{"id":48462,"date":"2022-02-02T11:40:20","date_gmt":"2022-02-02T16:40:20","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=48462"},"modified":"2025-07-29T13:32:53","modified_gmt":"2025-07-29T17:32:53","slug":"what-is-medicaid","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/what-is-medicaid\/","title":{"rendered":"What is Medicaid?"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Health insurance coverage is an important factor in not only staying healthy, but for getting quality health care when needed. In 2024, 27.2 million Americans of all ages didn\u2019t have health coverage, and nearly 82% of uninsured adults say it\u2019s hard to afford health care costs. Fortunately, Medicaid is a financial assistance program that helps certain groups of people who otherwise have a lack of access to affordable health coverage.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Understanding who is eligible for Medicaid and what it covers can be confusing. This is a general overview to help you understand the purpose of Medicaid, who can benefit from the program, and what it covers.<\/span><\/p>\n<h2 id=\"what-is-medicaid\"><span style=\"font-weight: 400;\">What is Medicaid?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Medicaid is a health insurance program funded jointly by the state and federal governments. It provides eligible citizens and certain qualified non-citizens with free or low-cost health coverage.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Originally passed into law in 1965, Medicaid has continued to evolve throughout the years to provide quality and affordable health care to additional groups of people. Today, Medicaid is the single largest source of health coverage in the nation, covering <\/span><a href=\"https:\/\/www.pewresearch.org\/short-reads\/2025\/06\/24\/what-the-data-says-about-medicaid\/#how-many-people-have-medicaid-coverage\"><span style=\"font-weight: 400;\">71.4 million enrollees as of January 2025<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h3 id=\"what-does-medicaid-cover\"><span style=\"font-weight: 400;\">What does Medicaid cover?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Federal law requires that states provide certain <\/span><a href=\"https:\/\/www.medicaid.gov\/medicaid\/benefits\/mandatory-optional-medicaid-benefits\/index.html\"><span style=\"font-weight: 400;\">mandatory benefits<\/span><\/a><span style=\"font-weight: 400;\"> under the Medicaid program, but allows each state to cover additional optional benefits if they choose. These mandatory Medicaid benefits that all states must cover include:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Inpatient and outpatient hospital services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Physician services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Early and periodic screening, diagnostic, and treatment services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nursing facility services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Home health services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Rural health clinic services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Federally qualified health center services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Laboratory and X-ray<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Family planning<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nurse midwife care<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Freestanding birth center services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Transportation to medical care<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Tobacco cessation counseling for pregnant women<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Certain behavioral and mental health services<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Like any covered insurance benefit, these Medicaid benefits above are covered when indicated and appropriate, and may be subject to Medicaid managed care provisions, limits to the number of times you can utilize a service, etc.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Medicaid plays an important and unique role in ensuring that millions of adults and children get necessary health care, regardless of socioeconomic factors. It allows these disadvantaged populations to get the quality care they would otherwise be unable to afford or access through other means, making Medicaid an essential part of the nation\u2019s healthcare system.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">It\u2019s important to note that only <\/span><a href=\"http:\/\/www.macpac.gov\/wp-content\/uploads\/2019\/01\/Physician-Acceptance-of-New-Medicaid-Patients.pdf\"><span style=\"font-weight: 400;\">71% of healthcare providers<\/span><\/a><span style=\"font-weight: 400;\"> accept Medicaid. If you are on Medicaid and in need of any of the services listed above, make sure your provider accepts Medicaid.<\/span><\/p>\n<h3 id=\"what-isn-t-covered-by-medicaid\"><span style=\"font-weight: 400;\">What isn\u2019t covered by Medicaid?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">While there is a broad range of Medicaid benefits, some items aren\u2019t covered. These include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Cosmetic surgery that is not medically necessary<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Missed appointments<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Most over-the-counter medications<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Dental care that is not considered medically necessary<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Because coverage varies by state, some benefits are considered <\/span><a href=\"https:\/\/www.medicaid.gov\/medicaid\/benefits\/mandatory-optional-medicaid-benefits\/index.html\"><span style=\"font-weight: 400;\">optional services<\/span><\/a><span style=\"font-weight: 400;\">. Each state has the opportunity to add coverage for these services, or not. Some optional Medicaid benefits include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Podiatry<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Eyecare and glasses<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Physical therapy<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Occupational therapy<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Chiropractic care<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Private duty nursing<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prescription drugs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Dental care for adults<\/span><\/li>\n<\/ul>\n<h3 id=\"who-is-eligible-for-medicaid\"><span style=\"font-weight: 400;\">Who is eligible for Medicaid?