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Best Medicaid Health Plans

October 14, 2021

Medicaid presents an opportunity for you to receive adequate healthcare if you earn a low income. This insurance program offers coverage for individuals across the board. These include adults, children, pregnant women, the elderly, and the disabled.

Below, we look at the best Medicaid plans specific to Pennsylvania and how you can apply for the coverage.

What Is Medicaid?

The Medicaid program is also called “medical assistance.” It provides comprehensive coverage for vulnerable populations and persons with low income. 

The federal and state governments fund this insurance program, so each state has somewhat different regulations for those eligible and the type of treatment costs covered. In most cases, if you qualify for the coverage, you'll enjoy cost coverage for nursing care, home healthcare, doctor's visits, ambulance rides, and more.

Let's look at the eligibility criteria for Medicaid coverage.

Who Qualifies for Medicaid in Pennsylvania?

Previously, Medicaid was specifically geared toward narrow groups. These included low-income and disabled adults and children. However, Pennsylvania ratified the Affordable Care Act. Consequently, it brought about Medicaid expansion in 2015. Today, adults and children can be eligible for coverage based entirely on having a low income.

Older adults: If you're advanced in age, you can rely on Medicaid to get the healthcare you need. Thanks to Medicaid long-term care support, senior citizens can now stay away from a nursing facility. Instead, you can receive care within your familiar surroundings. The coverage also extends to adult diapers, suppositories, and liquid nutrition. 

Disabled adults: Medicaid takes care of the medical costs that disabled persons cannot pay. For example, regular visits to the doctor, medications, and wheelchairs. 

Low-wage workers: If you’re a low-income person aged between 18 and 64 and you earn less than 139% of the Federal Poverty Level (FPL), you automatically qualify for Medicaid coverage, notwithstanding your health status.

Pregnant women and children: If you're a pregnant woman with an income below 215% of the federal poverty stipulations, you can receive Medicaid coverage. Medicaid also covers the services of skilled nurses needed to provide care to children with special needs either at home or in a healthcare facility.

To qualify for Medicaid in Pennsylvania, you will need to show proof of the following documents:

United States citizenship: Medicaid in Pennsylvania is only available to citizens of the United States. You will need to show proof of your citizenship through any of the following documentation: a birth certificate, American passport, or citizenship certificate. 

Pennsylvania residency: You can show proof of a valid Pennsylvania driver's license, a dated utility bill, or a Pennsylvania voter's registration card. 

• Documents proving your current housing condition

• Proof of monthly income

• Your Social Security Number

If you qualify for Medicaid, the next step would be applying for it through the proper channels. 

How Do I Apply for Medical Assistance?

Online: You can apply for Medical Assistance online at https://www.compass.state.pa.us/compass.web/Public/CMPHome.

COMPASS is a web-based tool for residents of Pennsylvania to apply for a myriad of medical and human service programs. You only need to create a COMPASS account and proceed with your application. 

By phone: Contact the customer service center at 1-866-550-4355 to apply over the phone.

At a local county assistance office: You can apply for Medicaid at a physical location. Find one at http://www.dhs.state.pa.us/findfacilsandlocs/countyassistanceofficecontactinformation/index.htm.

Now that you've applied for Medicaid coverage, it's time to choose the type of plan that fits your needs. Read on to find out about the options available.

Best Medicaid Plans in Pennsylvania 

Aetna Better Health 

Aetna Better Health is one of the Medicaid health plans available for you in Pennsylvania. You will receive most of the Medicaid benefits through this plan. Upon enrolling, you will receive a handbook highlighting all the benefits and services that you can access.

Covered Benefits

Your benefits are determined based on how you qualify for Medicaid. This is referred to as your category of assistance. The covered benefits include:

Doctor and hospital visits: These include emergency services, ambulance rides, lab and x-ray services, and visits to health specialists like cardiologists and urologists, among others.

Medication: If your doctor writes for you a prescription, you can get prescription drugs and over-the-counter tablets.

Dental care: Teeth whitening, braces, crowns, fillings, and so on.

Medical equipment: Diabetic supplies and wheelchairs.

Vision care: Eye exams, prescription glasses, and lenses.

Behavioral health services: Addiction and recovery therapy treatment.

Physical therapy, chiropractic care, and home healthcare

UPMC for You

As a member of UPMC for You, you can access the best doctors and health facilities in Pennsylvania. UPMC for you boasts a provider network totaling over 86 medical facilities and over 10,000 health practitioners.

Covered Benefits

The following services are covered: 

Pharmacy: Members can get all their medicine covered under Medicaid, plus a wide range of prescription drugs and vitamins.

Dental: If you need special care for your teeth or gums, UPMC for You has an extensive network of general dentists and specialists. Through this plan, you get coverage for dental exams, fillings, and cleanings. 

Vision: UPMC for You members can self-refer to practicing optometrists or ophthalmologists for routine eye examinations. If you have a specific eye problem—for example, eye cataract or shortsightedness—you will need a referral from your eye doctor before you can see an ophthalmologist. 

As a member, you're also eligible for a routine vision allowance that applies to eyeglasses, frames, or lenses. And you can also enroll in one of the health management programs for improved health. A health management program has health specialists who assist you in understanding your existing condition and take good care of yourself. 

UPMC for You features several special health management programs for:

• Asthma 

• Heart disease 

• Chronic obstructive pulmonary disease 

• Diabetes 

• Maternity 

• Hypertension (high blood pressure) 

• Hyperlipidemia (high cholesterol) 

• Low back pain 

• Chronic kidney disease

UnitedHealthcare Community Plan 

With UnitedHealthcare Community Plan, you can choose from the following four health plans available for Pennsylvania Medicaid patients:

2022 UnitedHealthcare Dual Complete® - PA (HMO D-SNP)

This health plan is a dual-eligible special needs plan. It's designed for beneficiaries who qualify for both Medicaid and Medicare insurance programs. UnitedHealthcare works with Medical Assistance to provide you with considerable coverage, more than original Medicare. 

