Is Medicaid Free in 2026? Premiums and Copays by State

Direct Answer: Is Medicaid Free in 2026?

It depends on your income and household circumstances. Most Medicaid enrollees, including all children, pregnant women, and people receiving hospice or nursing facility care, pay nothing at all because federal law exempts them from every premium and copay. Some adults with income above 100% of the federal poverty level in 2026 may owe small nominal copays or, in certain states, modest monthly premiums, but total costs can never exceed 5% of household income.

Who Pays $0 for Medicaid Coverage

Every state Medicaid program, from Medi-Cal in California to Texas Medicaid, must follow the same federal floor: certain groups can never be charged a premium or copay. Children under 19, pregnant women receiving pregnancy-related care, people living in a nursing facility or other institution, individuals receiving hospice care, and American Indians and Alaska Natives who have ever used an Indian Health Service or tribal health program are fully exempt from Medicaid cost sharing under federal law (42 CFR 447.56).

Medicaid is also an ACA-compliant form of coverage: it cannot deny enrollment, charge more, or limit benefits because of a preexisting condition, and every state's expansion Alternative Benefit Plan must cover the ACA's 10 essential health benefits, including maternity care, mental health treatment, and prescription drugs, at no extra premium for adults below 138% of the 2026 federal poverty level. That combination, no preexisting-condition penalty plus a federally exempt cost-sharing floor, is why the large majority of Medicaid and CHIP enrollees pay nothing out of pocket for their coverage.

Nominal Copays: How Much Medicaid Can Charge in 2026

For Medicaid enrollees who are not otherwise exempt, federal regulation 42 CFR 447.52 caps what a state can charge based on household income measured against the federal poverty level (FPL). At or below 100% FPL ($15,960 for one person in 2026), the maximum nominal copay is $4 for an outpatient visit, $4 to $8 for a prescription depending on whether the drug is on the state's preferred list, $8 for a non-emergency emergency-room visit, and up to $75 for an inpatient hospital stay. A provider cannot turn away a Medicaid patient who cannot pay that nominal amount.

Between 101% and 150% FPL ($16,120 to $23,940 for one person in 2026), states may charge up to 10% of the actual cost of outpatient or institutional services instead of the flat nominal amount, though prescription copays and non-emergency ER copays generally stay near the same $4 to $8 nominal range. Above 150% FPL, states have more flexibility and can charge up to 20% of the service cost for non-preferred drugs and institutional or outpatient care, with no fixed per-visit dollar cap on non-emergency ER copays, though the 5% aggregate income cap described below still applies as the ultimate backstop.

Medicaid Premiums: Which States Charge Them

Federal law bars any state from charging a Medicaid premium to a household at or below 150% of the federal poverty level, which is $23,940 for an individual or $49,500 for a family of four in 2026. Above that threshold, a handful of states use Section 1115 demonstration waivers to charge modest monthly premiums or required contributions, most commonly for expansion adults. Indiana's Healthy Indiana Plan (HIP) requires a POWER Account contribution as low as $1 a month for most members, and other states have used similarly small monthly charges tied to income for their expansion populations.

State premium programs change often as waivers are renewed, modified, or discontinued, so the accurate number for your household depends on your state's current Medicaid rules, not a national figure. The fastest way to check is to call your state Medicaid agency's member services line or look up your state's Medicaid page at medicaid.gov, since 42 CFR 447.56 requires every state to publish its current premium and cost-sharing schedule.

The 5% Income Cap: Medicaid's Federal Backstop

No matter how many copays, premiums, or other charges stack up, federal law limits the total combined cost of Medicaid premiums and cost sharing for everyone in a household to 5% of family income, applied on either a monthly or quarterly basis at the state's choice. Once a household hits that cap, the state must stop collecting further cost sharing for the rest of that period, and states are required to track spending and notify enrollees when they approach the limit.

The 5% cap is the single most important number to know if you are worried about affording Medicaid: even in a state that charges premiums and the maximum allowable copays, a family cannot be billed more than 5% of its income in a given month or quarter for Medicaid-covered services. If you believe you have been charged more than that, your state Medicaid agency and CMS both have complaint processes.

Dual Eligibles: How Medicaid Covers Medicare Costs

About 12 million Americans qualify for both Medicare and Medicaid, and for this group Medicaid often erases Medicare's own out-of-pocket costs rather than charging anything new. Through the Medicare Savings Programs, income-eligible dual eligibles can have Medicaid pay their Original Medicare Part B premium ($202.90 a month standard in 2026), and the Qualified Medicare Beneficiary (QMB) program also pays Medicare Part A and Part B deductibles, coinsurance, and copays, including the $283 Part B deductible and the $1,736 Part A inpatient deductible in 2026.

