Medicaid and CHIP: Free and Low-Cost Health Coverage
Medicaid and CHIP together cover over 90 million Americans with free or very low-cost health insurance. If you are uninsured or paying too much for coverage, these programs may provide full coverage for doctor visits, hospital stays, prescriptions, dental care, and more.
Medicaid vs. CHIP: What Is the Difference?
| Program | Who It Covers | Income Limit | Cost to You |
|---|---|---|---|
| Medicaid (adults) | Adults 19+ in expansion states | 138% FPL | Usually $0 premium |
| Medicaid (pregnancy) | Pregnant women | Up to 200% FPL in most states | Usually $0 |
| CHIP | Children under 19 | 200-300% FPL (varies by state) | Low or $0 premium |
| Medicaid (SSI/disability) | SSI recipients and disabled individuals | Varies (SSI limits apply) | Usually $0 |
| Medicare Savings Programs | Low-income Medicare recipients | 100-135% FPL | Pays Part B premiums |
Does Your State Matter? Expansion vs. Non-Expansion
The Affordable Care Act gave states the option to expand Medicaid to cover adults earning up to 138% FPL. As of 2025, 41 states and DC have expanded. In non-expansion states, adult eligibility is much more limited.
| State Type | Adult Medicaid Limit | What Happens Above the Limit |
|---|---|---|
| Expansion state (41 + DC) | 138% FPL (~$21,600/yr for 1 person) | May qualify for ACA marketplace subsidies |
| Non-expansion state | Varies – often 50-100% FPL for parents only | Childless adults often have no coverage option |
What Medicaid Covers
Medicaid provides comprehensive health coverage. Required benefits include: doctor visits, hospital stays, emergency care, lab tests, x-rays, family planning, prenatal and postnatal care, and home health services. Many states also cover dental, vision, mental health, prescription drugs, and long-term care.
Frequently Asked Questions
Can I apply for Medicaid at any time?
Yes. Unlike ACA marketplace plans, Medicaid has no open enrollment period. You can apply any time of year. If you are eligible, coverage can begin as soon as the same month you apply.
What if I just got a job and am not sure if I still qualify?
Report income changes to your Medicaid office. If your income increases above the limit, you may transition to an ACA marketplace plan, often with subsidies that can keep your costs low.
Can my child get CHIP if I have insurance through work?
It depends on your state. Some states allow children to enroll in CHIP even if a parent has employer coverage, if that coverage is considered unaffordable or inadequate.
