Jane Dotson
In Pennsylvania, Medicaid is known as Medical Assistance and provides healthcare services for eligible individuals. As of September 1, 2022, several changes were made to the Medicaid plans in the state, with some plans no longer operating in certain areas. This means that some Pennsylvanians may need to switch their Medicaid plans to avoid a lapse in coverage. If you need to change your Medicaid insurance in Pennsylvania, you can do so by visiting enrollnow.net or calling PA Enrollment Services at 1-800-440-3989.
| Characteristics | Values |
|---|---|
| What is Medicaid? | Medical Assistance, a program that pays for healthcare services for eligible individuals |
| Medicaid plans in Pennsylvania | Changing; some plans will no longer be offered in certain areas |
| What to do if your plan is leaving | Visit enrollnow.net to see which plans your doctors are in network with |
| How to choose a new plan | Visit enrollnow.net or call PA Enrollment Services at 1-800-440-3989 (TTY: 1-800-618-4225) |
| Deadline for choosing a new plan | August 16th |
| What if you don't choose a new plan | You will be automatically assigned a new plan that might not fit your needs |
| What if you need help choosing a new plan | Contact PHAN or PHLP's Helpline at 1-800-274-3258 |
| Will you lose your Medicaid benefits | No, but you might have to choose a new plan to avoid coverage interruptions |
| Will your doctors remain the same | For the first 60 days, yes; after that, your doctors will have to be "in-network" with your new health plan |
| Will your behavioral health plan change | No |
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What You'll Learn
How to switch Medicaid providers in PA
In Pennsylvania, Medical Assistance is known as Medicaid, and it pays for health care services for eligible individuals. As a Medicaid consumer in Pennsylvania, you have the right to choose your Managed Care plan based on the health plans available in your area, and you can switch plans at any time.
If you need to switch your Medicaid provider in Pennsylvania, you can do so by visiting www.enrollnow.net or calling PA Enrollment Services at 1-800-440-3989 (TTY: 1-800-618-4225). You will be auto-enrolled in a new plan if you do not choose one yourself. If you have been auto-assigned to a new plan, you will receive your new plan information and Member ID card directly from the new plan. You can also call PA Enrollment Services to see which plan you have been moved to and to ask for contact information for the new plan.
If you switch plans, your previous plan will continue to cover your medical needs for a period of time. For the first 60 days, you will be allowed to continue seeing your existing doctors, whether they are in your new plan or not. After this 60-day transition period, your doctors will need to be "in-network" with your new health plan to continue treating you. When you receive your new Member ID card, it is a good idea to call your existing doctors to give them your updated insurance information and confirm that they accept your new plan.
It is important to note that all insurance plans are different, and some benefits you currently receive may not be covered by a new plan. Before switching plans, be sure to review the benefits offered by each plan and consider using PA Enrollment Services' Comparison Tool. Additionally, if you use any home care or medical supply companies, call them to find out what plans they accept and if you will need to change companies with a new insurance plan.
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What to do if you've been auto-assigned a new plan
If you've been auto-assigned a new Medicaid plan in Pennsylvania, there are a few things you should know and some steps you can take. Firstly, understand that these changes to Medicaid plans in Pennsylvania do not affect people with Community HealthChoices. Additionally, your behavioural health plan will remain unchanged, and you will continue to receive behavioural and mental health services through the plan serving your county.
Now, here's what you can do if you've been auto-assigned a new plan:
- Contact PA Enrollment Services at 1-800-440-3989 (TTY: 1-800-618-4225) to find out which plan you were moved to and to obtain contact information for your new plan. They can also assist you in choosing a new plan and answering any questions.
- Get your member ID card and number for your new plan. Contact member services for your new health plan and ask them to send you this information. Your previous plan will cover your medical needs until August 31st, 2022.
- Inform your doctors of your updated insurance information and confirm that they accept your new plan. For the first 60 days after your plan change, you can continue seeing your existing doctors, regardless of whether they are in your new plan. After this 60-day transition period, your doctors will need to be "in-network" with your new plan.
- Review your benefits and understand that, while your Medicaid benefits remain largely the same, there may be some differences in how they are administered by your new plan. All Medicaid physical health plans are mandated to cover a basic benefits package, but some benefits you currently have may be different or not covered by the new plan.
- Request a plan change if you are unsatisfied with the auto-assigned plan. You can review other plans and request a change by contacting PA Enrollment Services. If your request is submitted by September 8th, your new plan will start on October 1st; otherwise, it will generally start on November 1st, unless there are exceptional circumstances.
