What if I Lose My Benefits? What Do I Do if I Lose My Benefits? It can feel overwhelming to lose Medicaid coverage, but there are steps you can take to reinstate it.e60dc2a1-f33c-4a05-9b50-8e3e8e59762915f8189a-3889-404d-855e-4e177ab22c16 Understand why you lost coverage. States regularly check your eligibility for Medicaid. If your income (or other factors) make you ineligible, your coverage may end. If you’ve received a notice or request from your state, don’t ignore it — respond quickly to avoid losing coverage unnecessarily. Document meeting the new work requirements and renew your coverage. By January 1, 2027, adults covered through Medicaid expansion programs must show 80 hours a month of work, school, or community activities, with some exceptions. This group of people must also renew their coverage every six months instead of annually. Reapply for Medicaid. If you believe there was a mistake, reapply — you can do so anytime your income or circumstances change. Apply for Marketplace coverage. Plans on the Health Insurance Marketplace, a government-run platform for finding health insurance, offers options for those transitioning off Medicaid. Depending on your income, you may qualify for premium tax credits or cost-sharing subsidies. You can apply up to 60 days before Medicaid ends or within 90 days after it ends, with coverage starting the next month. Get free help. Marketplace assisters can explain your health coverage options and help you apply for free. Visit HealthCare.gov to find local help or contact the Marketplace Call Center at 800-318-2596.
How Does Medicaid Work? How Does Medicaid Work? Despite variations across the country, all Medicaid programs must cover these core services:e60dc2a1-f33c-4a05-9b50-8e3e8e597629b2222a0f-b496-4089-b639-77afff883619 Doctors’ visits and hospital care Preventive care like checkups and vaccines Lab tests and X-rays Prenatal and maternity care Mental health services Transportation to medical appointments Emergency services Certain aspects of Medicaid vary from state to state, though, including:e60dc2a1-f33c-4a05-9b50-8e3e8e597629779da1bf-7a1f-4b7b-bb2f-feeb0ac9e6bf Eligibility rules Application processes Additional services such as dental care and physical therapy Provider reimbursement rates Coverage can start from the date you apply and may even retroactively cover medical bills . The rules on retroactive coverage are changing in 2027, though. Starting January 1, adults who are part of a state expansion can get one month of retroactive coverage, and other enrollees can get two months.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291c2d54bf-ec95-455c-9951-d48b5b8f01e4e60dc2a1-f33c-4a05-9b50-8e3e8e5976296e5546f5-76f9-460f-89ed-db425df8a803
Costs How Much Will It Cost Me? With Medicaid, costs are minimal — usually small copays, if anything.e60dc2a1-f33c-4a05-9b50-8e3e8e597629040ebc9f-0121-4100-8429-d6a2ea725e5a For instance, you might pay $4 to $8 for a doctor’s visit or a prescription. Services like emergency care, family planning services, pregnancy-related services, and preventive care for children are exempt from copays. Services can’t be withheld for failure to pay your copayments, but you can still be held liable if you don’t pay. States have the option to set higher out-of-pocket costs for enrollees above the federal poverty line, but they can’t exceed 5 percent of your family income. Children, people who are terminally ill, and people who are living in institutions are exempt from copayments.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294bbe16ea-2cbd-416c-8f10-9d644e670423e60dc2a1-f33c-4a05-9b50-8e3e8e597629461a3f90-a108-4473-88d0-1540fa5865ab For nursing home care, Medicaid can cover 100 percent of the costs, including rooming, meals, and medical supplies. But you’ll need to contribute nearly all your income toward these costs first, keeping only a small personal needs allowance (PNA), which varies by state. “Individuals with [Medicare and] Medicaid coverage are also eligible for ‘ Extra Help ,’ a Medicare program that reduces drug costs,” says Kertesz.
