How to Get Pennsylvania Medicaid Benefits | Best Answers

Last update:

We have scoured the internet to provide all you need to know about the Pennsylvania Medicaid Benefits.

Medicaid is a joint federal-state program that provides health insurance to low-income individuals who meet certain requirements, including kids, pregnant women, the elderly, and individuals with disabilities. Applying for Medicaid in person, via telephone, or online is simple.

This post will teach you all you need to learn about Medicaid in Pennsylvania.

What is the Pennsylvania Medical Program?

Pennsylvania Medicaid is a service for people and families with income and resources that fall within certain parameters. Resources primarily apply to the elderly, blind, or disabled population within the bounds of specified rules.

Who is eligible for the Pennsylvania Medical Program?

Pennsylvania Medicaid offers certain limited Medicare beneficiaries who are not eligible for the full Medicaid benefit package some partial financial help with Medicare premiums and copayments or coinsurance through the Medicare Savings Plan.

  • Expectant mothers
  • People who are blind or disabled or who have a spouse who is blind or disabled; 
  • People whom someone adopts;
  • People whom someone adopted; 
  • People who are blind or disabled or have a spouse who is disabled.

The Annual Household Income Limits (before taxes)

Household Size*The Maximum Income Level (Per Year)

*For households with more than eight people, add $6,277 per additional person.

Similar Articles:

How do I contact Medicaid in Pennsylvania?



Mailing Address

Local county assistance office (CAO)

What are the Medicaid plans in Pennsylvania?

Voluntary Managed Care Program

Beginning with its Voluntary Managed Care Program, a thorough risk-based MCO program accessible to most Medicaid participants in specified counties in 1972, Pennsylvania began experimenting with different managed care arrangements in the 1970s.

Pennsylvania HealthChoices

In 1997, the Pennsylvania HealthChoices, a dangerous managed care program, was offered voluntarily in some counties. 

Later it expanded to encompass more counties and services whose enrollment became required for most Medicaid beneficiaries residing in the counties where the program is implemented. 

Over the years, the state has expanded managed care.

ACCESS Plus Program

The ACCESS Plus program, a general practice case management solution that operates in 22 rural districts and is open to beneficiaries who don’t voluntarily choose one HealthChoices MCO within these areas was introduced by the state to extend managed care.

For more details regarding Medicaid Plans in Pennsylvania, visit here.

How do I apply for Pennsylvania Medicaid?

Call 844-626-6813 to enroll. 

Apply in person at the Local county assistance office (CAO).

Online:  Download and print the application.

Mail: ToLocal county assistance office (CAO)

What is covered by Pennsylvania Medicaid?

Pennsylvania Medicaid covers the following services:

Ambulatory surgeryHospital stays
Audiology servicesLaboratory tests
Behavioral health servicesVision care
Women’s health careNon-emergency transportation
DialysisOrthotic and prosthetic devices
Doctor visitsOccupational therapy
Smoking cessation servicesPharmacy (medications)
Emergency carePhysical rehabilitation
Family planning servicesPreventive care
Hearing aidsHospital outpatient care
Home health careX-rays and other radiology services

Similar Articles:

Can I have both Pennsylvania Medicaid and Medicare?

Only dual eligibles may enroll in Medicare-managed care plans known as Dual Eligible Special Needs Plans (D-SNPs).

Pennsylvania Waiver

  • Adult Autism Waiver (AAW)
  • Aging Waiver
  • Alternatives To Nursing Homes
  • Attendant Care Waiver
  • Community Living Waiver
  • Consolidated Waiver
  • Independence Waiver
  • Infant, Toddlers, and Families Waiver
  • OBRA Waiver
  • Person/Family Directed Support Waiver


They do not have to pay a copayment. When a member is 

  • under 21 years old; 
  • pregnant; 
  • Held by the state
  • Placed under government supervision
  • Native American participants who qualify for Contract Health funding
  • Services or Tribal Union of Indian Health Services
  • The hospital (inpatient)
  • A facility for skilled nursing
  • A nursing home

What is not covered by Pennsylvania Medicaid?

In Pennsylvania, Medicaid is not mandated to offer in-home caregiving services or private nursing coverage. Bandages, adult diapers, and other disposable items are frequently excluded from insurance coverage, as are cosmetic surgery and other elective procedures.

What is the highest income limit for Pennsylvania Medicaid?

The highest income limit for Pennsylvania Medicaid is $18,075 for an individual and $24,353 for a family of two per year.

What if a person’s income is too high to qualify for regular Medicaid benefits?

If your income is too high, you may still be eligible for Pennsylvania Medicaid, thanks to the asset spend down option.  

What documents do I need to apply for Medicaid?

The following documents are required with the application:

  • The Social Security Number;
  • Evidence of citizenship or authorized residency in the United States, such as a passport, driver’s license, birth certificate, green card, or job authorization card
  • Evidence of all income sources, both legal and illegal 
  • Proof of origin 
  • Proof of residency 
  • Including the Medicare card, any insurance cards
  • Pregnancy;
  • When non-parents apply for Medicaid on their behalf, they must provide proof of their financial position.

Similar Articles:

What is the best Medicaid in Pennsylvania?

The best plan for you is the one that meets your demands and offers the most benefits in terms of health insurance and monetary help because it varies from person to person. The best Medicaid plan in Pennsylvania is AmeriHealth Caritas Pennsylvania.

Where do I find the letter showing the reason(s) for denial or discontinuance from Pennsylvania Medicaid?

By signing into your account at Portal, you can see the progress of your Pennsylvania Medicaid application.

Photo of author
Sabrina is a former campaign manager who has decided to focus her effort to help people contact senators and get help. She leads our Editorial Team with Ronald and Lawrence to curate content and resources that help us navigate the system.

Leave a Comment