Here’s How You Can Qualify For Medicaid & Everything You Should Know About Medicaid

What is Medicaid? How can I qualify for Medicaid? What’s the difference between Medicare and Medicaid? We found all the answers you might have about the program, and even show you how the Affordable Care Act has changed the eligibility status for Medicaid.

Every state has its guidelines on Medicaid qualifications so for a detailed list of eligibility requirements, call one of our agents at (855) 968-5736. Our agents are dedicated to finding the best health insurance for you, and we are eager to help you. We’re available every weekday from 9 a.m. to 5 p.m.

What is Medicaid?

Medicaid provides free or low-cost health coverage to low-income people, families and children, pregnant women, the elderly, and people with disabilities. It is currently the largest source of health coverage in the US, and you can apply at any time of the year.

It is a joint federal and state government program, so coverage details and qualifications will differ depending on your state. However, because of the federal government guidelines, it must cover all the essential healthcare benefits as stated in the Affordable Care Act.

Some Medicaid programs will pay for your healthcare directly, while others will use private insurance companies to provide coverage. It will depend on the plan you have and where you reside. Medicaid also states that you can get coverage for medical care issues that have occurred within the last three months, even if you weren’t enrolled in Medicare at that time.

What is CHIP?

The Children’s Health Insurance Program (CHIP) offers low-cost health coverage to children in families whose household income disqualifies them from Medicaid. Certain states have also expanded CHIP to pregnant women.

Depending on your CHIP, you won’t need to pay for “well child” doctor or dental visits, but you could incur copayments for other services. Certain states also charge a monthly premium for their CHIP, but it will never be more than 5% of your household income. Here’s what every state covers under CHIP:

Routine check-ups
Immunizations
Doctor visits
Prescriptions
Dental and vision care
Inpatient and outpatient hospital care
Laboratory and X-ray services
Emergency services

If you qualify for coverage under a Federal Marketplace plan, your children could be covered by Medicaid or CHIP, but if you aren’t 100% sure if you can gain coverage under CHIP, call one of our agents at (855) 968-5736. We’re always happy to help you find the coverage that works for you.

Medicaid Qualifications

Medicaid qualifications will differ depending on where you live. Every state will have different qualifications that they use, so make sure to check your state’s status to find out their specific qualifications.

Income Guidelines for Medicaid

If your state has adopted Medicaid Expansion, you’ll qualify for Medicaid if your household income is less than 138% of the FPL.

Here’s what the FPL looks like in 2024:

Family Size	2024 Income Numbers
Individual	$15,060
Family of 2	$20,440
Family of 3	$25,820
Family of 4	$31,200
Family of 5	$36,580
Family of 6	$41,960
Family of 7	$47,340
Family of 8	$52,720
Family of 9+	Add $5,380 for each additional person

Other Medicaid Qualifications

Each state will have its qualifications outside of the FPL, but the most common ones we’ve seen are related to age, pregnancy, and disabilities. Requirements will also change depending on your status, but if you want to discover your state’s eligibility requirements, Call us at (855) 968-5738. We’re happy to help you find health coverage that fits your budget.

What Are the Differences Between Medicare vs Medicaid

We know. Medicare and Medicaid sound very similar which can cause confusion, but Medicare and Medicaid are very different programs in the healthcare field. Here’s the difference between the two programs:

Medicare is a federal health program that is reserved for those who are 65 or older and individuals who have received disability benefits for more than 24 months.
Medicaid is a joint federal and state program typically for low-income, pregnant, and disabled people.

You can have joint Medicare and Medicaid plans simultaneously, but you will have to pay for one of the programs in its entirety.

How to Apply for Medicaid

There are typically two ways you can apply for Medicaid. You can find a local Medicaid office or go through the Federal Marketplace. One of the best ways to find out about your Medicaid eligibility is to call one of our agents at (855) 968-5738. We’ll help you through the Marketplace and find a program that works for you and your budget.

You can also check out our unique plan search tool that will give you accurate healthcare information — pricing, eligibility, and exact coverage options.

What Should I Do If I’m Denied Medicaid?

If you’re denied Medicaid, you will receive a letter explaining why you were denied. It could be as little as an error on the application to a denial based on your income. When denied, you can always appeal the decision depending on the denial you received.

If your financial situation changes, you’ll be able to reapply as well.

Medicaid Expansion & How to Qualify

One of the main goals of the Affordable Care Act was to expand Medicaid to cover all adults with an income below 138% of the Federal Poverty Line (FPL). That eventually became Medicaid Expansion.

Basic Medicaid qualifications are typically based on income, household size, disability status, family status, or other factors depending on your state. However, if your state adopted Medicaid Expansion, you’ll qualify for Medicaid based on income alone.

The states that haven’t adopted Medicaid Expansion include WY, KS, TX, WI, MS, TN, AL, GA, SC, and FL. If you reside in one of those states, HealthCare.gov suggests you apply for a Marketplace plan to see what is available.

Want to know more about Marketplace plans? We’ve got you covered with talented agents ready to help you every Monday to Friday from 9 a.m. to 5 p.m. Call us at (855) 968-5738 or use our free pricing tool to help you start your health coverage journey.

Conclusion

Medicaid is a low-cost health coverage option for those in low-income households, pregnant, elderly, or disabled. Medicaid eligibility will depend on your state, but if you want to see if you fit those requirements, call us at (855) 968-5738. We’ll help you determine your status and walk you through your application.

If you’re looking for more information on healthcare plans, check out our plan search tool to see all the plans available to you through the Marketplace.

Frequently Asked Questions

Are Medicaid and Medicare the Same?

While Medicaid and Medicare are healthcare coverage programs, they differ in who they are meant to serve. Typically, Medicaid is a coverage option for low-income households and Medicare is reserved for those who are 65 or older.

What Does Medicaid Cover?

Each Medicaid plan is different based on where you live, but all Medicaid plans cover the ten essential health benefits as stated in the Affordable Care Act:

Ambulatory patient services
Emergency services
Hospitalization
Pregnancy, maternity, and newborn care
Mental health and substance use disorder services (i.e. counseling and psychotherapy)
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness service and chronic disease management
Pediatric services (including oral and vision care)

Why Was My Medicaid Application Denied?

Medicaid applications can be denied for multiple reasons. You could have accidentally put in the wrong information, you just were not eligible at the time, or more. However, if you feel like your application was unjustly rejected, you can appeal the decision.

If your income status has changed, you will be able to apply for Medicaid.

How Does Medicaid Work With Other Insurance?

Yes, you can get another insurance through the Federal Marketplace if you have Medicaid. However, you will be paying for the full price of the plan through the Marketplace as you won’t get a tax subsidy.

Does Medicaid Cover Dental?

If you are under the age of 21, Medicaid will cover your dental expenses, but if you’re older than 21, it’ll depend on your state’s benefits. Most states will cover emergency dental care but comprehensive dental care is harder to find in a Medicaid plan.