Medicaid Eligibility Calculator 2025

What Is the 2025 Medicaid Eligibility Calculator?

The 2025 Medicaid eligibility calculator is a free online tool that helps you find out if you qualify for Medicaid health coverage.

You enter your income, family size, and state to get an instant answer. It’s like having a quick helper that does the math for you.

This tool checks your income against your state’s Medicaid rules. Each state has different income limits.

The calculator uses the Federal Poverty Level to figure this out. It takes all the guesswork away.

When you use the calculator, you’ll need your monthly income, how many people live in your home, and what state you live in. Some programs also ask your age.

Why Use This Calculator?

Medicaid rules can be confusing. Income limits change every year. What works in Texas might not work in California.

Here’s what makes it helpful:

• You get instant results with no waiting
• It’s updated for 2025 with the newest income limits
• It knows your state’s exact rules
• It checks different types of Medicaid programs

The calculator gives you a simple yes or no answer. But it also explains why.

You might see results like “You qualify for regular Medicaid” or “Your income is too high for Medicaid.”

Income Limits for 2025

For 2025, most states use these basic rules:

• Regular adults: Up to 138% of Federal Poverty Level in expansion states
• Seniors needing long-term care: Up to $2,901 per month
• Families with children: Usually 138-200% of Federal Poverty Level
• Pregnant women: Often up to 200% of Federal Poverty Level or higher

The calculator checks for several Medicaid programs. Regular Medicaid is for low-income adults, children, and families.

Long-term Care Medicaid helps pay for nursing home care. Emergency Medicaid covers urgent medical care only.

There’s also special Medicaid for seniors age 65 and up.

Use this tool when you lost your job, had income changes, or want to check before applying. You can also use it when comparing health insurance options or if your family size changed.

2025 Medicaid Income Limits by State

Medicaid income limits for 2025 vary by state and type of coverage.

Most expansion states allow adults to qualify with income up to 138% of the Federal Poverty Level, which is $21,597 per year for one person in 2025.

For seniors needing long-term care, the income limit is $2,901 per month in most states.

Your state’s Medicaid expansion status makes a big difference. Expansion states cover more people with higher income limits.

Non-expansion states have much lower limits for adults without children.

Income Limits by Coverage Type

Regular Adult Medicaid (Ages 19-64)

• Expansion states: Up to $21,597/year ($1,800/month) for one person
• Non-expansion states: Often under $5,000/year for adults without kids
• The 138% limit includes a 5% income disregard, so more people qualify

Long-Term Care Medicaid (Nursing Homes & Home Care)

• Most states: $2,901/month for singles, $5,802/month for couples
• Some states have no income limit but use spend-down rules
• Covers nursing home care and home health services

Children and Families

• Usually 138% to 200% of Federal Poverty Level
• Some states go higher for kids
• Pregnant women often get higher limits too

State Categories

Expansion States (38 + DC) These states expanded Medicaid in 2014. Adults qualify easier here. States like New York, Pennsylvania, Ohio, and Washington use 138% of Federal Poverty Level.

Non-Expansion States (12 states) These states didn’t expand Medicaid. Adults face much stricter rules. Texas has some of the lowest income limits in the country.

2025 Federal Poverty Level Quick Reference

For 138% of Federal Poverty Level in 2025:

• 1 person: $21,597/year ($1,800/month)
• 2 people: $29,172/year ($2,431/month)
• 3 people: $36,747/year ($3,062/month)
• 4 people: $44,322/year ($3,694/month)

Add $7,575 for each extra person in your household.

Examples: Top 5 States

California

• Regular adults: 138% of Federal Poverty Level ($21,597/year)
• Long-term care: No income limit (uses spend-down)
• Expansion state with generous coverage

Texas

• Regular adults: Very low limits (non-expansion state)
• Parents: About 18% of Federal Poverty Level
• Long-term care: $2,901/month for singles

Florida

• Regular adults: No coverage (non-expansion state)
• Parents only: About 32% of Federal Poverty Level
• Long-term care: $2,901/month for singles

New York

• Regular adults: 138% of Federal Poverty Level
• Expansion state with full coverage
• Long-term care: $2,901/month for singles

Illinois

• Regular adults: 138% of Federal Poverty Level
• Long-term care: $1,304/month for singles, $1,762/month for couples
• Expansion state but lower long-term care limits

What This Means for You

If you live in an expansion state, you have better chances of qualifying. If you’re in a non-expansion state, you might only qualify if you’re pregnant, have kids, or need long-term care.

Use your state’s Medicaid calculator to get exact numbers. Rules change, and some states have special programs with different limits.

Who Qualifies for Medicaid in 2025?

Medicaid helps millions of Americans get health care. But who can get it? Let’s break down who qualifies for Medicaid in 2025.

Your income matters most. But your age, family size, and health also count. Each state has different rules too.

Here’s who qualifies for Medicaid:

• Low-income adults – In states that expanded Medicaid, you qualify if you make 138% of the federal poverty level or less
• Pregnant women – Usually qualify at higher income levels than other adults
• Children and teens – Get coverage through Medicaid or CHIP up to age 19
• Seniors 65 and older – Can get help with Medicare costs
• People with disabilities – May qualify even with higher incomes
• SSI recipients – Automatically get Medicaid in most states

Medicaid Eligibility for Adults Without Children

Single adults without kids can get Medicaid in expansion states. You need to make less than $20,780 per year in 2025. That’s about $1,732 per month.

If your state didn’t expand Medicaid, it’s harder to qualify. Most states only cover adults without children if they’re pregnant, disabled, or over 65.

You also need to be a U.S. citizen or legal resident. Some states have waiting periods for new residents.

Medicaid Eligibility for Seniors (65+)

Seniors can get two types of Medicaid help:

Full Medicaid covers everything Medicare doesn’t. You need to make less than $967 per month in most states. Some states allow up to $1,304 per month.

Medicare Savings Programs help pay Medicare premiums. Income limits are higher – up to $1,715 per month for single people in 2025.

Your assets matter too. You can’t have more than $2,000 in savings and investments as a single person.

Medicaid Eligibility for People with Disabilities

Disabled adults often qualify for Medicaid through SSI. If you get SSI payments, you automatically get Medicaid in most states.

Don’t get SSI? You might still qualify. Income limits range from $967 to $1,795 per month, depending on your state.

Medicaid covers things Medicare doesn’t, like:

• Long-term care
• Personal care services
• Some prescription drugs
• Medical equipment

Medicaid for Pregnant Women and Children

Pregnant women get the best Medicaid coverage. Most states cover pregnant women who make up to 200% of the federal poverty level. That’s about $2,760 per month in 2025.

Some states go even higher. Check your state’s rules.

Children qualify more easily than adults. Most states cover kids in families making up to 200-300% of the poverty level. That’s $55,500-$83,250 per year for a family of four.

CHIP covers kids whose families make too much for Medicaid but can’t afford private insurance.