Health Insurance For Low Income
The Pennsylvania Medicaid and CHIP coverage are handled through managed care organizations. Each individual organization creates a network of clinicians that work together to provide care to their qualified members. With the introduction of Obamacare (the Affordable Care Act), Pennsylvania opted to expand their Medicaid programs in 2015. If you were denied Medicaid coverage in Pennsylvania previous to this expansion, you may now qualify.
Pennsylvania Medicaid Plan Options
The HealthChoices Program is the name of Pennsylvania's mandatory managed care program for Medical Assistance recipients. Through Managed Care Organizations, recipients receive quality medical care and timely access to all appropriate physical health services. The Managed Care Organizations below offer services in Pennsylvania based on your county of residence.
- Aetna Better Health
- AmeriHealth Caritas Northeast
- AmeriHealth Caritas Pennsylvania
- Gateway Health Plan, Inc.
- Geisinger Health Plan
- Health Partners Plans
- Keystone First
- UPMC Health Plan, Inc./UPMC for You
- UnitedHealthcare Community Plan
Healthy Beginnings provides healthcare coverage for uninsured or underinsured pregnant women through 60 days after birth. The child is automatically covered by Medicaid up to age one, as long as the mother was eligible for and receiving Medical Assistance on the date of the child’s birth and the child continues to live with the mother in Pennsylvania.
Family Planning Services
The Family Planning Services program provides services, information, and counseling on healthcare for women, men, and teens with an income at or below 215% of the Federal Poverty Limit (FPL).
Breast and Cervical Cancer Prevention and Treatment
The Breast and Cervical Cancer Prevention and Treatment (BCCPT) Program is administered by the Department of Health and the Department of Human Services and provides healthcare benefits to women needing treatment for breast or cervical cancer, or a precancerous condition of the breast or cervix. A woman must be uninsured and under the age of 65 to qualify.
Substance Abuse Services
Pennsylvania provides a wide variety of substance and alcohol abuse services available to children and adults through Community substance abuse programs that are administered through county program offices called Single County Authorities (SCAs). The SCA determines eligibility for service funding, assesses the need for treatment or other services, and makes referrals to appropriate programs.
Health Benefits for Workers with Disabilities (HBWD)
Health Benefits for Workers with Disabilities (HBWD) covers persons with disabilities who work and have earnings up to 250% of the FPL who buy-in to Medicaid by paying a small monthly premium.
Long-Term Care Services
Long Term Care (LTC) services include both Home and Community Based Services (HCBS) and LTC Facility Services. An individual that has a medical need for LTC services may participate in the program of their choosing. If medical assistance and payment of LTC services are a need, both non-financial and financial medical assistance requirements must be meet.
Home and Community Based Services
Ohio Medicaid Long-Term Services and Supports provides opportunities for children, older adults or the disabled to continue participating in their community activities. Services range depending on the situation, but the goal is to improve the qualify of life of the entire family.
HIPP (Health Insurance Premium Payment) Program
Health Insurance Premium Payment (HIPP) Program provides financial assistance to families that qualify for healthcare support, despite having insurance through their employer. This program allows the family to begin to increase their long-term health support system while being able to take advantage of Medicaid’s coverage options. To qualify for this program, one person in the family must be qualified for or currently using Medicaid.
Pennsylvania Medicaid FAQs
- What is Medicaid?
Medicaid is a state funded insurance that that provides coverage to low income families, pregnant women, newborns, and children that may not be able to afford to purchase their own care.
- Who is eligible for Medicaid?
The following individuals are eligible for Pennsylvania Medicaid:
- Children with household incomes less than 319% of the Federal Poverty Limit;
- Adults with income less than 138% of the Federal Poverty Limit.
- How do I find out if I am eligible for Medicaid?
To find out if you are eligible for Medicaid, you must fill out an application for Medicaid or CHIP. You may fill out an application at any time of the year. See more on Medicaid.
- Will Medicaid cover my children?
Your household income level will determine if your child or children can be covered by Medicaid.
- What is CHIP?
CHIP is a program that supports children in families that cannot afford private health insurance, but whose household income is too high to qualify for Medicaid.
- Can I use Medicaid to satisfy the health insurance requirement?
Yes, Medicaid will satisfy the health insurance requirement for the covered individuals.
- What information and documents should I have when I'm signing up for Medicaid?
Depending on the Medicaid Part you are applying for you may need the following: identification documentation, Social Security documentation, proof you live in Pennsylvania, proof of income, proof of medical costs, and bank account information.
- What is HealthyChoices?
The HealthChoices Program is the name of Pennsylvania's mandatory managed care programs for Medical Assistance recipients. Most plans have regional specifications so once you obtain eligibility for HealthyChoices, you can narrow down available plans based on the county in which you reside. This is the program that provides the majority of the coverage for Pennsylvania residents that qualify for Medicaid.
- How does Obamacare work with Medicaid?
Because of Pennsylvania’s Medicaid eligibility requirements, Obamacare does not impact people who qualify for Medicaid and vice versa. As such, tax credits are only available for people who are not eligible for other plans.