Medicaid Eligibility in Pennsylvania

Eligibility Team
Researcher & Writer
December 12, 2017

The federal government funds many Medicaid programs, but only  those residents who qualify in each state get access to the funds  available. Low-income households may apply if they require medical  assistance in Pennsylvania. People who have a difficult time affording  regular hospital and physician rates may be able to get state covered  insurance that will pay a significant portion of the costs.

Pennsylvania  has its own rules regarding requirements for citizens to meet and  eligibility for residents of the state. Look into all stipulations set  forth before applying.

Pennsylvania’s Requirements for Medicaid Qualification

The Medicaid program of Pennsylvania follows certain requirements that enrollees must meet. Using the COMPASS questionnaire,  those who wish to apply for benefits can see if they or anyone in their  household may get approved. The name, age, and gender of each household  member must get added. It is also important to note the approximate  total value of resources available to the family.

Once all  questions get answered and the form gets submitted through the system,  an answer will be given informing the applicant of his or her potential  to receive benefits. People who fall below the poverty limit are often  among the first to receive assistance.

How to Apply for Medicaid in Pennsylvania

Several  methods exist for applying for coverage in Pennsylvania. Many people  use the online option as a quick way to fill out the application and get  approval or denial notifications fast. The COMPASS website offers an easy-to-use application form. Applicants may also  call 1-866-550-4355 to apply by telephone, visit their local county  office, or download the forms and send them to their local office.

Pennsylvania Medicaid Application

Applying  for Medicaid can be done solely, without the need to request any  additional assistance. The process starts by describing the names and  ages of each member of the household, as well as answering some  questions about pregnancy, disabilities, nursing home needs, and whether  anyone has bills from the last three months they need help paying. You  must also disclose the annual household income received. The website  indicates it may take between 20 and 45 minutes to complete the full  application. A username and password must then get created to set up an  account and begin the actual process.

What Does Medicaid Cover in Pennsylvania?

The  Medicaid program through the state of Pennsylvania covers an extensive  list of medical services. Yearly visits, often known as well-checks,  should get utilized by every person receiving medical assistance. Free  or low-cost emergency room visits, trips to urgent care, emergency  dental services, and more also get offered, which people should use when  truly necessary.

Senior citizens may also receive in-home care or  a short stay at a nursing facility if needed. Medicaid often covers  these costs for a specific timeframe, which will get detailed in the  insurance plan.

Income Requirements for Pennsylvania Medicaid

Household size, the total of outgoing bills, and eligibility requirements help determine the income requirements for each family applying for Medicaid in Pennsylvania. The amount  varies for everyone based on these details. Single adults between the  ages of 19 and 64 must have an income that falls below 133% of the  federal poverty guidelines to be eligible. A maximum income of $15,800  per year, or roughly $1,317 per month, is designated to an individual.

How Much Does Medicaid Cost in Pennsylvania?

The federal government, partnered with the state of Pennsylvania, spends a total of more than $27 billion per year on Medicaid costs. Thirty-seven percent of the state’s budget  is allocated to these funds. Plans to expand the program are in the  works, meaning even more people will get access to some of the funds for  medical coverage.

Cost and Coverage of Medicaid in Pennsylvania

Low-income  families may not be able to afford regular health care coverage.  Medicaid combats that problem, giving those who cannot pay an  opportunity to receive medical care and be seen by a regular physician.  The state takes on the expenses so the people do not have to pay  anything. Adults who are capable of working and paying at least a  portion of the costs may have a set copay amount for emergency room  visits, clinic appointments, and also for prescriptions, usually around  $3 each. People who receive general assistance may have a higher  payment, up to $6.

Prescription Drugs with Medicaid in Pennsylvania?

Medicaid  in Pennsylvania does not cover all prescription drugs. It does,  however, cover some of them, allowing people to pick up the  prescriptions they need for free. Adults may have a small copay of $3 to pick up their prescriptions. This price is for brand-name medicines. Generic versions often cost just a dollar.

Which Medicaid plan is best in Pennsylvania?

Health Partners Plans’ Medicaid Plan was rated one of the top choices in Pennsylvania. More than 180,000  Medicaid members use this plan. It is especially satisfactory as child’s  health coverage.

Eligibility Team
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Eligibility Team
We are a team of experts dedicated to finding the right government programs for you. Our mission is simple: help people quickly and easily understand which programs they might be eligible for—all in one place. Our team is dedicated to researching and providing you with the most relevant information. We compile only the most trusted information from government sources into one place so you can find the facts you need and skip what you don’t.
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