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Medicaid and the Health Care Law

What is Medicaid?

Medicaid is a government program that covers the cost of medical care for low-income people who meet certain criteria. To enroll in Medicaid, your family’s income and assets must be below a certain level. These levels vary from state to state. While Medicaid is a publicly funded program, care is provided by both public and private health care providers and plans.

Am I eligible for Medicaid coverage?

Some examples of people who have long been eligible for Medicaid include: pregnant women, children, adults with dependent children, people with disabilities, and seniors who have low incomes. Under the new health care law, states have the option to give more people access to Medicaid coverage by including everyone below a certain income level – about $16,000 for one person and roughly $33,000 for a family of 4 – whether or not they fall into one of the groups listed above.

In states that chose to accept federal money to improve access to Medicaid, millions of people across the country who didn’t have insurance are now able to get lifesaving preventive care and treatments for cancer and other serious diseases. Legal permanent residents (also known as green card holders) may have to wait 5 years before they can enroll in Medicaid. Undocumented immigrants are generally not eligible for Medicaid.

In states that have not broadened access to Medicaid coverage, many low-income people will not qualify for Medicaid. Some of the poorest of these people also won’t qualify for help paying for private insurance in the health insurance marketplace either.

Will Medicaid provide the health coverage I need?

In the past, Medicaid covered a range of health services, including doctor visits, hospital care, lab and x-ray services, and prescription drugs. These services are still offered to the groups that had this coverage in the past (pregnant women, children, adults with dependent children, people with disabilities, and seniors who have low incomes). People who are “newly eligible” in states that expand access to Medicaid are also covered for health care services to prevent and treat serious diseases, such as cancer.

Not all health providers take patients with Medicaid. It’s important to be sure that the doctor you want to see will take Medicaid patients before making an appointment. If they don’t, you may have to pay for the full cost of the visit.

How do I enroll?

You can apply for Medicaid at any time – you don’t have to wait for special enrollment periods. You can find out if you qualify for Medicaid through your state’s health insurance marketplace. Since October 2013, each state has had an online health insurance marketplace that allows people looking for coverage to shop for plans and compare them by benefits, quality, and price. The marketplace is where people who need to find health coverage on their own can get information about health plans that are available to them.

If you don’t qualify for Medicaid, you may be able to buy a private health plan sold in the health insurance marketplace. Many uninsured people who aren’t eligible for Medicaid can get help to purchase a plan in the marketplace, depending on their income and whether they already have the option of getting health insurance option through work.

You can find your state’s marketplace at www.Healthcare.gov/Marketplace, or by phone at 1-800-318-2596. You can also contact your state Medicaid department to find out if you are eligible. To apply, you’ll need to provide basic information, including your social security number, household size, and estimated income.

Where can I get help?

Information is available in multiple languages online through www.healthcare.gov and www.GetCoveredAmerica.org. You can also learn more through a toll-free call center at 1-800-318-2596 or TTY: 1-855-889-4325 – both of which are available 24 hours a day, 7 days a week.

You can use the website https://localhelp.healthcare.gov to find people in your community who can help you apply, enroll, or give you answers to any questions you might have.

No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-227-2345 or visit www.cancer.org.

Last Medical Review: 06/30/2014
Last Revised: 06/30/2014