How to Find Government Assistance for Medical Expenses
Government programs and coverage options can help pay for medical care, but the right place to start depends on your household and circumstances. Your next step may be finding health coverage or managing costs insurance leaves behind. Rules can vary by state and program.
Income, age, work status, and qualifying health issues can affect eligibility. The Children’s Health Insurance Program (CHIP) is a joint federal-state program that provides free or low-cost coverage to eligible children and, in some states, pregnant women in families whose income is too high for Medicaid.
One person may need a new plan, while another may already have coverage but still face high costs. The right information can help you find a program that fits the person who needs care.
Write down who needs care and whether the immediate need is coverage, an unpaid bill, or prescription costs.
Which Government Medical Assistance Programs May Fit Your Situation?
The main options are Medicaid, CHIP, Medicare, ACA Marketplace coverage, and COBRA, and each serves a different situation. Start with the person who needs care and the group each program serves.
Medicaid and CHIP are joint federal-state programs, and their eligibility and benefits differ by state. Medicaid is also known as Medical Assistance. It can cover eligible low-income adults, families, children, pregnant women, older adults, and people with disabilities.
| Program | Typical audience or situation | How it helps with care costs | Where to start |
|---|---|---|---|
| Medicaid | Eligible low-income people, older adults, and people with disabilities | State Medicaid benefits cover eligible care | State Medicaid agency |
| CHIP | Eligible children and, in some states, pregnant women | Free or low-cost health coverage | State Medicaid agency or Marketplace |
| Medicare | Older adults and some people with disabilities | Health coverage through Medicare | Medicare |
| ACA Marketplace plans | People seeking individual or family health insurance | Plan coverage, with savings for eligible enrollees | Health Insurance Marketplace |
| COBRA | Some people losing employer coverage after a qualifying event | Temporary continuation of employer health insurance | Former employer or plan |
Medicaid benefits, eligibility levels, coverage, and costs vary by state. CHIP can serve children whose families earn too much for their state’s Medicaid program.
Insurance can help pay for covered care, but it does not erase a bill you already owe.
Medicare serves older adults and some people with disabilities. COBRA may let you keep employer coverage temporarily after a qualifying event, though you may have to pay the full plan cost.
Start with the program whose eligibility group most closely matches the person who needs care.
Which Medicaid Options Can Help When Standard Eligibility Does Not Fit?
Medicaid eligibility depends on state rules and eligibility category, so a household that misses one income test may still have another route to check. More than one category may apply to a person’s circumstances.
Medicaid and CHIP eligibility can depend on income, household size, age, pregnancy, family status, and disability. Applying can still be useful when you are unsure whether someone qualifies.
Medicaid eligibility for children, adults, older people, and people with disabilities
States set eligibility rules for many groups, and their limits are not all the same. A free medical application can be submitted through a state Medicaid agency or the Health Insurance Marketplace, where household members can be assessed for Medicaid or CHIP.
To apply for free medical insurance, start with a state Medicaid agency or the Marketplace. An application can screen household members for different coverage options.
In 2026, a person receiving SSI may qualify through the SSI Medicaid group with monthly income of up to $994 and financial resources below $2,000. These limits apply to that eligibility group, not every Medicaid applicant.
In 2026, federal minimum rules for Medicare Savings Programs allow an individual monthly income of $1,816 and resources of $9,950. These programs help pay Medicare costs, rather than giving full Medicaid benefits. Eighteen states expanded eligibility beyond those federal minimums.
Additional pathways for people with disabilities and families
In 2026, 47 states offered Medicaid Buy-In programs for working adults with disabilities. The median income limit was 250% of the federal poverty level, or $3,325 per month. Median asset limits were $10,000 for an individual and $15,000 for a couple.
In 2026, 34 states offered medically needy Medicaid coverage. This route can let people qualify after health care expenses reduce their income or assets. The median income limit was $563 per month.
In 2026, 28 states offered poverty-level Medicaid coverage for low-income older adults and people with disabilities whose income exceeds SSI limits. Nine states offered Family Opportunity Act coverage, which let families with incomes up to 300% of the federal poverty level buy coverage.
All states must offer Medicaid until age 26 to eligible young people transitioning from foster care who meet the foster-care and Medicaid conditions. Check the rules for the specific eligibility group, since a limit for one category does not determine eligibility for every Medicaid pathway.
How Do You Apply and Find the Right Contact Information?
You can start a Medicaid or CHIP application through your state agency or the Health Insurance Marketplace, then follow the instructions from the agency handling your case. Choose a route that works for your household.
Medicaid and CHIP applications are accepted at any time of year. Application channels and contact information vary by state, so use the official state Medicaid agency website to find current options.
Online applications through a state agency or Marketplace
You can apply for free medical online through your state Medicaid agency or the Health Insurance Marketplace. The Marketplace can securely send an application to the state when household members may qualify for Medicaid or CHIP.
