What is Medicaid? Coverage, Eligibility, and How to Apply

Written by Nerris Nassiri

NowRx Pharmacy

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It’s no secret that navigating health insurance in America can be tricky, to say the least. This is even more true for those who struggle from paycheck to paycheck.

Medicaid is a program that allows low-income individuals in the United States to receive affordable healthcare. Roughly 1 in 5 individuals in the US receive Medicaid.

But who and what does Medicaid cover, and how is it different from Medicare?

Most importantly, how do you apply if you’re eligible?

Let’s dive in and take a closer look.

What is Medicaid?

Medicaid is a health insurance plan for people who are disabled or in lower-income brackets. Medicaid is funded by the U.S. federal and state levels of government. However, each state administers and manages its own individual Medicaid program. As a result, the care you will receive will depend on the state you live in.

As of November 2020, over 70,000,000 individuals were enrolled in Medicaid.

What Does Medicaid Cover?

Because Medicaid varies from state to state, the exact coverage you’ll get will depend on where you live. However, broadly speaking, every state’s program will cover the equivalent of Medicare Parts A and B.

Under federal law, all Medicaid services must include the following:

  • Doctor visits and services
  • Radiology (labs and X-rays)
  • Inpatient hospital care
  • Short-term home health care
  • Ambulances
  • Long-term care

Medicaid coverage of additional services will vary from state to state and may sometimes involve a co-pay. Some of these include:

  • Eye exams and glasses
  • Dental care
  • Hearing aids
  • Physical therapy
  • Chiropractic care
  • Dentures
  • Prosthetics
  • Preventive services
  • Family planning services

While Medicaid covers a broad range of medical care, programs usually don’t cover the following:

  • OTC medications and supplements
  • Cosmetic surgery
  • Medical services outside of the US
  • Custodial care
  • Missed appointments
  • Routine physical checkups

For more information on the specific coverage provided by your state, visit the Medicaid website.

Does Medicaid cover dental?

States are required to provide dental benefits to children and adults under 21 covered by Medicaid and the Children’s Health Insurance Program (CHIP). However, dental coverage for adults 21 and over is up to the states. States that do not cover dental care under Medicaid include:

  • Alabama
  • Delaware
  • Tennessee

Every other state offers some level of coverage for dental care services, and 17 states offer extensive coverage:

  • Alaska
  • California
  • Connecticut
  • District of Columbia
  • Iowa
  • Massachusetts
  • Montana
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oregon
  • Rhode Island
  • Washington
  • Wisconsin

Does Medicaid cover Invisalign?

If you are eligible for Medicaid and live in a state that offers dental care services, or you are under 21, your Medicaid program may cover Invisalign. However, states are only required to provide dental care that is “medically necessary” to those under 21. If orthodontics, such as braces or Invisalign, are medically necessary, i.e., there is a problem that interferes with talking, eating, or swallowing, then they will be covered.

For adults over 21, coverage for orthodontic care is left up to each individual state. For instance, in California, Medi-Cal only covers orthodontic care for children who qualify. In fact, very few states offer any coverage for adults who receive orthodontic care unless it is required due to an illness or accident. If a healthcare program does cover orthodontic care, including Invisalign, there is also usually a lifetime cap.

Does Medicaid cover hearing aids?

Hearing aids are typically covered under Medicaid; however, the extent of coverage for impaired hearing does vary from state to state. That said, state Medicaid programs are required to provide coverage of necessary diagnostic and treatment services, including further testing, hearing aids, replacement batteries, and cochlear implants for children, even if the services are not covered for adults.

States that do not cover hearing aids under Medicaid include:

  • Alabama
  • Arizona
  • Arkansas
  • Colorado
  • Delaware
  • District of Columbia
  • Georgia
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Michigan
  • Mississippi
  • Michigan (with few exceptions)
  • North Carolina
  • Oklahoma
  • Pennsylvania
  • South Carolina
  • Tennessee
  • Utah
  • Virginia
  • West Virginia

States that do cover hearing aids under Medicaid include:

  • Alaska
  • California
  • Connecticut
  • Florida
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Massachusetts
  • Minnesota
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Dakota
  • Ohio
  • Oregon
  • Rhode Island
  • South Dakota
  • Texas
  • Vermont
  • Washington
  • Wisconsin
  • Wyoming

Who Qualifies for Medicaid?

Because Medicaid is operated and administered by the state, who qualifies will differ from state to state. However, federal law requires states to cover certain groups of individuals, including low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI). Despite varying criteria, you can easily find out if you qualify by visiting your state’s Medicaid website.

Here are some of the factors that affect eligibility for Medicaid:

Income and Family Size

Generally speaking, income is the biggest factor that will determine if you qualify for your state’s Medicaid program. The Affordable Care Act of 2010 helped expand Medicaid so that nearly all low-income individuals under 65 may qualify. 