Medicaid and Private Insurance Can I Have Medicaid and Other Insurance? Yes, Medicaid can work alongside other health coverage you may have. For instance, 12 million people are enrolled in both Medicaid and Medicare right now. Medicaid works with:e60dc2a1-f33c-4a05-9b50-8e3e8e597629c00ea4a3-1d37-4c7d-b0e2-65c9114c5fd2e60dc2a1-f33c-4a05-9b50-8e3e8e5976291ff5599c-bb22-4fa3-acd1-fbc9e14dffc2 Private health insurance Medicare Employer-sponsored plans Workers’ compensation Court-ordered health coverage When you have Medicaid plus another form of health coverage, know that: Medicaid pays last. Medicaid acts as a secondary payer, covering what your other plan doesn’t, including copays, deductibles , or remaining balances. So if you’re on Medicare, too, “Medicaid will pick up your Medicare deductible and copays,” says Sandy Kemp , a registered Social Security analyst in Las Vegas. Medicaid coordinates with other coverage. If your other insurance is responsible for part of a medical bill, Medicaid works directly with that insurer to make sure your providers are paid. Drug benefits are coordinated. If you have both Medicare and Medicaid, you’ll be automatically enrolled in Medicare Extra Help, which covers your medication costs in addition to Medicaid.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298743b9fb-01b7-4e41-a7b4-a983fa7856bb
Signing Up Where and How Do I Sign Up? “Even though rules vary by state, generally people applying for Medicaid should be ready to provide documentation of all sources of income, as well as assets like bank accounts and any trusts,” says Kata Kertesz , the managing policy attorney for the Center for Medicare Advocacy. Unlike Medicare, with its specified enrollment periods, you can sign up for Medicaid at any time in a few different ways:e60dc2a1-f33c-4a05-9b50-8e3e8e597629ac84c52d-fe44-4e5f-9efd-ba87a37a6c3a State Medicaid Agency Apply online, by phone, or in person in your state’s Medicaid office . Healthcare.gov Go to Healthcare.gov to apply. If you qualify, your application will be forwarded to your state Medicaid agency. Automatic Enrollment In 34 states and DC, Supplemental Security Income (SSI) recipients are automatically enrolled.
Resources We Trust Medicaid.gov: Eligibility PolicyNational Council on Aging: Why Is Medically Needy Medicaid Good for Long-Term Care?HealthCare.gov: Staying Covered if You Lose Medicaid or CHIPUSA.gov: How to Apply for Medicaid and CHIP
Which Doctors Take Medicaid? How Do I Know Which Doctors Accept Medicaid? Not all doctors accept Medicaid. In fact, research shows that roughly 75 percent of physicians are accepting new Medicaid patients. This compares with about 88 percent for Medicare and 96 percent for private insurance. To find a provider, contact your state Medicaid agency or visit Medicaid.gov for state-specific details.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290d20f44d-bb53-4fa5-9091-a804c85202a4
Are There Different Types? Are There Different Types of Medicaid? While Medicaid is often discussed as a single program, there are, in fact, different types, each of which provides coverage through different pathways. Traditional Medicaid This program exists in every state, plus DC and all U.S. territories. It covers children, pregnant women, parents with dependents, adults 65 and older, and people with disabilities based on their income and household size.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292d1a6362-1221-4e17-b73f-ee7ea3b57a2f Expansion Medicaid This program covers adults under the age of 65 in 40 states and DC who have an income that’s no more than 138 percent of the Federal Poverty Level. In 2026, that amount is about $22,025 annually for a single person and about $45,540 for a household of four.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ac950958-2116-4a11-9707-45b7344e5689 Long-Term Care Medicaid Even though more than 60 percent of all nursing home residents are covered by Medicaid, most Americans are unaware that Medicaid covers this type of care.e60dc2a1-f33c-4a05-9b50-8e3e8e597629dc05e636-025e-484e-9207-6eacc0b86109e60dc2a1-f33c-4a05-9b50-8e3e8e5976296e4e75c7-61d5-4f86-be8e-44b8ba3e4756 Beyond nursing homes, Medicaid helps pay for home care and other extended care needs, known as long-term services and supports (LTSS).e60dc2a1-f33c-4a05-9b50-8e3e8e597629a7bea52a-49e9-4c9e-975f-12eb2fe1cf4b These services assist people who need help with daily activities like eating or bathing. While all states cover nursing home care for those who meet income and asset requirements, home and community-based service coverage varies by state.e60dc2a1-f33c-4a05-9b50-8e3e8e59762901d97c31-f533-492f-85de-bbbceaeb1434
