Orlando Harmon
In Pennsylvania, there are several options for medical support for people without insurance. The state's Department of Human Services offers Medical Assistance, also known as Medicaid, which provides healthcare services for eligible individuals based on factors such as income, family size, age, and disability status. Additionally, Pennie, Pennsylvania's official health and dental insurance marketplace, offers low-cost or no-cost health coverage for those who are not eligible for Medicaid. For older Pennsylvanians, there is also the option of Medicare, and supplemental plans are available through PA MEDI. The state also has programs like the Children's Health Insurance Program (CHIP) and Community HealthChoices, which provides long-term support and services for adults with disabilities.
| Characteristics | Values |
|---|---|
| Name of the program | Medical Assistance, also known as Medicaid |
| Who is eligible? | Eligibility is based on factors such as income, family size, age, and disability status. |
| Cost | Low-cost or no-cost health coverage |
| How to apply? | Apply online, in-person, on the phone, or through the mail |
| Contact | Call the Consumer Service Center for Health Care Coverage at 1-866-550-4355 |
| Alternative options | Pennie, Pennsylvania's official health and dental insurance marketplace |
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What You'll Learn
Medicaid/Medical Assistance eligibility
Medicaid, also known as Medical Assistance (MA) in Pennsylvania, is a healthcare program that helps eligible individuals and families facing financial challenges access physical and behavioral healthcare. It covers a broad range of health services, including doctor visits when you’re sick, preventive care like health screenings, vaccines, hospital stays, prescription medications, mental health and substance use disorder treatment, and more.
To be eligible for Medicaid/Medical Assistance in Pennsylvania, you must be a resident of the state. There is no requirement for how long you must have been a resident of Pennsylvania. Additionally, you must be either a US citizen, a refugee, or a lawfully admitted non-citizen. Other non-citizens may be eligible for limited benefits in the case of an emergency medical condition. Citizens and lawfully admitted non-citizens must provide documentation to prove their status.
When determining eligibility, the state will also consider your income and resources. Resources include money in bank accounts, life insurance, vehicles, and owned property (aside from your primary residence). Your identity will also need to be verified with a form of identification, such as a driver's license or passport, and you will need to provide your Social Security Number (SSN).
If you are not eligible for Medicaid/Medical Assistance, you may still be able to obtain low-cost or no-cost health coverage through Pennie, Pennsylvania's official health and dental insurance marketplace.
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Pennie health insurance marketplace
In Pennsylvania, eligible individuals can receive health care services through Medical Assistance, also known as Medicaid. However, for those who are not eligible for Medicaid or have lost their coverage, there is Pennie, Pennsylvania's official health and dental insurance marketplace.
Pennie is the only place where Pennsylvania residents can receive financial assistance to lower the cost of health coverage and care. It is a platform where individuals can shop for, compare, and buy health insurance. Nine out of ten Pennie customers qualify for financial savings, with an average monthly saving of over $500. Pennie coordinates with Pennsylvania's Medicaid program, offering an alternative for those who no longer qualify for Medicaid due to changes in income.
Pennie's open enrollment period typically runs from November through January every year, with an annual deadline of December 15 for coverage starting on New Year's Day. However, depending on an individual's circumstances, they may qualify for a special enrollment period outside of the yearly open enrollment. This could be due to changes in circumstances, such as getting married, having a baby, or losing health coverage.
To apply for coverage through Pennie, individuals can apply online, in-person, over the phone, or through the mail. Pennie provides support to help navigate coverage options, with local experts, including enrollment assisters, health insurance brokers, and customer service representatives, available to assist.
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Medicare and Medicaid
In Pennsylvania, eligible individuals without insurance can receive medical support through Medicaid, also known as Medical Assistance (MA). Medicaid is a joint program between federal and state governments that provides medical and long-term care to low-income individuals and families. The federal government provides up to 50% of the funding for each state's Medicaid program, with more affluent states receiving less financial support. Pennsylvania's Medicaid program offers insurance, waiver programs, and long-term care. To be eligible for Medicaid, individuals must meet strict requirements, including income and resource limits. For example, the resource limit for coverage other than long-term care is $2,000 for an individual and $3,000 for a couple.
Through Pennsylvania's Medicaid program, eligible individuals can access quality physical and behavioural healthcare, as well as long-term support. This includes doctor visits, preventive care such as health screenings and vaccines, hospital stays, prescription medications, mental health services, and substance use disorder treatment. Additionally, Pennsylvania offers HealthChoices, a managed care program for Medicaid recipients. With HealthChoices, individuals can choose a managed care organization (MCO) to help coordinate their care and find doctors in their community.
