USA Medicaid Program 2025 – Eligibility, Benefit Amount, and How to Apply

Medicaid remains one of the most important public health insurance programs in the United States, offering affordable coverage to millions of low-income Americans. Whether you’re a child, pregnant, a senior citizen, or living with a disability, Medicaid helps ease the financial burden of healthcare by covering critical services like doctor visits, hospital stays, and prescriptions.

In 2025, Medicaid continues to expand in reach and coverage. This guide walks you through who qualifies, what’s covered, and exactly how to apply, no matter what state you live in.

Overview

Medicaid is a joint federal and state program that provides healthcare coverage to eligible individuals based on income and other criteria. It’s different from Medicare, which is mostly for people aged 65 or older. Medicaid serves a wider group—kids, adults, pregnant women, seniors, and people with disabilities.

Here’s a snapshot:

Key Topic	Details
Eligibility	Based on income, age, family size, disability, and state-specific rules
Income Limits	Up to 138% of the Federal Poverty Level (FPL) in expanded states
States with Expansion	38 states have expanded Medicaid under the ACA
Coverage	Hospital, doctor visits, prescriptions, maternity, mental health
Application Options	Online, phone, mail, or in-person through your state Medicaid office
Special Programs	CHIP, programs for pregnant women and people with disabilities

Who

Medicaid eligibility in 2025 depends on several factors, but the biggest one is income. Some groups also have more generous income thresholds.

Income Limits (2025)

In Medicaid expansion states:

• Single adult: Up to $20,120/year
• Family of four: Up to $41,400/year

In non-expansion states, the limits are lower and may only apply to specific groups.

Groups That May Qualify

• Children: Often covered with higher income thresholds
• Pregnant Women: Usually covered up to 138–200% of FPL
• Seniors (65+): Can qualify for long-term care and Medicare-related help
• People with Disabilities: May qualify through SSI or state-specific criteria
• Immigrants: Must be legal residents, usually with a five-year wait, unless pregnant or under 18

What

Medicaid coverage varies by state, but all states must cover a core set of services. Some offer even more.

Mandatory Benefits

• Doctor visits and preventive care
• Inpatient and outpatient hospital services
• Prescription medications
• Maternity and newborn care
• Lab tests and X-rays
• Mental health and addiction services
• Nursing home care
• Pediatric services

Optional Benefits (State-Dependent)

• Dental and vision care
• Non-emergency transportation
• Home and community-based services
• Physical and occupational therapy

Medicaid gives you access to a wide network of providers, and in most cases, you’ll pay little to nothing out of pocket.

Apply

Applying is easier than many people think. Follow these steps:

Step 1

Use your state’s Medicaid site or visit HealthCare.gov to check income and eligibility. Each state has different rules, so don’t assume you’re ineligible.

Step 2

You’ll likely need:

• Proof of income (recent pay stubs or tax return)
• Social Security number
• Proof of citizenship or immigration status
• Medical records (if applying due to a disability)
• Birth certificates for children

Step 3

• Online: Fastest method via your state’s Medicaid site
• By Phone: Call your state’s Medicaid office
• In-Person: Visit local health departments or enrollment centers
• By Mail: Paper applications are available in most states

Step 4

Approval usually takes 30 to 45 days. You may receive a request for additional documentation.

Step 5

Once approved, you’ll receive a Medicaid card. You may also be enrolled in a managed care plan, where you’ll pick a primary care provider.

Medicaid Models

Many states use Managed Care Organizations (MCOs) that contract with the state to provide services. These plans offer a network of doctors and typically include extra support.

Fee-for-Service (FFS)

In this model, Medicaid pays healthcare providers directly for each service. It offers more flexibility but may involve more paperwork.

Medicaid vs Medicare

Some people qualify for both—known as dual eligibles. In these cases:

• Medicaid helps pay Medicare premiums and deductibles
• You’ll get more complete coverage by combining both programs

Special Programs

Covers kids in families who earn too much for Medicaid but can’t afford private insurance. Benefits include vaccines, doctor visits, and dental care.

Medicaid Buy-In for Workers with Disabilities

Allows people with disabilities to work and still qualify for Medicaid coverage.

Common Mistakes

• Not applying due to assumptions: Many who think they don’t qualify actually do.
• Missing paperwork: Be sure to include all required documents.
• Not reporting changes: Update your state if income, address, or household size changes.

Expansion

Thanks to the Affordable Care Act, Medicaid expanded in 38 states and Washington, D.C., covering millions of low-income adults. Expansion states have higher income limits, streamlined enrollment, and often better access to care.

Non-expansion states have stricter rules. Adults without children may not qualify at all unless they’re elderly or disabled.

FAQs