Who Qualifies? Who Qualifies for Medicaid? Medicaid provides free or low-cost health coverage to millions of Americans. As of October 2026, Medicaid eligibility is largely restricted to U.S. citizens, green card holders (usually after a five-year wait), and certain other residents, with some exceptions for pregnant women and children.e60dc2a1-f33c-4a05-9b50-8e3e8e59762950c3e220-23d8-47eb-b27d-c7b34578562d Here’s who may be eligible. Financial Eligibility Most people qualify for Medicaid because of their income, which is evaluated according to taxable income and household size. (The formula for calculating Medicaid eligibility is called Modified Adjusted Gross Income, or MAGI.) All states must cover families with incomes up to certain levels.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298c5ad20e-1a66-4f9f-b9c1-ca74692cabb4 In states that have expanded Medicaid (which includes 40 states and the District of Columbia), you may qualify if your income is below 138 percent of the federal poverty level in 2026. A family of four, for instance, would be eligible if they earn $45,540 or less per year. Starting in January 2027, enrollees who qualify for Medicaid through state expansion programs have to meet new work requirements. You must work, participate in a work program, or perform community service activities 80 hours a month or attend school at least part-time. Parents who are the primary caregivers of children under 13, people who are pregnant or postpartum, and those who are medically frail are exempt from these requirements.e60dc2a1-f33c-4a05-9b50-8e3e8e59762945e95d88-81d9-4db1-a115-e5ea301fa5f4e60dc2a1-f33c-4a05-9b50-8e3e8e59762958b0c69c-52df-4115-9617-05a7c338f88c That said, children can still qualify for Medicaid or CHIP in most states, even if their families have higher income levels.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c671347a-1259-459d-a4ca-4c0570fde37b If you’re at least 65 years old or have a disability, you can also qualify for Medicaid if your income and assets are low, even if you’re on Medicare.e60dc2a1-f33c-4a05-9b50-8e3e8e59762984fb1c77-acb0-4a7d-9ec0-fa70cb82b701 Medicaid reviews income and household size, plus assets and savings, and verifies age or disability status when applicable. In addition to the income guidelines, most states require proof that assets fall within limits for people who qualify because of age or disability.e60dc2a1-f33c-4a05-9b50-8e3e8e59762953e636e3-70f9-4670-858e-c7fa7530cba7 Medical Eligibility In some states, if you have very expensive medical bills, but your income is higher than the Medicaid requirements, you may still qualify for the program if your healthcare expenses exceed a certain amount, called the medically needy income limit. For example, if you have an $800 monthly income and a $500 medically needy income limit, you must “spend down” $300 each month to qualify for Medicaid.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294512812c-4931-4f3b-9b29-f7b11a92c8a6e60dc2a1-f33c-4a05-9b50-8e3e8e597629b3d94e22-35ea-4fd8-8c9e-61fa289872db Special Circumstances Eligibility Some people can qualify for Medicaid through other means. For example, former foster youth can be eligible up until the age of 26, and people who’ve been diagnosed with breast cancer or cervical cancer through a Centers for Disease Control and Prevention (CDC) screening program can have their cancer care paid for by Medicaid. e60dc2a1-f33c-4a05-9b50-8e3e8e597629f80b5485-893d-4b1b-b6d7-095df86852d9e60dc2a1-f33c-4a05-9b50-8e3e8e597629c5bcdcef-2425-4545-8537-056c5abfac64
Medicaid is the single largest source of healthcare coverage in the United States, offering free or low-cost medical benefits to 66 million low-income Americans or those with disabilities.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290b74bce6-635d-40fd-8b22-66bb59b174a4 Despite its widespread use, though, many people still aren’t familiar with the program — or they confuse it with Medicare . “People tend to use the terms interchangeably, but they are not at all the same,” says Josh Hodges , the chief impact officer at the National Council on Aging in Arlington, Virginia. Unlike Medicare , which is funded by the federal government and is primarily for people age 65 and older, Medicaid is jointly funded by both the state and federal government. That means each state determines who qualifies, which nonmandatory services are covered, and how care is delivered.e60dc2a1-f33c-4a05-9b50-8e3e8e59762938162e06-446a-4781-ae58-0d5d9d3f471c One thing is the same, though: For millions of families, Medicaid provides a critical safety net that makes healthcare accessible to people who would not be able to afford it otherwise. Here’s what you need to know.
Am I Eligible? How Do I Know if I’m Eligible? You can determine your eligibility for Medicaid by entering your state and household size on HealthCare.gov or contacting your state Medicaid agency directly.
What Is Medicaid?
