Medicaid 101: Am I eligible and is it really free?

Medicaid is often misunderstood. It is a joint federal and state program designed to provide totally free or incredibly low-cost health coverage to millions of Americans. Many people avoid seeking care simply because they don't realize they qualify for this massive safety net.

Who Actually Qualifies?

In the majority of states (those that "expanded" Medicaid under the ACA), eligibility is based purely on your current monthly income. If you make less than 138% of the Federal Poverty Level (about $1,835 a month for a single adult in 2026, per HHS's updated poverty guidelines), you automatically qualify. Your assets, savings, and past income do not matter for this specific type of Medicaid—only your current monthly cash flow.

Is it genuinely free?

For most enrollees, there are zero monthly premiums, and routine visits, emergency care, and many prescriptions carry little to no cost — though the exact copay rules vary by state. You can see your state's specific cost-sharing rules on Medicaid.gov's beneficiary resources page.

Good to Know: The Network Challenge

While the financial coverage of Medicaid is unbeatable, the practical challenge is the provider network. Because Medicaid reimburses doctors at a much lower rate than private insurance, many private clinics and specialists do not accept it. You may have to rely on larger hospital systems, community health centers, or endure longer wait times to see a specialist. Despite this, having Medicaid is infinitely better than being uninsured.

How to Apply

You can apply for Medicaid 365 days a year—there is no "Open Enrollment" deadline. Simply visit Healthcare.gov, enter your income, and the system will automatically route your application to your state's Medicaid office if you qualify. You can also apply directly through your state's Medicaid agency — find yours via the official state-by-state directory.

Does my state actually count assets?

For most working-age adults, only your current monthly income counts — not your savings or past earnings. That said, rules differ for certain groups (such as long-term care or aged/blind/disabled applicants), where assets can matter. Coverage details, including whether your state has expanded Medicaid, are tracked by KFF's state Medicaid expansion tracker.

What About My Kids? (CHIP)

If your income is a bit too high to qualify for Medicaid but you still can't afford private coverage for your children, look into the Children's Health Insurance Program (CHIP). It's run alongside Medicaid in every state, covers kids up to age 19, and typically has premiums of $50 a month or less, with no premium at all in many states. Applying for Medicaid automatically checks your eligibility for CHIP too — you don't need a separate application.

What Happens If My Income Changes Mid-Year?

Medicaid eligibility is re-checked periodically (often every 6–12 months, sometimes triggered by a reported income change). If your income rises above the threshold, you'll typically get a 60-day notice and qualify for a Special Enrollment Period to move to a Marketplace plan — you won't be left with a sudden coverage gap if you report the change and act within that window.

New: Work Requirements Are Being Added

A 2025 federal law now requires most states to add a work requirement (generally 80 hours/month of work, volunteering, or school, or a $580/month income) for adults on ACA expansion Medicaid, with a national deadline of January 1, 2027 and some states starting earlier. Several groups are exempt, including pregnant women, parents of children under 14, and people with disabilities. See our full Medicaid Work Requirements guide for exactly what's required, who's exempt, and what to do to avoid losing coverage over paperwork.

Frequently Asked Questions

Can I have Medicaid and a job at the same time? Yes — Medicaid eligibility in expansion states is based on your income level, not your employment status. Many working adults with lower-wage jobs qualify.

Will using Medicaid affect my immigration status? Rules here are complex and depend on your specific immigration category — this is one area where getting advice from a local legal aid organization or licensed enrollment counselor (not just a website) is worth doing before applying.