Medicaid and CHIP: Comprehensive Health Coverage for Those Who Qualify
Together, Medicaid and CHIP cover more than 90 million Americans with comprehensive health insurance at little or no cost. If you are uninsured or underinsured, these programs cover everything from routine doctor visits to hospital stays, prescription medications, mental health care, and dental services — often with zero monthly premium.
Medicaid vs. CHIP: Side-by-Side Comparison
| Program | Who Is Covered | Income Limit | Typical Cost |
|---|---|---|---|
| Medicaid (adults) | Adults 19+ in Medicaid expansion states | 138% FPL | $0 premium in most states |
| Medicaid (pregnancy) | Pregnant women in most states | Up to 200% FPL | $0 in most cases |
| CHIP | Children under age 19 | 200–300% FPL (state-dependent) | Low-cost or $0 |
| Medicaid (SSI/disability) | SSI recipients and qualifying disabled individuals | Based on SSI limits | $0 in most cases |
| Medicare Savings Programs | Low-income Medicare beneficiaries | 100–135% FPL | Covers Medicare Part B premiums |
Does Your State Have Expanded Medicaid?
The Affordable Care Act allowed states to expand Medicaid eligibility to adults earning up to 138% of the Federal Poverty Level. As of 2025, 41 states plus Washington, D.C. have expanded. In the remaining states, eligibility for adults without dependent children is extremely limited.
| State Category | Adult Income Limit | If You Exceed the Limit |
|---|---|---|
| Expansion states (41 + DC) | 138% FPL (~$21,600/yr for a single adult) | May qualify for ACA marketplace subsidies |
| Non-expansion states | Often 50–100% FPL for parents only; very limited for others | Childless adults often have no affordable coverage option |
What Medicaid Covers
Federal law requires Medicaid to cover a broad set of essential services. Required benefits include inpatient and outpatient hospital care, doctor visits, emergency services, lab work, X-rays, family planning, and prenatal care. Most states go further and also cover prescription drugs, dental care, vision, mental health and substance use treatment, and long-term services.
Frequently Asked Questions
Is there a limited enrollment window for Medicaid?
No. Unlike ACA marketplace plans, Medicaid does not have an open enrollment period. You can apply any day of the year. If approved, coverage can begin as early as the first day of the month in which you applied.
I just started a new job. Will I lose Medicaid?
A pay increase may affect your eligibility, but you will receive advance notice before any coverage change takes effect. If your new income puts you above the Medicaid limit, you will likely qualify for subsidized marketplace coverage, often at a comparable or lower cost.
Can my child get CHIP if I have employer health insurance?
Possibly. Some states allow children to enroll in CHIP even when a parent has employer-sponsored coverage, particularly if that coverage is unaffordable or does not adequately cover the child. Check your state’s CHIP rules specifically, as they vary.
Does Medicaid cover dental and vision for adults?
It depends on the state. Federal law requires dental and vision coverage for children, but adult coverage is optional. Many states do cover adult dental and vision services, though the scope varies. Contact your state Medicaid office to find out what is included in your plan.
