Medicare and Medicaid · Lesson 16 of 16
Could I qualify for Medicaid or CHIP, and how do I apply?
The short answer
Medicaid is free or low-cost health coverage for people with limited income, run by each state within federal rules. CHIP covers children, and in some states pregnant people, in families that earn too much for Medicaid. You can apply any time of year through your state Medicaid agency or HealthCare.gov.
Key takeaways
- There is no open enrollment period. Apply as soon as your income or family changes.
- Rules, benefits, and program names differ by state.
- Open every letter from your state Medicaid agency and answer by the deadline to keep coverage.
Who it is for
Medicaid covers many people with limited income, including children, pregnant people, parents, older adults, and people with disabilities. Many states also cover other adults with low income. CHIP covers children in families whose income is too high for Medicaid.[1] Your state decides the exact income limits.
How to apply
Apply through your state Medicaid agency, or fill out an application on HealthCare.gov or your state Marketplace. The application checks Medicaid, CHIP, and Marketplace savings at the same time.[1] You can apply any month of the year.
Have these ready: proof of income, Social Security numbers, immigration documents if they apply, and information about any current coverage.
Bills from before you applied
Medicaid can sometimes pay bills from the months before you applied, if you were eligible then. Today this can reach back up to three months. Starting January 1, 2027, that window becomes shorter, so apply soon after you get care you cannot afford.[2]
Changes starting in 2027
Under a 2025 federal law, many adults ages 19 to 64 who qualify through Medicaid expansion will need to show they work, volunteer, go to school, or meet an exemption. Many in this group will also renew every six months instead of every year. Children, pregnant people, and many people with disabilities are not part of this change.[2] Dates and details depend on your state, so watch for letters from your state agency.
What can be different for you
Some states have not expanded Medicaid to most low-income adults, so coverage for adults without children may be limited. Program names differ, such as Medi-Cal in California. Most Medicaid members get care through a managed care plan chosen in their state. If you have both Medicare and Medicaid, Medicaid may help pay Medicare costs. If you lose Medicaid and are eligible for Medicare, you have a special window to sign up for Medicare without a penalty.[3]
More detail (optional)
If you are denied
Your notice must explain why and how to ask for a fair hearing. Ask for one by the deadline on the notice. A legal aid office or patient advocate can help.
If you earn too much
If you do not qualify, the same application may show you can get lower premiums on a Marketplace plan. Hospital financial assistance may also help with bills.
Words in this lesson
- Medicaid and CHIP
- Public health coverage for people with limited income, and for children through CHIP. Each state runs its own program within federal rules.
- Health Insurance Marketplace
- The government-run place to compare and buy individual health plans, such as HealthCare.gov or a state Marketplace.
- Medicare
- Federal health insurance for people 65 and older and for some younger people with disabilities or certain conditions.
Related
Where can I go for help?
Free help is often close by: the member services number on your insurance card, the billing office for your provider, your state insurance department, and nonprofit patient advocates.
This is general education. For decisions about your own plan, taxes, or legal rights, check your plan documents or a qualified professional.