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">At its inception, Medicaid was designed to provide health coverage to those receiving cash assistance as part of the welfare system. It has since expanded to cover additional groups of people, including:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Low-income adults, children, and families<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Qualified pregnant women and children<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">People of all ages with blindness or disabilities<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">People who need long-term care<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">The 2010 Affordable Care Act expanded <\/span><a href=\"https:\/\/www.medicaid.gov\/medicaid\/national-medicaid-chip-program-information\/medicaid-childrens-health-insurance-program-basic-health-program-eligibility-levels\/index.html\"><span style=\"font-weight: 400;\">Medicaid eligibility<\/span><\/a><span style=\"font-weight: 400;\"> to all individuals younger than 65 with incomes below 133% of the Federal Poverty Level (FPL), as determined by their Modified Adjusted Gross Income (MAGI). MAGI determines an individual&#8217;s financial eligibility for medical assistance based on their taxable income and tax filing relationships. This change allowed many more low-income persons to be covered by the Medicaid program.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There are, however, some individuals with different income eligibility requirements than those set for the Medicaid program. These include people with blindness, a disability, or those aged 65 and older. For these individuals, financial eligibility is determined based on Supplemental Security Income (SSI) budgeting methodology set by the Social Security Administration.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">While federal law defines the mandatory populations and financial thresholds to be covered by the Medicaid program, states have the flexibility to further expand on these eligibility requirements to include additional groups of people, including those considered \u201cmedically needy\u201d and individuals with incomes above the mandatory coverage limits. This results in variations from state to state regarding who is eligible for Medicaid coverage.\u00a0<\/span><\/p>\n<h3 id=\"what-medicaid-is-not\"><span style=\"font-weight: 400;\">What Medicaid is not<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">While Medicaid does cover a broad range of services, it isn\u2019t all-inclusive. There may still be costs associated with medical care that enrollees will be responsible for paying. There are also restrictions and networks of doctors you\u2019ll be limited to. It\u2019s important to understand the potential for these costs and restrictions and plan accordingly.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Additionally, Medicaid is not only for seniors or unemployed people. People with disabilities account for <\/span><a href=\"https:\/\/www.aha.org\/fact-sheets\/2025-02-07-fact-sheet-medicaid\"><span style=\"font-weight: 400;\">10% of Medicaid beneficiaries and children account for 36%<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h3 id=\"medicare-vs-medicaid\"><span style=\"font-weight: 400;\">Medicare vs. Medicaid<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Medicaid provides healthcare coverage to low-income people based on state-determined eligibility. Medicare, on the other hand, is a federal health insurance program serving individuals aged 65 and over, as well as people younger than 65 with certain disabilities.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">While <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/difference-between-medicare-and-medicaid\/\"><span style=\"font-weight: 400;\">Medicare and Medicaid<\/span><\/a><span style=\"font-weight: 400;\"> eligibility requirements differ, there is overlap for some qualifying beneficiaries. Approximately <\/span><a href=\"https:\/\/www.medicaid.gov\/medicaid\/eligibility\/seniors-medicare-and-medicaid-enrollees\/index.html\"><span style=\"font-weight: 400;\">12 million people<\/span><\/a><span style=\"font-weight: 400;\"> are dually eligible for Medicare and Medicaid, although, not everyone who is dually-eligible are enrolled in <\/span><a href=\"https:\/\/www.cms.gov\/Medicare\/Health-Plans\/SpecialNeedsPlans\/D-SNPs\"><span style=\"font-weight: 400;\">Dual Eligible Special Needs Plans (D-SNPs)<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Dual plans combine the benefits of Medicaid and Medicare to help individuals that qualify for both programs pay for their premiums or out-of-pocket medical expenses. Additionally, there are some benefits that Medicaid covers but Medicare does not, including dental care, optometry services, and nursing home care.\u00a0<\/span><\/p>\n<h3 id=\"what-is-chip\"><span style=\"font-weight: 400;\">What is CHIP?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">The <\/span><a href=\"https:\/\/www.healthcare.gov\/medicaid-chip\/childrens-health-insurance-program\/\"><span style=\"font-weight: 400;\">Children\u2019s Health Insurance Program (CHIP)<\/span><\/a><span style=\"font-weight: 400;\"> was passed in 1997 to provide health coverage to children of families that exceed the normal Medicaid financial eligibility requirements but are unable to afford private health coverage.