So if your income is lower than 133% of the federal poverty level, you will likely qualify for Medicaid. The 2022 federal poverty level for individuals is $13,590 and $27,500 for a family of four.

In addition to income, you’ll usually also have to be a resident of the state where you’re getting Medicaid and a citizen or permanent resident of the United States. However, some states offer exceptions to this.

Asset Limits

In addition to income, there are a number of limits on how many assets an individual can have in order to qualify for Medicaid. These assets include checking and savings balances, home equity, investments, annuities, and others. Most states have an asset limit of $2,000.

However, there are some assets that don’t count towards this limit. These include the value of one car, your primary residence, life insurance policies, and a funeral fund.

Because the asset limit of most states is so low, many individuals may choose to spend their “countable” assets on “non-countable” assets. One example of this would be using your savings (a countable asset) to pay down your mortgage since your primary residence doesn’t count towards your asset limit.

Special Programs

Many states have special programs for individuals and families with specific medical needs. For example, an uninsured woman who becomes pregnant will usually qualify for her state’s Medicaid program.

What is the Difference Between Medicare and Medicaid?

Medicare and Medicaid are two completely different programs. However, they are both federal health insurance programs, and given how complex our healthcare system is, it’s easy to mix up the two. Additionally, there can be some overlap in who can receive coverage from these programs.

Here are the main differences between Medicare and Medicaid:

Medicare Qualifications

Medicare is primarily for individuals over 65 years old. In order to qualify for Medicare, you must have been working and paying Medicare taxes for a minimum of 10 years.

However, people under 65 can qualify for Medicare in a variety of different ways. For instance, if you’ve been on Social Security (i.e., have a disability) for at least two years, you can qualify for Medicare.

Furthermore, if you have Lou Gehrig’s disease (ALS) or End-Stage Renal Disease (ESRD), you can usually qualify for Medicare right away with no waiting period.

While Medicaid is dependent on having a low income, Medicare doesn’t have an income requirement. As long as you’ve met one of the above criteria, you can qualify for Medicare regardless of your socioeconomic status.

Who Funds What?

Another big difference between the two programs is their source of funding. Medicare is completely funded and operated by the federal government. This means, no matter where you are in the country, you’re going to get the same benefits.

However, Medicaid is funded by both the state and federal governments. Moreover, each state controls how Medicaid is operated and how funds are distributed, so benefits can vary depending on where in the country you live.

Long-Term Coverage

Another major difference between Medicare and Medicaid is long-term care coverage. Medicare doesn’t cover long-term care. So, for instance, a nursing home wouldn’t be covered under Medicare. Medicaid, on the other hand, usually covers some types of long-term care, though this coverage is fairly limited.

Similarities between Medicaid and Medicare

While there are many differences between Medicaid and Medicare, there are some similarities. Both programs are run by the government and funded by taxpayers. Additionally, there are some overlaps in terms of coverage. Both Medicare and Medicaid cover hospitalizations, labs, medications, doctor visits, and radiology (X-rays). However, the programs are meant to serve different groups of people.

How to Apply for Medicaid?

Currently, there are two ways to apply for Medicaid. You can:

  • Contact your state’s Medicaid agency. You can find their contact information at Remember, you’re required to be a resident of the state where you apply.
  • Fill out the online form on the insurance marketplace.

Applying for Medicaid is different than applying for private health insurance. When you apply for a marketplace insurance plan, you must do so during a period called “open enrollment.”

This is to prevent something called “adverse selection,” which is when sick people sign up for health insurance, but healthy people don’t sign up. Adverse selection skews the overall risk of the medical industry and causes prices to go up, as insurance companies have to pay exclusively for higher-risk individuals. Having a set open enrollment period is how the health industry can keep prices stable across the board.

That said, with Medicaid, there is no open enrollment period. Individuals or families may enroll at any time, as long as they’re eligible.

One important thing to remember is that most states require you to reapply for Medicaid every year. If your state requires this, it might be a good idea to set annual reminders, so you don’t forget.


Understanding healthcare in the US can be a bit complicated. However, with the abundance of information available online, it’s become much easier to understand programs like Medicaid and how you can get health insurance through it if you qualify.

Here’s a quick cheat sheet:

  • Medicaid is a program primarily for low-income individuals, while Medicare is for the elderly.
  • Medicaid coverage and eligibility vary from state to state.
  • Eligibility is primarily based on income, though certain individuals with higher medical needs may qualify.

Remember, you can visit for all of the information you’ll need. If you have questions about medications and pharmacy coverage for your specific insurance plan, you can always reach out to us at We’ll be more than happy to help.

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