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Medicaid Benefits in Pennsylvania

November 16, 2021

With COVID-19 still being a prevalent part of the world, the desire for the safety blanket of healthcare is paramount. But if you don’t have access to standard insurance, you might worry about how to keep healthy.

 

Read on to learn about some of the benefits of Medicaid in Pennsylvania.

 

What Is Medicaid?

You might be asking yourself…what is Medicaid? If you’re looking for that safety blanket of health care, but you’re struggling for money, Medicaid could change your life.

 

Medicaid is an insurance program that provides free or low-cost health coverage to very, very low-income families, pregnant women, and the elderly, as well as to people with disabilities.

 

Medicaid is a way to stay healthy without having to break the bank to prioritize your health. You might not even realize that you’re eligible for Medicaid, but the requirements are quite encompassing.

 

Who Is Eligible for Medicaid in Pennsylvania?

Although it may seem difficult to dig through the specific requirements for eligibility, it’s not as difficult as it might seem initially.

 

To be eligible for Medicaid in Pennsylvania, the qualifications are as follow:

 

●     you must be aged between 19-years-old and 64-years-old and have an individual income that falls at or below 133% of the Federal Poverty Level (to put it into a more specific example for ease of understanding, that is about $20,420 for a family of three)

●     you must be aged 65-years-old or older, blind, or disabled

●     you must be part of a family that contains children who are under the age of 21

●     have special conditions—if you feel like this last one might be you, please check your specific eligibility requirements to make sure where you fall

 

However, you may not fit into any of these categories. Does that mean you’re ineligible?

 

Not entirely. There are some other—more specific—eligibility requirements that might allow you to still have free, government-provided health care.

 

In Pennsylvania, these additional specifications fall under the CHIP program.

 

What is CHIP? Who is Eligible?

Although we are focusing specifically on Medicaid coverage in Pennsylvania, CHIP is available—in different forms—in all states.

 

CHIP stands for the Children’s Health Insurance Program. CHIP, as a part of the national Medicaid program, provides free or low-cost health insurance for uninsured Pennsylvania children and teens who fall into some very specific categories.

 

To quality, these children must be:

 

●     less than 19 years of age

●     part of families where parents do not have the necessary health coverage through their jobs

●     not eligible for or enrolled in Medicaid

●     U.S. citizens or legal residents

 

If you’ve made it this far into the article and you’ve found that you’re eligible for Medicaid, you might be wondering what the next steps are.

 

Well, the next step is to apply for Medicaid. Luckily, there are several ways to do that.

 

How to Apply for Medicaid?

The time has come to apply for Medicaid. But, as with all applications, especially through government programs, it can seem like a bit of a headache to jump through all the hopes.

 

That’s why, if you find yourself struggling, you can try a different application method. When it comes to Medicaid, there are many different ways to apply for it.

 

These ways include:

 

●     By phone

If this is the method most suitable for you, please contact them at 1-866-550-4355.

 

●     Online

In this day and age, it’s much easier to get things done on your schedule and in your own time. As such, check out COMPASS HHS Home to find more information to apply online.

 

●     In-person

It can be much easier to apply to something if you have real, live people to speak with if you come across any questions. Thus, if you think you’ll have a lot of concerns when it comes to applying for Medicaid, you may want to find your local office and speak to someone there.

 

If you’re looking for more information about other requirements for applying, make sure to check out the website.

 

As you begin looking into applying for Medicaid, you may be starting to wonder just what sort of coverage you’ll receive.

 

It’s time to talk about mandatory vs. optional benefits when it comes to Medicaid.

 

Mandatory VS. Optional Benefits

When it comes to government-provided aid programs such as Medicaid, you might be thinking that it’s not as good an insurance choice as other options.

 

It’s possible, but that comes down to what ailments might be afflicting you and your family.

 

Because Medicaid is a government assistance program, it’s held to very specific standards and regulations, which can work as both a good thing and a bad thing.

 

According to the law, when it comes to Medicaid programs, states must provide 15 mandatory benefits. Across the entire nation, those 15 benefits will be the same.

 

However, governments can also decide to provide additional benefits. These are called optional benefits, and they can truly make or break a policy, depending on what your needs are.

 

Pennsylvania is one of the better ones. When it comes to these optional benefits, there are a total of 28 total options. Medicaid in Pennsylvania provides applicants with 24 out of 28 of those benefits.

 

Of course, you’re now wondering what those mandatory and optional benefits are.

 

Mandatory Benefits

Although you may believe that the mandatory benefits are the bare benefits, that’s not the case. They are quite widespread and include.

●     Inpatient hospital services

●     Outpatient hospital services

●     EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services

●     Nursing Facility Services

●     Home health services

●     Physician services

●     Rural health clinic services

●     Federally qualified health center services

●     Laboratory and X-ray services

●     Family planning services

●     Nurse Midwife services

●     Certified Pediatric and Family Nurse Practitioner services

●     Freestanding Birth Center services (when licensed or otherwise recognized by the state)

●     Transportation to medical care

●     Tobacco cessation counseling for pregnant women

 

But if you have very specific health concerns, you may be wondering about those optional benefits, as well.

 

The optional benefits might make or break whether you go for Medicaid or dip into your savings to get a bigger, more standard insurance plan.

 

Optional Benefits

It’ll largely depend on what you’re trying to get out of your health care, but you might be swayed for or against Medicaid depending on the following optional benefits.

 

Optional benefits that might be offered are:

 

●     Prescription Drugs

●     Clinic services

●     Physical therapy

●     Occupational therapy

●     Speech, hearing, and language disorder services

●     Respiratory care services

●     Other diagnostic, screening, preventive, and rehabilitative services

●     Podiatry services

●     Optometry services

●     Dental Services

●     Dentures

●     Prosthetics

●     Eyeglasses

●     Chiropractic services

●     Other practitioner services

●     Private duty nursing services

●     Personal Care

●     Hospice

●     Case management

●     Services for Individuals who are age 65 or older in an Institution for Mental Disease (IMD)

●     Services in an intermediate care facility for Individuals with Intellectual Disability

●     State Plan Home and Community Based Services- 1915 (i)

●     Self-Directed Personal Assistance Services- 1915 (j)

●     Community First Choice Option- 1915 (k)

●     TB Related Services

●     Inpatient psychiatric services for individuals under age 21

●     Other services approved by the Secretary*

●     Health Homes for Enrollees with Chronic Conditions – Section 1945

 

It’s best to double-check which of these specific benefits are being offered, as Pennsylvania only offers 24 out of 28 of the aforementioned ones.

 

If you’ve reached this point and you’re still interested in applying for Medicaid, what should come next?

 

Next Steps

The time has come to start your Medicaid journey. Medicaid can be a life-saving option for many people out there, and it’s one that there is no shame in pursuing.

 

Having life insurance can honestly be the difference between life and death in some cases, so if you’re worried that something might happen or that your health might take a turn for the worse, you should look into Medicaid.

 

Additionally, if you have insurance, doors open to you. Whether it’s the COVID-19 vaccine or the flu shot, having insurance can help you make sure that you’re in the healthiest state to take on the world.