Full dual eligibles, those who qualify for both full Medicaid and Medicare Savings Program help, generally owe nothing for Medicare-covered services whether they stay on Original Medicare, enroll in a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP), or, less commonly, pair Original Medicare with a separate Medigap policy. Medicaid also coordinates with Medicare Part D: most duals automatically qualify for the Extra Help low-income subsidy, which caps 2026 Part D copays at a few dollars per prescription rather than the full cost-sharing amount. Medicaid picks up what Medicare does not cover, such as long-term nursing facility care, and continues to apply the exemptions and caps described above to any Medicaid-only services a dual eligible uses.

CHIP Costs by Comparison

The Children's Health Insurance Program (CHIP), which covers kids in families with income too high for Medicaid but who still cannot afford private insurance, plays by slightly different cost-sharing rules than Medicaid. Unlike Medicaid, CHIP can charge modest premiums even to some families below 150% FPL as long as the state's CHIP plan is a separate program from its Medicaid expansion. In 2026, 18 states charge CHIP premiums, and the typical income level where those premiums start is around 163% FPL, or roughly $44,500 a year for a family of three.

CHIP copays are also capped, but the ceiling is the same 5% aggregate limit that applies to Medicaid: combined CHIP premiums and cost sharing for a family cannot exceed 5% of household income in a year. Most CHIP copays run $5 or less for a doctor visit, and preventive care, well-child visits, and immunizations are always free of charge under CHIP, the same way they are under Medicaid.

What to Do if You're Billed for a Medicaid Service That Should Be Free

If a Medicaid provider bills you for a service that should have been exempt, or charges more than your state's nominal copay allows, you have several concrete options before that bill goes to collections.

• Call your state Medicaid agency's member or beneficiary services line first. Most billing errors get corrected with one phone call once the exempt status or copay cap is confirmed.
• File a Medicaid Managed Care Organization (MCO) grievance if you are enrolled in a managed care plan. MCOs are required to have a formal complaint process separate from the state agency.
• Request a spend-down or medically needy review if your income fluctuates. Some states let high medical bills count against income for eligibility purposes, which can lower or eliminate cost sharing going forward.
• File a complaint with CMS through the Medicaid.gov consumer complaint process if the state agency does not resolve the issue, since federal cost-sharing limits are enforceable federal law, not just state policy.
• Ask the provider's billing office about a Federally Qualified Health Center (FQHC) sliding-scale option or hospital charity care policy if you are between eligibility periods or facing a bill from before your Medicaid coverage started.

Does Medicaid charge a monthly premium?

Usually not. Federal law bars states from charging any Medicaid premium to households at or below 150% of the federal poverty level ($23,940 for one person in 2026). Above that income, a handful of states use Section 1115 waivers to charge small monthly premiums, often as low as $1 to $20, mainly for expansion adults. Check your state Medicaid agency for the exact current rule.

What is the maximum Medicaid copay in 2026?

For enrollees at or below 100% FPL, federal rules cap copays at $4 for outpatient visits, $4 to $8 for prescriptions, $8 for non-emergency ER visits, and up to $75 for an inpatient hospital stay. Above 150% FPL, states can charge up to 20% of the service cost for some services, but total premiums and copays combined can never exceed 5% of household income.

Are children ever charged for Medicaid?

No. Children under 19 are fully exempt from Medicaid premiums and copays under federal law (42 CFR 447.56), regardless of household income. This applies in every state and to every Medicaid-covered service for that age group, including preventive, dental, and behavioral health care.

Does Medicaid cover people with no income at all?

Yes. Medicaid does not require any minimum income; it is an income cap, not a floor. People with $0 income who meet their state's eligibility category, such as low-income adults, children, pregnant women, or people with disabilities, qualify and are automatically exempt from cost sharing since they fall well under 100% of the 2026 federal poverty level.

What is the Medicaid 5% cost-sharing cap?

Federal law limits combined Medicaid premiums and cost sharing for an entire household to 5% of family income, tracked monthly or quarterly depending on the state. Once a household reaches that limit, the state must stop collecting further charges for the rest of the period, no matter how many services were used.

Does Medicaid pay my Medicare premium if I have both?

Often, yes. Through the Medicare Savings Programs, income-eligible dual eligibles can have Medicaid pay their Medicare Part B premium ($202.90 a month standard in 2026), and the Qualified Medicare Beneficiary (QMB) program also covers Medicare Part A and B deductibles, coinsurance, and copays in full.

What happens if I can't afford my Medicaid copay?

A provider cannot deny you a covered service just because you cannot pay a nominal Medicaid copay, though the state can still bill you for the amount owed. If costs are a hardship, call your state Medicaid agency to confirm your exempt status, ask about a spend-down program, or request an MCO grievance review.

Is CHIP free too?

Mostly. CHIP has the same 5% aggregate income cap as Medicaid, but 18 states charge modest CHIP premiums in 2026, typically starting around 163% of the federal poverty level. Most CHIP copays are $5 or less, and preventive care and well-child visits are always free.