Before you begin, gather these details to make the application easier to complete:
- Household members and their birth dates
- Social Security numbers, when available
- Job, training, and other income details
- Benefits and household resources
- Current coverage and household contact details
Keep your address, phone number, and email current while the agency reviews your case. You need to receive notices and status updates, including requests for more details.
Phone, in-person, and paper application routes
You can apply for medical care in person at a local or county office when that service is available. Call or check the agency’s contact page before visiting, since office services differ across states.
To apply for medical over the phone, use your state agency’s contact page to find its number and available phone services. The same page can provide a mailing address if you need a paper application.
Medicaid may be able to pay for medical care from the previous three months when you meet eligibility requirements. Ask the agency handling your case whether this applies to your care dates.
Save the confirmation or case number and check for requests for documents or follow-up.
How Can Marketplace Coverage Lower Premiums, and Who Can Enroll?
Eligible Marketplace enrollees can use the Premium Tax Credit to lower monthly premiums in advance or claim the credit when they file their taxes. The credit scales with income, giving larger credits to people with lower incomes.
Marketplace savings depend on household circumstances and plan eligibility, not one nationwide income figure. People eligible for Medicaid do not qualify for Marketplace plan savings, and a Marketplace plan may cost full price after Medicaid begins.
How the Premium Tax Credit affects monthly premiums and tax filing
The Premium Tax Credit is refundable and helps eligible people with low or moderate income afford Marketplace insurance. You can have estimated credits paid to your insurer, or claim the credit when filing your tax return.
| Feature | Advance payment | Claim at tax filing |
|---|---|---|
| When the credit is paid | Paid to the insurer during the year | Claimed on the tax return |
| Effect on monthly premiums | Lowers the premium during the year | Does not lower monthly bills in advance |
| Tax filing or reconciliation | File IRS Form 8962 to reconcile payments | Claim the allowed credit on the return |
People receiving advance Premium Tax Credit payments must file IRS Form 8962. The form compares advance payments with the credit allowed for actual household income and family size.
For tax years after 2025, excess advance payments have no repayment cap. The full difference is subtracted from a refund or added to the tax balance due.
Marketplace eligibility and special enrollment rules
Marketplace applicants must live in the United States, be a U.S. citizen or national or lawfully present noncitizen, and not be incarcerated. People with Medicare cannot enroll in a Marketplace health or dental plan.
Residents of U.S. territories cannot get Marketplace coverage unless they also qualify as residents of one of the 50 states or Washington, DC. Beginning August 25, 2025, DACA recipients became ineligible for Marketplace coverage, even without Premium Tax Credits.
Beginning August 25, 2025, some applicants must submit income documents within 90 days. This applies when federal data show income below 100% of the federal poverty level but projected income above 100%, or when tax data are unavailable.
For a special enrollment period after losing minimum essential coverage, the qualifying loss may occur within 60 days before or after the loss date. Verification is due within 30 days after plan selection.
Beginning January 1, 2026, people using a year-round, income-based special enrollment period not tied to a life change cannot get Premium Tax Credits. Report income and household changes promptly so estimated advance payments are less likely to differ from the credit allowed at tax filing.
What Can Help With Medical Bills or Prescriptions When Coverage Falls Short?
Insurance does not always settle every bill, and people with Medicare may have separate programs for premiums and cost sharing. Other forms of help can address remaining bills, prescription costs, or gaps in care.
Charity care may help with eligible bills left after insurance or Medicaid payments. Patients generally apply through the doctor or hospital that provided treatment.
Help with bills left after insurance
Four Medicare Savings Programs may help pay Medicare Part A and Part B premiums, deductibles, coinsurance, and copayments. Medicare Extra Help can lower Medicare Part D prescription drug costs.
A debt management plan uses a credit counselor’s payment schedule. You make payments to a credit counseling organization, which then pays your debts.
Review the payment schedule and fees before agreeing to a debt management plan.
The billing office can explain how the provider handles charity care and what details it needs. Keep bills and coverage notices together so you can discuss the same charges with the provider.
Prescription costs and local care referrals
Medicine and device manufacturers may offer low-cost options, samples, or discounts when contacted. State social services agencies may also refer people with limited health care access to local health centers and community organizations.
- Ask the provider’s billing office about charity care.
- Check eligibility for Medicare cost-help programs.
- Contact the manufacturer about lower-cost options.
- Ask the state social services agency for a local health-center referral.
Before agreeing to a debt plan, review its payment schedule and fees with the credit counseling organization.
Conclusion
The best next step is to check the program that matches your household and the cost you need help with now. Eligibility depends on the person, household, and state, and more than one route may be worth checking.
Open your state Medicaid agency’s official application or contact page and begin an application or status check. That gives you a direct way to share your information and learn what the agency needs.
Keep the application confirmation and respond promptly to any request for information.
