PA Medicare and Medicaid You can have both Medicare and Medicaid benefits if you meet the qualifications for both programs. Know that when you become eligible for Medicare, the PA Medicaid program will no longer cover your prescription drugs.
Full Answer
Can I have Medicare and Medicaid benefits in Pennsylvania?
You can have both Medicare and Medicaid benefits if you meet the qualifications for both programs. Know that when you become eligible for Medicare, the PA Medicaid program will no longer cover your prescription drugs. You will have to enroll in a Medicare plan that includes prescription drug coverage, like Part D or Medicare Advantage.
How does Medicaid work with Medicare?
Medicaid, via Medicare Savings Programs, also helps to cover the costs of Medicare premiums, deductibles, and co-payments. Medicaid provides a wide variety of long-term care benefits and supports to allow persons to age at home or in their community.
How many people in PA have Medicaid?
The Pennsylvania Medicaid program, often called the Pennsylvania Medical Assistance (MA) program, covers about 20% of the Pennsylvania population. That includes about one in every six adults, three out of every eight kids, half of all PA disabled people, and one out of every six Medicare beneficiaries!
Are Medicaid program payments to Pennsylvania hospitals adequate?
The Hospital and Healthsystem Association of Pennsylvania (HAP) commissioned the health care economics and consulting firm Dobson DaVanzo & Associates, LLC, to complete a report about the adequacy of Medicaid program payments to Pennsylvania hospitals. Based upon the fiscal year 2016 data, Medicaid paid only 81.
Can you have both Medicare and Medicaid in Pennsylvania?
PA Medicare and Medicaid You can have both Medicare and Medicaid benefits if you meet the qualifications for both programs. Know that when you become eligible for Medicare, the PA Medicaid program will no longer cover your prescription drugs.
Who is eligible for Medicare and Medicaid in PA?
Adults age 19-64 with incomes at or below 133% of the Federal Income Poverty Guidelines (FPIG) (Identified for Medical Assistance purposes as MAGI-related) Individuals who are aged (age 65 and older), blind and disabled.
What is the maximum income to qualify for Medicaid in Pennsylvania?
This income limit, now $2,523 /month, normally changes on January 1st of each year. This monthly figure represents 300% of the federal SSI benefit amount and is usually revised upwards each year due to inflation. $2,523 is the income threshold amount for 2022.
Can you have Medicare and Medicaid at the same time?
Yes. A person can be eligible for both Medicaid and Medicare and receive benefits from both programs at the same time.
What is the monthly income limit for medical assistance in PA 2021?
Specified Low-Income Medicare Beneficiary (SLMB) ProgramNumber of Persons2021 Federal Poverty Level (FPIG)Monthly Income Limit (FPIG + $20 Deductible = Limit)2At least 100 percent but less than 120 percent$1,452 + $20 = $1,472 Less than $1,742 + $20 = $1,7621 more row
What are the requirements for Medicaid in PA?
Adults age 19-64 with incomes at or below 133% of the Federal Income Poverty Guidelines (FPIG) (Identified for Medical Assistance purposes as MAGI-related) Individuals who are aged (age 65 and older), blind and disabled.
What is the highest income to qualify for Medicaid?
Federal Poverty Level thresholds to qualify for Medicaid The Federal Poverty Level is determined by the size of a family for the lower 48 states and the District of Columbia. For example, in 2022 it is $13,590 for a single adult person, $27,750 for a family of four and $46,630 for a family of eight.
How do I spend down for Medicaid in PA?
An acceptable way to spend down is to pay for goods and services that you need, or that have a legitimate purpose, such as nursing home care, legal services for Medicaid planning, the withholding of taxes, and normal household expenses.
How long does it take to get approved for Medicaid in PA?
How long will it take for my application to be processed? It should not take longer than 45 days if all necessary documentation needed to determine your eligibility for the Medical Assistance program is given to the county assistance office.
What is considered low income in Pennsylvania?