For those who are not eligible for Medicaid or have lost their coverage, Pennsylvania offers Pennie™, the state's official health and dental insurance marketplace. Pennie™ provides low-cost or no-cost health coverage options with open enrollment from November through January each year. Special enrollment periods may also be available depending on an individual's circumstances.
In addition to Medicaid, Pennsylvania residents may also be eligible for Medicare, a federal program run by the Centers for Medicare & Medicaid Services. Unlike Medicaid, Medicare is an insurance program that individuals pay into during their employment, and it primarily serves people over 65, regardless of their income. It also covers younger disabled individuals and dialysis patients. Medicare hospital insurance (Part A) covers hospital stays and post-hospital care, while Medicare medical insurance (Part B) pays for doctor visits, laboratory costs, and some outpatient services. Medicare Part A and Part B are automatically available to individuals approaching their sixty-fifth birthday or those receiving Social Security Disability Insurance (SSDI) for at least twenty-four months.
Pennsylvania also has healthcare providers like PA Health & Wellness, which serves both Medicaid and Medicare members. They offer benefits such as unlimited doctor visits with no copays and a 24-hour Nurse Advice Line. Additionally, individuals can explore options like Allwell, a Medicare Advantage plan that includes prescription drug coverage, and Ambetter health insurance plans, which offer quality, affordable coverage with reward programs for maintaining a healthy lifestyle.
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Children's Health Insurance Program (CHIP)
The Children's Health Insurance Program (CHIP) provides low-cost health coverage for children in families who earn too much to qualify for Medicaid but still need assistance in paying for health insurance. CHIP is available in every state, and each state has its own rules regarding eligibility. In some states, CHIP also covers pregnant women.
CHIP offers comprehensive coverage, including routine "well child" doctor and dental visits at no cost. There may be a fixed amount that beneficiaries must pay for covered health care services after paying their deductible. The costs for CHIP coverage vary by state but will not exceed 5% of a family's income for the year. If a child is eligible for CHIP, they will not be eligible for any savings on Marketplace insurance.
Individuals can apply for CHIP at any time of year and may qualify for immediate coverage. Applications can be submitted online, in person, over the phone, or through the mail. To apply for CHIP, individuals can visit their state's Health Insurance Marketplace or call 1-877-KIDS-NOW (1-877-543-7669) to find information on their state's health insurance programs.
In Pennsylvania, Medical Assistance (also known as Medicaid) provides health care services for eligible individuals. Those who are not eligible for Medicaid coverage may still obtain low-cost or no-cost health coverage through Pennie, Pennsylvania's official health and dental insurance marketplace.
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Applying for Medicaid
In Pennsylvania, Medicaid is known as Medical Assistance (MA). It is a vital safety net for individuals and families facing financial challenges, providing access to comprehensive healthcare coverage. Eligibility for Medicaid depends on factors such as income, family size, age, and disability status. Even if you are not eligible for Medicaid, you may be able to get low-cost or no-cost health coverage through Pennie™, Pennsylvania's official health and dental insurance marketplace.
There are several ways to apply for Medicaid in Pennsylvania:
- Online: You can apply online via the COMPASS website.
- In-person: Visit your local County Assistance Office (CAO) to apply in person.
- Phone: Call the Consumer Service Center for Health Care Coverage at 1-866-550-4355.
- Mail: Download, fill out, and print a paper application, then send it to your local County Assistance Office.
Regardless of the application method you choose, it is helpful to have certain information ready to complete your application:
- Proof of income: This includes income from jobs, child support, and other sources.
- Resource information: Information about your bank accounts, vehicles, homes, property, life insurance, etc.
- Non-U.S. citizen documentation: If applicable, provide documentation showing lawful residence in the U.S.
Once you have submitted your application, the Department of Human Services can help you determine your eligibility. If you are eligible, you will receive information about your benefits and be able to choose a HealthChoices managed care organization (MCO) to coordinate your care.
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Frequently asked questions
Medicaid, also known as Medical Assistance in Pennsylvania, is a healthcare program that helps eligible people access physical and behavioural healthcare. Eligibility is based on factors such as income, family size, age, and disability status.
You can apply for Medicaid online, in person, on the phone, or through the mail. You will need to submit information that verifies your identity, income, citizenship or residency status, and Social Security Number.
If you are not eligible for Medicaid, you may be able to get low-cost or no-cost health coverage through Pennie, Pennsylvania's official health and dental insurance marketplace. You can also call PHAN's helpline to see if you qualify for the Medical Assistance for Workers with Disabilities (MAWD) program.
Pennie is Pennsylvania's official health and dental insurance marketplace. Depending on your income, you may qualify for a $0 premium plan.
HealthChoices is the name of Pennsylvania's managed care programs for Medicaid/Medical Assistance recipients. Eligible individuals can access physical and behavioural healthcare through participating managed care organizations.
