Medicaid, the federal-state program providing health coverage to over 80 million low-income Americans, is often described as “free” or low-cost, but the reality depends on your state, income, and program type. In 2025, Medicaid covers adults, children, pregnant women, seniors, and people with disabilities, but costs like copays or premiums vary. The “One Big Beautiful Bill” (signed July 4, 2025) introduces $1 trillion in cuts through 2034, potentially adding out-of-pocket costs for some.
This blog explores whether Medicaid is free, what costs you might face, state variations, and how to check eligibility. Use the Medicaid Eligibility Calculator to see if you qualify.
Is Medicaid Free for Everyone?
Medicaid is generally free for most enrollees, particularly children, pregnant women, and low-income adults in expansion states, but costs depend on your category and state. In 2025, 39 states plus D.C. have expanded Medicaid under the Affordable Care Act (ACA), covering adults up to 138% of the Federal Poverty Level (FPL) ($21,597/year for one person). Non-expansion states (e.g., Texas, Florida) have stricter eligibility, often limiting adults to specific groups like parents or disabled individuals.
Free Coverage
- Children (0–18): Covered under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, with no premiums or copays in all states.
- Pregnant Women: Free coverage, including prenatal care and delivery, in most states (up to 200–375% FPL, depending on state).
- Low-Income Adults (Expansion States): Typically no premiums or copays for those below 138% FPL ($29,187 for two).
- Seniors/Disabled (Regular Medicaid): Often free, especially for Supplemental Security Income (SSI) recipients ($967/month for singles).
Potential Costs
- Premiums: Rare but allowed in some states for adults above 100% FPL (e.g., Indiana’s HIP charges $1–$20/month for incomes 100–138% FPL).
- Copays: Limited to $4–$8 for services like doctor visits or prescriptions in some states (e.g., Florida, Kentucky). Exempt for children, pregnant women, and preventive care.
- Out-of-Pocket Costs (OBBBA): Starting October 2028, non-exempt adults in expansion states may face up to $35 per specialist visit or procedure, but primary care remains free.
Check your state’s income limits at Income for Medicaid Eligibility to understand eligibility and potential costs.
“Big Beautiful Bill” Impact on Medicaid Costs
The “One Big Beautiful Bill” (OBBBA) introduces changes that could increase Medicaid costs for some:
- Work Requirements (January 2027): Adults 19–64 in expansion states must work, volunteer, or study 80 hours/month, unless exempt (e.g., disabled, caregivers). Non-compliance may lead to coverage loss, indirectly increasing medical expenses.
- Reduced Retroactive Coverage (January 2027): Coverage drops to 1 month (expansion adults) or 2 months (others) prior to application, down from 90 days, risking medical debt.
- Frequent Eligibility Checks (December 2026): Six-month renewals for expansion adults may cause coverage gaps if documentation lapses.
- New Copays (October 2028): Up to $35 for specialist visits/procedures for non-exempt adults, potentially affecting 11.8 million enrollees.
- Funding Cuts: $1 trillion reduction may limit state budgets, prompting cuts to optional benefits like dental (see Does Medicaid Cover Dental?).
In California, Medi-Cal remains free for most, but $705 million in SNAP-related costs could strain budgets, potentially adding copays.
Costs by Medicaid Program Type
Medicaid programs vary, affecting costs:
1. Regular Medicaid (Aged, Blind, Disabled)
- Cost: Usually free for SSI recipients ($967/month single, $1,450/month couple). Some states charge $1–$4 copays for prescriptions or non-emergency ER visits.
- Income Limits: $967–$1,795/month for singles; up to $2,901/month for nursing home care.
2. Medicaid Expansion (Adults 19–64)
- Cost: Free in most states (e.g., California, New York) for incomes up to 138% FPL. States like Indiana or Michigan may charge small premiums ($1–$20/month) or copays ($4–$8).
- OBBBA Impact: $35 specialist copays start in 2028.
3. Children’s Medicaid and CHIP
- Cost: Free for children under EPSDT or CHIP (up to 200–350% FPL). No copays or premiums.
