your state's Medicaid agency website.

About Medicaid

What is Medicaid?

Medicaid is a joint federal and state program that provides free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities.

  • Free or low-cost health coverage
  • Covers doctor visits, hospital stays, prescriptions
  • No monthly premiums for most people
  • Low or no copayments for services
  • Comprehensive health benefits

Eligibility Categories

Medicaid eligibility is based on several factors:

  • Children: Up to 138% of Federal Poverty Level
  • Pregnant Women: Up to 138% FPL in expansion states
  • Adults: Up to 138% FPL in expansion states only
  • Disabled: Up to 100% FPL in most states
  • Seniors: Up to 100% FPL in most states

2025 Federal Poverty Level

Medicaid income limits are based on the Federal Poverty Level (FPL). For 2025:

$1,240

1 Person Monthly

$1,677

2 People Monthly

$2,114

3 People Monthly

$2,551

4 People Monthly

$2,988

5 People Monthly

$3,425

6 People Monthly

Frequently Asked Questions

What's the difference between Medicaid and Medicare?

Medicaid is a needs-based program for low-income individuals and families, while Medicare is primarily for people 65 and older regardless of income. Medicaid covers more services and has lower out-of-pocket costs.

Can I have both Medicaid and private insurance?

Yes, you can have both. Medicaid will typically pay for costs that your private insurance doesn't cover, such as copayments, deductibles, and services not covered by your private plan.

How do I apply for Medicaid?

You can apply for Medicaid in several ways:

  • Online through Healthcare.gov
  • Through your state's Medicaid office
  • In person at a local office
  • By phone with your state's hotline

What documents do I need to apply?

You'll typically need:

  • Proof of identity and citizenship
  • Social Security numbers
  • Proof of income
  • Proof of residency

Find Benefits Near You

Select your city below to see hyper-local government assistance offices, exact income limits, and localized application guides. Or use our ZIP Code Locator Tool for your specific neighborhood.

Medicaid 2025 — Income Limits, Expansion States & Coverage Guide

Medicaid is the largest health insurance program in the U.S., covering over 90 million Americans in 2025. It provides free or very low-cost healthcare to low-income adults, children, pregnant women, elderly adults, and people with disabilities.

Under the Affordable Care Act (ACA) expansion, 41 states plus DC have expanded Medicaid to cover adults earning up to 138% of the Federal Poverty Level ($20,120/year for a single person in 2025). Non-expansion states still use pre-ACA rules with much stricter income limits.

2025 Medicaid Income Limits — Expansion vs. Non-Expansion States

Source: Medicaid.gov — Eligibility

CategoryState TypeIncome Limit (Single)Income Limit (Family of 4)
Adults (ACA expansion)41 states + DC$20,120/yr (138% FPL)$41,400/yr
Children (CHIP/Medicaid)All statesUp to 200%–400% FPL by state$62,400–$124,800/yr
Pregnant womenAll statesTypically 185%–250% FPL$57,720–$78,000/yr
Elderly/disabled (SSI-linked)Most states$943–$1,255/mo (varies)Varies by state
Adults (non-expansion)10 statesVery low — often below $10,000/yrVaries widely

ACA Expansion States vs. Non-Expansion States (2025)

Expansion States (41 + DC)

Adults up to 138% FPL (~$20,120/yr single) qualify for Medicaid regardless of disability status.

Includes: CA, NY, TX (no), FL (no), IL, PA, OH, MI, WA, OR, CO, MN, MA, MD, AZ, NV, NJ, CT, ME, NM, LA, VA, KY, AR, WV, IN, IA, MO, SD, NC, OK, and more.

Non-Expansion States (10)

Most low-income adults without children cannot get Medicaid unless disabled or elderly.

Texas, Florida, Georgia, Alabama, Mississippi, Tennessee, South Carolina, Wisconsin, Kansas, Wyoming.

What Does Medicaid Cover in 2025?

Mandatory Benefits (all states)

  • ✓ Doctor and hospital visits
  • ✓ Lab tests and X-rays
  • ✓ Family planning
  • ✓ Nursing facility care
  • ✓ Pediatric services (EPSDT)

Optional Benefits (most states)

  • ✓ Prescription drugs
  • ✓ Dental and vision
  • ✓ Physical therapy
  • ✓ Mental health services
  • ✓ Home health care

Medicaid FAQ 2025

Yes — "dual eligibles" qualify for both. Medicaid pays Medicare premiums, deductibles, and copays, and provides extra drug coverage. About 12 million Americans are dual-eligible in 2025. Use our Medicare calculator to estimate your Medicare costs first.
It depends on your state. Dental care is mandatory for children (EPSDT) and optional for adults. As of 2025, most expansion states provide at least limited adult dental and vision coverage. Check your state plan at Medicaid.gov.
No. If your income increases above the limit, you typically have a 12-month continuous eligibility period. Report income changes to your state, but you generally stay covered until your next renewal. This protects families from coverage gaps during temporary income fluctuations.

Reviewed by Medicaid Policy Specialists

Eligibility data from Medicaid.gov. 2025 FPL from HHS.gov. State expansion status verified Jan 2025.

Last verified: Feb 202541-state expansion confirmed

Official Sources

↗ Medicaid.gov — Eligibility ↗ Healthcare.gov — Apply ↗ State Medicaid Programs ↗ HHS — 2025 FPL Guidelines

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