What Does Medicaid Cover in Pennsylvania

Medicaid offers comprehensive healthcare coverage to eligible low-income individuals and families in Pennsylvania, ensuring access to necessary medical services. This includes preventative care like check-ups and immunizations, as well as treatment for illnesses, injuries, and chronic conditions. Medicaid covers various services such as doctor visits, hospital stays, prescription drugs, mental health services, and substance use disorder treatment. It also provides coverage for long-term care, including nursing home care and home and community-based services. Additionally, there are programs specifically tailored for children, pregnant women, and people with disabilities. Medicaid plays a vital role in ensuring access to quality healthcare for vulnerable Pennsylvanians, helping them maintain their health and well-being.

Medicaid Eligibility in Pennsylvania

To be eligible for Medicaid in Pennsylvania, you must meet certain requirements. These requirements include:

  • Being a resident of Pennsylvania
  • Being a U.S. citizen or a qualified non-citizen
  • Meeting certain income and asset limits
  • Being pregnant, a child, a parent or caretaker of a child, elderly, or disabled

If you are unsure if you are eligible for Medicaid, you can apply online or by calling the Pennsylvania Department of Human Services at 1-800-692-7462.

There are a number of different ways to apply for Medicaid in Pennsylvania. You can apply online, by mail, or in person at your local county assistance office. You will need to provide proof of income, assets, and identity. If you are applying for Medicaid for a child, you will also need to provide proof of the child’s age and relationship to you.

Once you have applied for Medicaid, you will be notified of the decision within 45 days. If you are approved for Medicaid, you will receive a Medicaid card in the mail. This card will allow you to access covered services from any provider who accepts Medicaid.

Medicaid Coverage in Pennsylvania
CategoryServices Covered
Medical ServicesDoctor visits, hospital care, emergency care, prescription drugs, mental health services, dental care, and vision care
Long-Term Care ServicesNursing home care, home health care, and personal care services
Children’s Health ServicesWell-child checkups, immunizations, and dental care
Women’s Health ServicesPregnancy care, childbirth, and postpartum care

List of Covered Services under Medicaid in Pennsylvania

Medicaid is a joint federal and state program that provides health coverage to low-income individuals and families. In Pennsylvania, Medicaid is administered by the Department of Human Services (DHS). Medicaid covers a wide range of health care services, including:

Benefit CategoryCovered Services
Physician Services
  • Regular checkups
  • Sick visits
  • Specialist care
  • Surgery
  • Laboratory and X-ray services
  • Hospital Services
  • Inpatient hospital stays
  • Outpatient hospital services
  • Emergency room visits
  • Nursing Home Care
  • Long-term care in a nursing home
  • Skilled nursing care
  • Intermediate care
  • Home Health Care
  • Skilled nursing care
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Homemaker services
  • Mental Health Services
  • Inpatient psychiatric care
  • Outpatient psychiatric care
  • Counseling
  • Medication management
  • Substance Abuse Treatment
  • Inpatient drug and alcohol treatment
  • Outpatient drug and alcohol treatment
  • Counseling
  • Medication management
  • Dental Services
  • Routine dental care
  • Emergency dental care
  • Orthodontic care
  • Vision Care
  • Eye exams
  • Glasses or contacts
  • Hearing Care
  • Hearing tests
  • Hearing aids
  • Prescription Drugs
  • Prescription medications
  • Over-the-counter medications
  • Transportation
  • Transportation to and from medical appointments
  • In addition to the covered services listed above, Medicaid also offers a number of other benefits, such as:

    • Help paying for premiums for employer-sponsored health insurance
    • Help paying for Medicare Part B premiums
    • Help paying for Medicare Part D premiums and prescription drug costs
    • Help paying for nursing home care
    • Help paying for home and community-based services (HCBS)

    Medicaid is a valuable program that provides much-needed health care coverage to low-income individuals and families in Pennsylvania. If you are interested in applying for Medicaid, you can contact your local DHS office or visit the DHS website.

    Income and Asset Limits for Medicaid Eligibility in Pennsylvania

    To qualify for Medicaid in Pennsylvania, individuals must meet specific income and asset limits. These limits vary depending on the type of Medicaid program for which an individual is applying. The income and asset limits are periodically reviewed and adjusted by the Pennsylvania Department of Human Services to ensure they remain current and align with federal guidelines.

    Income Limits:

    • For individuals applying for regular Medicaid, the income limit is determined based on 138% of the Federal Poverty Level (FPL).
    • For pregnant women and children, the income limit is higher, typically set at 185% of the FPL.
    • Income limits also vary based on family size. For example, in 2023, the income limit for a single individual is $1,563 per month, while the limit for a family of four is $3,292 per month.

    Asset Limits:

    • Individuals applying for Medicaid in Pennsylvania are subject to an asset limit of $2,000 for individuals and $3,000 for couples.
    • Certain assets, such as a primary residence, one vehicle, and retirement savings accounts, are excluded from the asset limit calculation.
    Income and Asset Limits for Medicaid Eligibility in Pennsylvania
    CategoryIncome Limit (138% of FPL)Asset Limit
    Individual$1,563 per month$2,000
    Couple$2,127 per month$3,000
    Family of Three$2,691 per month$3,000
    Family of Four$3,292 per month$3,000

    It’s important to note that the income and asset limits for Medicaid eligibility in Pennsylvania are subject to change. Individuals interested in applying for Medicaid should contact their local county assistance office or visit the Pennsylvania Department of Human Services website for the most up-to-date information.

    Well, folks, that’s a wrap on our deep dive into the world of Pennsylvania Medicaid. We’ve covered everything from eligibility and benefits to application procedures and provider networks. I hope you found this article informative and helpful. Remember, Medicaid offers a helping hand to those who need it most, providing access to essential healthcare services. If you think you might qualify, or if you have any questions, don’t hesitate to reach out to the appropriate authorities. And be sure to come back and visit our blog for more informative and engaging content. Take care, and until next time, stay healthy and stay informed!