Medicaid & CHIP: Free Health Coverage for Families in 2025
More than 92 million Americans are currently enrolled in Medicaid or CHIP — free or nearly free health insurance through the government. Many working families qualify and simply don’t know it. This guide explains who is eligible, what income limits apply, what’s covered, and how to apply today.
What Is Medicaid?
Medicaid is a joint federal and state health insurance program that provides free or very low-cost coverage to people with limited income and resources. It is administered by each state’s Medicaid agency with federal oversight and funding from the Centers for Medicare & Medicaid Services (CMS). While the core rules are set federally, states have flexibility in how they run their programs — which is why eligibility thresholds, covered services, and program names vary by state.
Medicaid is not just for people who are unemployed. A significant portion of enrollees are working adults in households where income is not sufficient to afford private insurance. The program covers a wide range of health services with little to no out-of-pocket cost for most beneficiaries.
Who Qualifies for Medicaid in 2025?
Eligibility is primarily based on household income measured as a percentage of the Federal Poverty Level (FPL). In states that expanded Medicaid under the Affordable Care Act, most adults with incomes up to 138% of the FPL are eligible regardless of family status. In the 10 states that have not expanded Medicaid, eligibility for adults without children is much more restricted.
2025 Income Limits — Medicaid Expansion States (138% FPL)
The following annual income limits apply for adults in the 40 states (plus Washington D.C.) that have expanded Medicaid. You may qualify even if you are employed.
| Household Size | Monthly Income Limit | Annual Income Limit |
|---|---|---|
| 1 person | $1,732 | $20,783 |
| 2 people | $2,351 | $28,208 |
| 3 people | $2,969 | $35,633 |
| 4 people | $3,588 | $43,057 |
| 5 people | $4,206 | $50,478 |
| 6 people | $4,825 | $57,900 |
| Each additional person | +$619/month | +$7,422/year |
States That Have NOT Expanded Medicaid
As of 2025, the following 10 states have not expanded Medicaid under the ACA: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. In these states, Medicaid eligibility for adults without dependent children is extremely limited. Working adults with no dependents typically do not qualify regardless of income. Adults with dependent children may qualify at lower income thresholds.
If you live in one of these states and your income is too high for Medicaid but too low to afford private insurance, you may be eligible for subsidized coverage through your state’s ACA Marketplace. The ACA provides premium tax credits to individuals earning between 100%–400% of the FPL in these states specifically to address the coverage gap.
CHIP: Free and Low-Cost Coverage for Children
The Children’s Health Insurance Program (CHIP) provides coverage for children in households that earn too much to qualify for Medicaid but cannot afford private insurance. CHIP is available in every state and covers children up to age 19. In most states, CHIP income limits for children are significantly higher than adult Medicaid limits — often covering households earning up to 200–300% of the FPL.
| Household Size | 200% FPL (Monthly) | 200% FPL (Annual) |
|---|---|---|
| 1 person | $2,509 | $30,120 |
| 2 people | $3,407 | $40,880 |
| 3 people | $4,304 | $51,640 |
| 4 people | $5,200 | $62,400 |
| 5 people | $6,098 | $73,163 |
| 6 people | $6,994 | $83,920 |
Many states set their CHIP limits even higher — some up to 300% of the FPL or more for children. In a family of four earning $80,000/year, the children may still qualify for CHIP coverage even if the adults do not qualify for Medicaid. Always check your state’s specific CHIP thresholds, which are higher than the 200% figures shown above in many states. You can find your state’s limit at InsureKidsNow.gov, the federal CHIP information portal.
What Does Medicaid Cover?
Federal law requires all state Medicaid programs to cover a set of mandatory services. States can — and most do — go beyond the mandatory minimum. Here is what is universally covered:
- Inpatient and outpatient hospital services — emergency care, surgeries, and hospital stays
- Physician services — primary care visits, specialist visits, and preventive care
- Laboratory and X-ray services
- Prescription drug coverage — included in nearly all state programs (federally optional but practically universal)
- Mental health and substance use disorder services — including therapy, counseling, and psychiatric treatment
- Family planning services
- Prenatal and maternity care
- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) — comprehensive preventive and treatment services for anyone under 21
- Nursing facility services — long-term care for eligible elderly and disabled individuals
Many states also cover dental care for adults, vision care, non-emergency medical transportation, and home and community-based services for elderly or disabled beneficiaries. Cost-sharing (co-pays) for Medicaid is generally very low — often $0–$4 per service for most enrollees — and is legally capped at a small percentage of income.
Special Eligibility Groups
Pregnant Women
Pregnant women are a prioritized eligibility group in every state. Most states cover pregnant women at income levels up to 200% of the FPL or higher, regardless of whether they would otherwise qualify for Medicaid. Coverage includes all prenatal care, labor and delivery, and postpartum care. Since 2022, most states must provide coverage for at least 12 months postpartum (previously 60 days in many states), following changes enacted through the American Rescue Plan.
Elderly Adults (Age 65+)
Older adults can qualify for both Medicare and Medicaid simultaneously — known as being “dual eligible.” For those who qualify, Medicaid typically covers Medicare premiums, deductibles, and copayments, and provides additional benefits Medicare doesn’t cover, including long-term care and personal care services. Asset rules apply for long-term care Medicaid, which is a different and more complex eligibility category.
