Medicaid covers roughly 90 million Americans, making it the largest health insurance program in the country. Despite that scale, a meaningful number of people who qualify have never applied, either because they did not know they were eligible or assumed the process would be too complicated. It is worth understanding the basics.
Who qualifies
Medicaid eligibility is based primarily on income and household size. Since the Affordable Care Act expanded Medicaid in most states, adults with income up to 138 percent of the federal poverty level are typically eligible in expansion states. For 2026, that is roughly $20,000 for a single person or $34,000 for a family of three, though the exact figures vary. Children, pregnant individuals, people with disabilities, and seniors may qualify under different rules with higher income thresholds. Eligibility also depends on which state you live in, since not every state expanded Medicaid.
What Medicaid covers
Federal law requires Medicaid to cover certain services: doctor visits, hospital care, lab tests, x-rays, family planning services, and pediatric care including vision and dental for children. Many states also cover dental care for adults, vision care, prescription drugs, and behavioral health services. The specific coverage varies by state and by the type of Medicaid plan you are enrolled in. The coverage is often more comprehensive than people expect.
How to apply
The main ways to apply are through your state's Medicaid agency website, through HealthCare.gov, in person at your local Department of Social Services or equivalent agency, or by phone through your state's benefits hotline. The application asks for basic information: household size, income, citizenship or immigration status, and residency. You will typically need to provide proof of income and identity. Most applications are processed within 45 days, and many states make a decision in a week or two for straightforward cases.
What happens after you apply
If approved, coverage often starts retroactively to the first of the month you applied, or in some cases earlier. You will receive a Medicaid card and information about which providers accept your coverage. If you are denied, you have the right to appeal. Many denials result from missing documentation rather than genuine ineligibility, so it is worth reviewing the reason before deciding not to reapply.
If your income fluctuates
Medicaid eligibility is based on your current monthly income, not annual income. If your income drops because of job loss, reduced hours, or a change in household size, you may become eligible even if you were not before. It is worth checking eligibility any time your situation changes significantly, not just once when you first look into it.