Understanding Medicaid: Eligibility and Coverage
Medicaid is a joint federal and state program that provides health coverage to individuals and families with low incomes, including the elderly, people with disabilities, and some families with children. Each state administers its own Medicaid program within federal guidelines, resulting in variations in eligibility criteria and benefits across states.
To determine your eligibility and understand the specific benefits available in your state, visit the official Medicaid website.
General Eligibility Guidelines
While Medicaid eligibility varies by state, some general guidelines include:
Income Levels: Under the Affordable Care Act (ACA), many states expanded Medicaid coverage to adults under 65 with incomes up to 133% of the Federal Poverty Level (FPL). As of 2025, this equates to an annual income of approximately $20,763 for an individual. Medicaid+1Medicaid+1
Individuals with Disabilities: People with disabilities may qualify for Medicaid in every state. In some states, eligibility for Supplemental Security Income (SSI) automatically qualifies an individual for Medicaid. Other states may assess additional income and asset criteria.
Elderly Individuals: Seniors may be eligible for Medicaid based on income and asset tests, which can vary by state.
It’s essential to check your state’s specific eligibility requirements, as they can differ significantly.
Special Coverage for Women
Medicaid offers specialized programs for women, including:
Breast and Cervical Cancer Prevention and Treatment (BCCPT): Available to eligible women diagnosed with breast or cervical cancer through state screening programs. Eligibility may extend to those whose income exceeds standard Medicaid limits.self.com
Pregnant Women: Medicaid provides coverage for pregnant women with limited income. All states cover pregnant women with incomes up to 133% of the FPL, and many states offer coverage at higher income levels. Some states may also provide coverage through the Children’s Health Insurance Program (CHIP). Medicaid+2Medicaid+2Medicaid+2
Access to early prenatal care is crucial for the health of both mother and child. If you’re pregnant and seeking coverage, contact your state’s Medicaid office promptly.apnews.com
Dual Eligibility: Medicaid and Medicare
Individuals eligible for both Medicaid and Medicare (known as dual-eligible individuals) may benefit from additional programs:
Medicare Advantage Plans: These plans can offer additional benefits beyond Original Medicare. To explore whether a Medicare Advantage Plan suits your needs, contact a MedicareMall representative or call toll-free at (877) 413-1556.
Additional Resources
For comprehensive information about Medicaid, including how to apply and details specific to your state, visit the official Medicaid website.
If you’re interested in learning more about Medicare Supplement Plans, Medicare Advantage, or other aspects of senior health insurance, contact a licensed MedicareMall representative. We’re here to guide you confidently through the Medicare landscape.