- Services: Includes dental, vision, and preventive care.
4. Pregnant Women
- Cost: Free in most states, covering prenatal care, delivery, and postpartum (up to 60 days).
- Income Limits: 200–375% FPL (e.g., $44,367–$98,625 for a family of four).
5. Long-Term Care (Nursing Home/HCBS)
- Cost: Free after income contributions (except $30–$200 Personal Needs Allowance). Copays rare.
- Income Limits: Up to $2,901/month (single) or $5,802/month (couple) in most states.
State-Specific Cost Variations
Costs vary by state due to Medicaid’s flexibility:
- California (Medi-Cal): Free for most, including children, pregnant women, and adults up to 138% FPL. No asset limits. Dental is covered (see Does Medicaid Cover Dental?).
- Florida: $2–$8 copays for adults in limited programs; free for children and pregnant women. No expansion for adults.
- New York: Free for most, with $3–$6 copays for prescriptions in some cases. Extensive dental coverage.
- Texas: $3–$5 copays for adults (limited eligibility); free for children and pregnant women.
- Non-Expansion States (e.g., Alabama, Georgia): Free for eligible groups (children, pregnant women), but adults rarely qualify without disability.
Use state Medicaid sites (e.g., www.dhcs.ca.gov for California) or the Medicaid Eligibility Calculator for specifics.
How to Check If Medicaid Is Free for You
- Verify Eligibility: Check income against 138% FPL ($21,597 for one) for expansion states or lower limits for non-expansion states at Income for Medicaid Eligibility.
- Apply: Use Healthcare.gov, state portals (e.g., BenefitsCal.com), or county offices. Provide income, household size, and residency proof.
- Review Costs: Ask your Medicaid agency about copays or premiums (e.g., 1-877-543-7669 for California).
- Monitor OBBBA Changes: Prepare for 2026–2028 changes (work requirements, copays) by updating documentation regularly.
Challenges and Considerations
- Provider Access: Only 70% of providers accept Medicaid due to low reimbursements, causing delays (e.g., 3–6 month waits in rural areas).
- OBBBA Risks: 11.8 million may lose coverage due to work requirements or eligibility checks, increasing out-of-pocket medical costs.
- Non-Expansion States: Stricter eligibility (e.g., $235/month for parents in Texas) limits free coverage to children or pregnant women.
In California, Medi-Cal’s no-cost structure may face pressure from OBBBA’s $1 trillion cuts, potentially adding copays by 2028.
Frequently Asked Questions (FAQs)
Is Medicaid free in 2025?
Medicaid is free for most (children, pregnant women, low-income adults), but some states charge $1–$20/month premiums or $4–$8 copays for adults. OBBBA may add $35 specialist copays in 2028.
Do children get free Medicaid?
Yes, children under 21 get free coverage (no copays/premiums) via EPSDT or CHIP, including dental and vision.
Are there copays with Medicaid?
Rarely; some states charge $1–$8 for prescriptions or visits for adults. Children and pregnant women are exempt. OBBBA introduces $35 specialist copays in 2028.
Does Medicaid cover dental costs?
Children: Yes, fully covered. Adults: Varies by state (15 extensive, 12 none). Check Does Medicaid Cover Dental? for details.
How do I know if I qualify for free Medicaid?
Check income against 138% FPL ($21,597 for one) using the Medicaid Eligibility Calculator or state portals.
Conclusion
In 2025, Medicaid is free for most enrollees, especially children, pregnant women, and low-income adults in expansion states, but some face small copays ($4–$8) or premiums ($1–$20/month). The “One Big Beautiful Bill” may introduce $35 specialist copays by 2028 and reduce enrollment, impacting access.
Use the Medicaid Eligibility Calculator to confirm eligibility and review Income for Medicaid Eligibility for state-specific limits. For dental coverage details, see Does Medicaid Cover Dental?. Contact your state Medicaid office (e.g., www.dhcs.ca.gov for California) for applications and provider lists.