Medicaid Basics in 2025
Medicaid is a joint federal-state program providing health coverage to low-income individuals—children, pregnant women, elderly, disabled, and more. In 2025, it includes programs like SSNAP, QMB, and extensive benefits, often overlapping with SSI, Medicare, and SNAP. This guide covers eligibility, coverage, application, and more, with tools to help you navigate.
Check Your Eligibility
Who Qualifies for Medicaid?
Eligibility varies by state, based on income, assets, and category:
| Group | Income Limit (2025 FPL) | Asset Limit |
|---|---|---|
| Children | 138%-300% FPL (~$41,000 family of 4) | None in most states |
| Pregnant Women | 138%-200% FPL (~$30,000 single) | Varies |
| Adults (Expansion) | 138% FPL (~$20,784 single) | Varies |
| Elderly/Disabled | ~74% FPL (~$11,177 single) or SSI | $2,000 single/$3,000 couple |
Example: Lisa, 35, earns $19,000 (130% FPL) in an expansion state—she qualifies. Tom, 67, on SSI—auto-eligible.
Note: 38 states expanded Medicaid (138% FPL); others use stricter rules—check yours (here).
What’s Covered?
Mandatory benefits (all states) vs. optional (varies):
- Mandatory: Doctor visits, hospital care, labs, X-rays, prenatal care.
- Optional: Prescriptions, dental, vision, long-term care (nursing homes, home health).
SSNAP (State Supplementary Nursing Assistance Program): Extra help for nursing home costs in some states—e.g., California’s Medi-Cal supplements.
Example: Jane’s state covers dental—she gets free cleanings with Medicaid.
SNAP and Medicaid
Medicaid often pairs with SNAP (food assistance). Apply for SNAP at USDA SNAP Application or your state agency (find here).
Hospitals & Clinics Accepting Medicaid
Most public hospitals, community clinics, and some private providers accept Medicaid. Examples:
- Federally Qualified Health Centers (FQHCs): Nationwide, sliding-scale fees.
- Rural Hospitals: Often Medicaid-friendly—check locally.
- Major Chains: Some HCA, Tenet facilities—varies by location.
Find providers: Medicaid Provider Directory.
Medicaid and Other Programs
SSI Link: In 35 states, SSI auto-enrolls you in Medicaid—others require separate apps.
Medicare Dual Eligibility: QMB pays Medicare premiums/copays if income < 100% FPL ($14,580 single). Other programs: SLMB, QI.
Medicaid vs. Medicare Coverage
Chart: Relative coverage strengths.
Watch this video for a Medicaid overview!
How to Apply
Three main paths—varies by state:
- HealthCare.gov: Online for expansion states (apply).
- State Agency: Direct to your state’s Medicaid office (find here).
- SSI Path: Auto-enrollment in 35 states with SSI approval—takes 1-3 months.
Example: Mike applies via HealthCare.gov—approved in 30 days for $18,000 income.
QMB and Other MSPs
| Program | Income Limit (2025) | Covers |
|---|---|---|
| QMB | 100% FPL ($14,580 single) | Part A/B premiums, copays |
| SLMB | 120% FPL ($17,496) | Part B premiums |
| QI | 135% FPL ($19,683) | Part B premiums (limited spots) |
Latest Medicaid News
- Jan 2025: NY expands SSNAP funding for nursing homes.
- Feb 2025: Telehealth coverage permanent in 42 states.
- More News
Myths vs. Facts
Myth: Medicaid is only for the unemployed.
Fact: Working adults under 138% FPL qualify in expansion states.
Myth: Medicaid doesn’t cover good care.
Fact: Includes top hospitals and specialists—varies by state.
2025 Updates
- FPL Increase: ~2.5% rise—$14,580 single (100% FPL).
- Telehealth: Expanded in 40+ states—check locally.
- SSNAP: More states boost nursing home aid.
Need Help?
Call 1-800-633-4227 (Medicaid) or 1-800-772-1213 (SSA/SSI). Visit Medicaid.gov.