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">CHIP works closely with its state\u2019s Medicaid program to provide low-cost health insurance to children. While CHIP benefits do vary from state to state, all states provide at least the mandatory benefits, including:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Routine check-ups\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Immunizations<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Doctor visits<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prescriptions\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Vision and dental care<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Inpatient and outpatient hospital care<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Laboratory and X-ray services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Emergency services<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">While some of these services are free, there may be copayments for others. Some states may also charge a monthly premium for coverage under the CHIP program.\u00a0<\/span><\/p>\n<h2 id=\"how-to-apply-for-medicaid\"><span style=\"font-weight: 400;\">How to apply for Medicaid<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">There are two ways to apply for Medicaid. You can either apply through the <\/span><a href=\"https:\/\/www.healthcare.gov\/create-account\"><span style=\"font-weight: 400;\">Health Insurance Marketplace<\/span><\/a><span style=\"font-weight: 400;\"> or your <\/span><a href=\"https:\/\/www.medicaid.gov\/about-us\/contact-us\/contact-your-state-questions\/index.html\"><span style=\"font-weight: 400;\">state\u2019s Medicaid agency<\/span><\/a><span style=\"font-weight: 400;\">. Some people are also sometimes deemed automatically eligible, such as those on supplemental security income.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">While initial enrollment for Medicaid and CHIP can be done year-round and people in managed Medicaid plans can change plans once per month, you should take into account the open enrollment period for certain non-Medicaid health insurance plans, especially for individuals who are near their <\/span><a href=\"https:\/\/www.healthcare.gov\/lower-costs\/\"><span style=\"font-weight: 400;\">state\u2019s income eligibility threshold<\/span><\/a><span style=\"font-weight: 400;\"> for Medicaid.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Some people have other health plan coverage in addition to Medicaid. In most cases, the other health insurance is required to act as the \u201cprimary payer\u201d and pay for the initial costs. Medicaid will then act as the \u201csecondary payer\u201d to help cover the remaining costs, although it may not cover the entire remaining amount.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If throughout the year your income exceeds your state\u2019s Medicaid eligibility threshold or you lose Medicaid coverage for any other reason, you will qualify for a Special Enrollment Period. During the Special Enrollment Period, you will be able to enroll in a health insurance plan through the Affordable Care Act marketplace outside of the normal open enrollment window.\u00a0\u00a0<\/span><\/p>\n<h2 id=\"how-to-save-money-on-medicaid-related-costs\"><span style=\"font-weight: 400;\">How to save money on Medicaid-related costs<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">While Medicaid does provide many people with free health coverage, each state is given the flexibility to charge certain groups with low-cost deductibles, premiums, and copayments.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There are additional resources that can help you save money on Medicaid-related costs. Some of these resources include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.fns.usda.gov\/wic\"><b>WIC:<\/b><\/a><span style=\"font-weight: 400;\"> Special nutrition services for pregnant women, new mothers, infants, and children up to age 5 provide families with the resources they need to help ensure a healthy start. WIC may help cover some medical-related costs like specialty formula, breastfeeding supplies, and various tests.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/familiesusa.org\/about\/\"><b>Families USA:<\/b><\/a><span style=\"font-weight: 400;\"> This non-profit agency makes it easy to find out if you could get help paying for your healthcare coverage, prescription drugs, dental care, and more. The program is free and personalized to your specific needs. There are also many other non-profit agencies and government agencies with similar resources.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/blog\/singlecare-medicaid\/\"><b>SingleCare<\/b><\/a><b>: <\/b><span style=\"font-weight: 400;\">This online program offers discounts on medications. Compare pharmacy prices, get a free discount card, and save up to 80% on your medications at more than 35,000 nationwide pharmacies. SingleCare can help cover medication costs that Medicaid may not cover. <\/span><a href=\"https:\/\/www.singlecare.com\/prescription-discount-card\"><span style=\"font-weight: 400;\">Get your free prescription discount card here.<\/span><\/a><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Health insurance coverage is an important factor in not only staying healthy, but for getting quality health care when needed. In 2024, 27.2 million Americans of all ages didn\u2019t have health coverage, and nearly 82% of uninsured adults say it\u2019s hard to afford health care costs. Fortunately, Medicaid is a financial assistance program that helps [&hellip;]<\/p>\n","protected":false},"author":133,"featured_media":48596,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[2],"tags":[608,16,15],"coauthors":[20704],"class_list":["post-48462","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-company","tag-health-insurance","tag-medicaid","tag-medicare","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>What is Medicaid? Who\u2019s eligible and is it free?<\/title>\n<meta name=\"description\" content=\"Medicaid offers free or low-cost health care to millions of low-income Americans. 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