USA Medicaid Program 2025 – Eligibility, Benefit Amount, and How to Claim

Medicaid remains one of the most important healthcare lifelines in America. If you’re navigating rising medical costs or uncertain insurance options, this public program might be exactly what you need. In 2025, Medicaid continues to serve millions of low-income families, children, seniors, and people with disabilities. But how do you know if you’re eligible, and what does it really cover?

This guide breaks everything down in simple terms—who qualifies, how to apply, and what services Medicaid pays for—so you can take full advantage of this vital resource.

Overview

Let’s start with the basics: Medicaid is a joint state and federal program that provides free or low-cost health insurance to people with limited income. Every state has its own version of the program, but they all follow certain federal rules.

If your income is low and you’re worried about healthcare costs, Medicaid is worth checking out.

Basics

So what exactly does Medicaid cover? Quite a bit, actually. While states have some flexibility, there are mandatory services that all Medicaid programs must offer. These include hospital stays, lab tests, prescription drugs, maternity care, and mental health services.

Some states go further and offer additional services like dental, vision, or non-emergency transportation. If you’re in a Medicaid expansion state, you likely have access to even broader benefits.

Mandatory Medicaid Services

• Hospital and emergency services
• Doctor visits and preventive care
• Lab tests and X-rays
• Mental health and addiction services
• Nursing home and long-term care

Optional Benefits (varies by state)

• Dental and vision
• Transportation to medical appointments
• In-home care and personal support services

Eligibility

Medicaid eligibility in 2025 is mainly based on your income and household size. Some states offer expanded Medicaid under the Affordable Care Act, which makes it easier for low-income adults to qualify.

Here’s a rough idea of income limits in expanded states (138% of the Federal Poverty Level):

In non-expansion states, eligibility can be stricter, often limited to certain groups like children or people with disabilities.

Other Eligibility Rules

• You must be a U.S. citizen or lawful permanent resident
• Immigrants may have to wait five years, depending on their status
• Seniors and people with disabilities may qualify even if their income is slightly higher, especially if they have high medical expenses

Application

Applying for Medicaid isn’t as hard as you might think. In fact, you can do it multiple ways, and help is often available.

How to Apply

• Online: Go to your state’s Medicaid website or HealthCare.gov
• In Person: Visit your local Medicaid office
• By Phone: Most states offer a dedicated hotline
• By Mail: Some states still allow mailed paper applications

Documents You’ll Need

• Proof of income (recent pay stubs or tax return)
• Social Security number
• ID and proof of citizenship or immigration status
• Birth certificates (for family members applying)
• Medical records (if applying due to disability)

Once you submit your application, processing can take 30 to 45 days. If you’re approved, you’ll receive a Medicaid card in the mail.

Dual Eligibility

Some people qualify for both Medicare and Medicaid. These “dual eligibles” usually include seniors with limited income or younger people with disabilities. In these cases, Medicaid can help cover what Medicare doesn’t—like copayments, coinsurance, and even nursing home costs.

Medicaid for Kids

Children often qualify for Medicaid or the Children’s Health Insurance Program (CHIP), even if their parents don’t. CHIP helps families who earn too much for Medicaid but still can’t afford private insurance.

Most states offer generous income limits for children and pregnant women. Kids enrolled in Medicaid or CHIP get access to immunizations, dental care, doctor visits, and emergency services.

Managed Care vs Fee-for-Service

Most Medicaid recipients are enrolled in Managed Care plans. These are run by private insurance companies under state contracts. You get assigned a provider network and primary care doctor, and the insurer coordinates your care.

Fee-for-Service Medicaid is more traditional. You see any provider that accepts Medicaid, and the state pays them directly. Some rural areas still use this model.

Medicaid Expansion Impact

Thanks to the Affordable Care Act, 38 states (plus D.C.) have expanded Medicaid, giving more low-income adults access to coverage. Expansion has:

• Increased preventive care use
• Reduced medical debt
• Boosted rural hospital funding

States that haven’t expanded Medicaid still have narrower rules, so fewer adults qualify. If you’ve been denied before, it’s worth checking again—your state may have changed its policy.

FAQs