People with Disabilities
Individuals who receive SSI (Supplemental Security Income) are automatically eligible for Medicaid in most states. Individuals with disabilities who do not receive SSI may still qualify through disability-based eligibility pathways that consider functional limitations and medical needs in addition to income. Medicaid provides critical coverage for long-term services and supports that private insurance typically does not cover.
Former Foster Youth
Thanks to the Fostering Connections Act and ACA provisions, individuals who were in foster care are eligible for Medicaid up to age 26 in states that have opted into the extension — and most states have. If you aged out of foster care, you may qualify regardless of current income.
How to Apply
- Apply online at HealthCare.gov or your state’s Medicaid portal (fastest): Visit HealthCare.gov to apply for Medicaid and CHIP in most states. When you apply for Marketplace coverage, the system automatically checks your eligibility for Medicaid and CHIP based on your income. Many states also have their own Medicaid portals — a quick search for “[your state] Medicaid application” will find the direct link.
- Call the Medicaid helpline: Call 1-800-318-2596 (the federal Marketplace call center, available 24/7) to get help applying and to find out if you may qualify. TTY users: 1-855-889-4325. You can also call your state’s Medicaid office directly for state-specific guidance.
- Apply in person at your local Medicaid office: Find your local office through Medicaid.gov’s contact directory. Bring documentation of income, household size, and identity. In-person applications are especially helpful if your situation is complicated (self-employment income, recent job change, disability, pregnancy).
- Get free help from a certified enrollment navigator: Trained and federally certified navigators can help you apply for free. Find one near you at LocalHelp.HealthCare.gov. Community health centers (Federally Qualified Health Centers) also offer free enrollment assistance and can treat you regardless of insurance status while you apply.
Documents to Have Ready
- Proof of identity (driver’s license, state ID, passport, or birth certificate)
- Social Security numbers for all household members applying
- Proof of income (recent pay stubs, employer letter, most recent tax return, benefit award letters)
- Proof of residency (utility bill, lease agreement, or recent mail with your address)
- Proof of immigration status if applicable (green card, visa documentation)
- Information about any current health insurance coverage
Common Myths — Cleared Up
“I work, so I can’t qualify for Medicaid.”
In Medicaid expansion states, any adult earning under 138% of the FPL qualifies — employed or not. A single adult earning $18,000/year at a part-time job likely qualifies. Working families with children may qualify at even higher income levels.
“Medicaid coverage is low-quality or limited.”
Medicaid covers the same types of services as private insurance — hospital care, specialist visits, prescriptions, mental health, and more — with little to no out-of-pocket cost. Provider availability varies by state and region, but managed care Medicaid plans in most states have broad provider networks.
“Applying will affect my children’s immigration case.”
Under current federal rules, Medicaid and CHIP for children and pregnant women are exempt from the “public charge” rule used in immigration decisions. U.S. citizen children of any parent’s immigration status may apply for CHIP without immigration consequences for the child.
“I missed open enrollment so I can’t apply.”
Medicaid and CHIP have no open enrollment period. You can apply at any time of year, and if eligible, coverage begins quickly — sometimes within days. This is one of the key differences between Medicaid/CHIP and private Marketplace plans.
If You Don’t Qualify for Medicaid: ACA Marketplace Options
If your income is above the Medicaid limit but you still can’t afford private insurance, you may qualify for significant subsidies through the ACA Health Insurance Marketplace. The Affordable Care Act provides premium tax credits to individuals and families earning between 100% and 400% of the FPL — and enhanced subsidies passed in 2021 (and extended through 2025) make these plans even more affordable.
- A family of four earning up to $104,800/year (400% FPL) may qualify for premium subsidies
- Many people in this income range can find Silver or Bronze plans for under $100/month after subsidies
- All Marketplace plans cover the same essential health benefits as Medicaid-covered services
- Open enrollment typically runs November 1 – January 15 each year; qualifying life events (job loss, birth, marriage) trigger a Special Enrollment Period year-round
Frequently Asked Questions
How long does it take to get approved?
Federal rules require states to make an eligibility decision within 45 days of receiving your application (90 days for disability-based applications). In practice, many states process straightforward applications much faster — sometimes within a few days for online applications where income can be electronically verified. If you have an urgent medical need, tell the person processing your application. Some states offer expedited processing in urgent situations.
Does Medicaid cover dental and vision for adults?
For children, yes — dental and vision are mandatory under EPSDT. For adults, it depends on the state. Some states cover comprehensive adult dental and vision; others cover only emergency dental services. The ACA Medicaid expansion did not require states to add adult dental coverage, so there is significant variation. Check your state’s specific benefit package at Medicaid.gov’s State Overviews to see exactly what is covered in your state.
What happens if my income changes while I’m on Medicaid?
You are required to report significant income changes to your state’s Medicaid office. If your income increases above the eligibility limit, your coverage will end — typically at your next renewal date, not immediately. You will then be eligible to apply for ACA Marketplace coverage with a Special Enrollment Period triggered by the loss of Medicaid. If your income decreases, you may become newly eligible and can apply at any time. Report changes promptly to avoid overpayments that the state may seek to recover.
Can I have Medicaid and employer insurance at the same time?
Yes. If you have access to employer-sponsored insurance, you can still apply for and receive Medicaid if you meet the income requirements. Medicaid will typically act as secondary insurance — paying costs your employer plan doesn’t cover. In some cases, Medicaid will also pay your employer plan’s premiums through a program called HIPP (Health Insurance Premium Payment), if the state determines it’s cost-effective. Ask your state Medicaid office about HIPP if you have employer coverage.