You'll still keep your original Medicare benefits. However, you'll enjoy added benefits like Part A (hospital coverage) and Part B (health coverage) policy, all courtesy of UnitedHealthcare. 

As a local HMO, this health plan requires you to get medical treatment from an in-network provider. This means you have to pick a primary care physician (PCP). The PCP will be responsible for providing all of your primary healthcare services. They can also refer you to a health specialist for special care within the network. 

Benefits and features include:

• Covered costs for prescription drugs

• Dental coverage

• Vision care

• Hearing coverage

• Laboratory services

• Personal emergency response system (PERS)

• Nurse hotline

• Foot care

• Acupuncture services

• Chiropractic services

• Renew Active® Fitness Program

2022 UnitedHealthcare Dual Complete® Select (HMO D-SNP)

This is another dual eligible special needs plan. It's suitable for both Medicaid and Medicare patients. Of course, you'll enjoy more added benefits than your original Medicare plan, with premiums as low as zero dollars. 

As a Health Maintenance Organization plan, you get to pick your personal doctor.

Benefits and features include:

• Dental coverage

• Covered costs for prescription drugs

Transportation for non-emergency doctor visits

• Vision care

• Laboratory services

• Preventive care

• Renew Active® Fitness Program

• Nurse hotline

• Primary care visits

• Foot care

• Acupuncture services

• Hearing coverage

• Chiropractic services

• Specialist visits

UnitedHealthcare Community Plan for Families

This health plan covers medical treatment costs for those eligible for the Medicaid program in Pennsylvania. UnitedHealthcare ensures its network of physicians and hospitals provides quality healthcare services. Beneficiaries get to choose their own personal doctor within the network. 

Benefits and features include:

• Primary visits to your personal caregiver

• Specialist care

• Round-the-clock assistance from your personal doctor

• Round-the-clock emergency room care

• Immunizations for kids

• Vision care

• Dental services

• Prescription coverage

• EPSDT tests and treatment

UnitedHealthcare Community Plan for Kids

This health plan is a Children's Health Insurance Program (CHIP). It provides health coverage to kids and teens who have no health insurance. If you're eligible for a CHIP program, you may get it for free or at a small monthly fee. Either way, you can expect no deductibles.

Covered benefits include:

• Doctor visits

• Immunizations

• Hospital care

• Lab services and X-rays

• Eyewear

• Dental services

• Emergency care

• Prescription medication

• Maternity care

• Behavioral health and substance abuse services 

• Family planning

Gateway Health Plan

Apart from the typical Medicaid benefits, signing up for the Gateway Health plan affords you access to the following benefits and services:

• 24/7 nurse line

• Wellness coaching

• Access to affordable housing

• Access to healthy nutrition

• Counseling to help you give up smoking

• Online member portal

• Free cell phone service

• Information and support for pregnant women 

• GED testing programs

If you're wondering how to choose from the plans mentioned above, read on to find out how.

How to Choose a Plan?

Picking a health plan can be daunting. The sheer amount of options out there can be overwhelming. Here's a guide to picking the best plan for you and your loved ones:

Review All Your Options

Probably you're enrolled in a health plan and see no point in searching around. While you may be happy with your existing plan, it's important to always check whether there's a better value out there.

Each year, there may be different adjustments that affect the types of plans available and the costs of those health plans. So, it makes perfect sense to always search around to see what's new and whether it's beneficial to switch things up.

When comparing health plans, check out the summary of benefits. Typically, online marketplaces provide a link to a detailed list of benefits. You should also find the list of doctors and hospital institutions within the plan's network. If your job provides health insurance, inquire with your workplace supervisor about the summary of benefits.

Calculate Yearly Costs for All Options

When you visit an in-network health practitioner, you'll enjoy lower costs because insurers have agreed-upon rates with doctors within their network. If you go out of network, expect to pay a higher segment of the price. 

Besides the network, out-of-pocket costs are also significant. Every health plan's summary of benefits will indicate the exact amount you're expected to pay out of pocket for medical services. Generally, lower premiums translate to higher out-of-pocket costs.

Many people concentrate on the cost of monthly premiums when comparing health insurance plans. However, it's also essential to look at the yearly expenses. 

The total annual cost factors in the plan's deductible—that is, the amount you have to shell out for treatment for covered medical services before your insurer assumes the responsibility. Also, it considers the copayments, combined with the amount of healthcare you predict you’ll use in the forthcoming year.

Avoid Plans That Are Too Good to Be True

Ideally, you want to deal with only Affordable Care Act (ACA) plans. Any plan should encompass the ACA'S renowned ten important benefits, including things like mental health services, prescription drugs, and emergency services

If you come across a plan that promises unbelievable stuff, read the fine print. Also, consider checking out the plan's star rating to see the opinions of other customers on that plan. You're likely to notice any red flags, if there are any.

Consider What's Best for You

Check out the summary of benefits for each plan. Some plans offer a broader scope of services. Some provide better insurance coverage for mental healthcare, physical therapy, or maternity care, while others boast better preventive and wellness coverage. Narrow down your search to just the plans well suited to the medical needs specific to you and your family.

Get Affordable Medical Coverage!

You don't have to have costly medical insurance to gain access to good medical care. If you live in Pennsylvania and have a low income, you can benefit from the Medicaid program. All you need to do is apply for it through the proper channels and choose a program that matches your needs.