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How to choose a new plan
As a Medicaid consumer in Pennsylvania, you have the right to choose your Managed Care plan based on the health plans available in your area. You can change your plan at any time, but your new plan will not start right away. If you request a change before the second Thursday of the month, the new plan will start on the first of the next month; otherwise, it will start the month after.
To choose a new plan, you can visit www.enrollnow.net or call PA Enrollment Services at 1-800-440-3989 (TTY: 1-800-618-4225). If you do not actively choose a plan, you will be automatically enrolled in one. PA Enrollment Services has a Comparison Tool that allows you to see the benefits offered by the different health plans.
When choosing a new plan, it is essential to consider your specific needs and preferences. All insurance plans are different, and some benefits covered by your current plan may not be covered by a new one. Call all the home care or medical supply companies you use to find out what plans they accept. Your new plan may need special permission or authorization to cover prescriptions and other benefits like home nursing and medical supplies. If you already see other adult providers, call to make sure they accept any new plan.
Additionally, be aware that while all health plans must offer the same basic health benefit package, each plan can offer extra benefits. These might include additional dental or adult vision benefits beyond what is included in your regular Medicaid package. You can refer to PHLP's factsheet, which provides a step-by-step guide on what to consider when changing health plans.
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How to find out which plans your doctors are in network with
If you need to change your Medicaid insurance plan in Pennsylvania, you may also need to change your doctor or other providers to ensure they are in-network and your costs are covered.
There are a few ways to find out if your doctor is in a Medicare Advantage plan network. If you have a specific plan or insurer in mind, you can go to the insurer's website and search for your doctor in their provider directory. You can also contact your provider directly to see if they participate in any Medicare Advantage plans. If you already have a doctor and want to find out which plans they are in-network with, you can call all the insurance companies you are considering to find out if the doctor is included in their network.
It's important to understand your plan's network and make sure your doctor is in-network before you see them. Seeing an out-of-network doctor may not be covered by your plan, and you could end up paying out of pocket for any services rendered. If you have a Medicare Plus BlueSM PPO plan, for example, you will pay less when you get medical services in-network.
If you are a Medicaid member with special needs, you are eligible for support from the Special Needs Unit (SNU) under your individual plan. They can provide more information about the help they offer and how to contact your plan.
If your Medicaid plan in Pennsylvania is leaving, you can go to enrollnow.net to see which plans your doctors are in-network with. You can also call PA Enrollment Services at 1-800-440-3989 (TTY: 1-800-618-4225) to select a new plan or get help choosing one.
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Extra benefits offered by different plans
Medicaid in Pennsylvania is a healthcare program that helps eligible people access physical and behavioral healthcare and other supportive services. Medicaid eligibility is determined by factors such as income, family size, age, and disability status. It is available to Pennsylvania residents, U.S. citizens, refugees, and lawfully admitted non-citizens.
The specific benefits offered by Medicaid plans in Pennsylvania vary, but here are some of the extra benefits that may be available:
- Community HealthChoices: This program serves more people in communities rather than in facilities by providing necessary support services. It includes services such as home care, medical supplies, and nursing.
- Behavioral HealthChoices: This program focuses on behavioral health and provides access to mental health and substance use disorder treatment, including services for drug and alcohol issues.
- Medicaid for Children with Special Needs (PH95): This program provides full and free medical assistance coverage to children up to age 18 with disabilities whose parents make too much money to qualify for traditional Medicaid.
- Support for individuals with special needs: All Medicaid members with special needs are eligible for additional support from the Special Needs Unit (SNU) under their individual plans.
- Preventive care: Medicaid covers preventive care services such as health screenings, vaccines, and prescription medications.
- Comprehensive healthcare coverage: Medicaid provides access to a broad range of physical healthcare services, including annual check-ups, doctor visits when you're sick, hospital stays, and appointments to manage chronic illnesses or health needs.
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Frequently asked questions
Medical Assistance, also known as Medicaid, pays for health care services for eligible individuals.
To change your Medicaid insurance in Pennsylvania, visit www.enrollnow.net or call PA Enrollment Services at 1-800-440-3989 (TTY: 1-800-618-4225). You can request a plan change at any time, but your new plan will not start right away. If you request your plan change before the second Thursday of the month, your new plan will start on the first of the next month. Otherwise, the new plan will not start until the month after.
If you do not choose a new plan, you will be automatically enrolled in one.
No, you will not lose your Medicaid benefits. All Medicaid physical health plans are required to cover the same basic benefits package, including ambulance, dental care, well-child visits, eye care, inpatient and outpatient hospital care, primary care, specialist visits, medical equipment, non-emergency medical transportation, pregnancy and newborn care, prescriptions, and diagnostic tests.