2022 POVERTY INCOME GUIDELINES CONTIGUOUS STATES U.S. GRANTEES EFFECTIVE January 12, 2022House Hold/Family Size100%200%1$13,590$27,1802$18,310$36,6203$23,030$46,0604$27,750$55,5004 more rows
What are the disadvantages of Medicaid?
Disadvantages of Medicaid They will have a decreased financial ability to opt for elective treatments, and they may not be able to pay for top brand drugs or other medical aids. Another financial concern is that medical practices cannot charge a fee when Medicaid patients miss appointments.
When a person has both Medicare and Medicaid insurance charges are submitted first to?
gov . Medicare pays first, and Medicaid pays second . If the employer has 20 or more employees, then the group health plan pays first, and Medicare pays second .
What is covered by Medicaid?
Mandatory benefits include services including inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, among others. Optional benefits include services including prescription drugs, case management, physical therapy, and occupational therapy.
What is the maximum income to qualify for food stamps in Pennsylvania?
SNAP Income LimitsHousehold SizeMaximum Gross Monthly Income1$1,3962$1,8883$2,3794$2,8717 more rows
How much can you make and get medical assistance in PA?
View coronavirus (COVID-19) resources on Benefits.gov....Who is eligible for Pennsylvania Medicaid Program?Household Size*Maximum Income Level (Per Year)1$18,0752$24,3533$30,6304$36,9084 more rows
What is the difference between Medicare and Medicaid?
The difference between Medicaid and Medicare is that Medicaid is managed by states and is based on income. Medicare is managed by the federal government and is mainly based on age. But there are special circumstances, like certain disabilities, that may allow younger people to get Medicare.
How to apply for medicaid in PA?
How to Apply for Medicaid PA. To apply for Medicaid in Pennsylvania, visit “ COMPASS .”. Before you start your application, you may want to gather the information you’ll need. Look for proof of household income, tax filing information, Social Security numbers, other health insurance information, proof of property, proof of citizenship, etc.
How many people in Pennsylvania have Medicaid?
The Pennsylvania Medicaid program, often called the Pennsylvania Medical Assistance (MA) program, covers about 20% of the Pennsylvania population. That includes about one in every six adults, three out of every eight kids, half of all PA disabled people, and one out of every six Medicare beneficiaries! That’s right – you can have both Medicare and ...
How many dentists did the PA Medicaid expansion add?
In 2015, Pennsylvania Governor Tom Wolf expanded the PA Medicaid program, resulting in over 700,000 new beneficiaries. The expansion also added over 600 more dentists, about 450 nurse practitioners, and almost 4,500 more physicians. With these additions came a large decrease in the Pennsylvania uninsured rate, a huge increase in employment (15,500 jobs added), a decrease in hospitals going without payment, and an overall healthier Pennsylvania.
How to find a doctor in Pennsylvania?
The best way to find doctors in Pennsylvania who accept PA Medicaid is by using an online doctor search tool like doctor.com or ZocDoc. Through these tools, you can enter the type of insurance you have (Medicaid), your location (usually by zip code), and the type of doctor you are looking for. You can then read reviews and compare doctors in your area before you schedule your first appointment.
What is the yellow access card in Pennsylvania?
Everyone in Pennsylvania who receives either Medicaid or welfare (or both) will receive an “access” card with different colors based on which programs you qualify for. This card will serve as proof of your benefits. Be sure to always keep your yellow access card in a safe place and bring it with you to your medical appointments. Your doctor can use the card to figure out what benefits you have.
How much can a family of two earn to get food stamps in Pennsylvania?
For example, in 2019, a household of two cannot earn more than $1,784 to qualify for food stamps in Pennsylvania (SNAP), but a family of two can earn up to $1,945 to qualify for PA Medical Assistance.
Is PA Medicaid covered by Medicaid?
PA Medicaid Covered Drugs. The medical assistance program includes a list of “preferred” drugs that are considered the best in their class based on effectiveness and safety. These drugs are almost always covered, while non-preferred drugs will only be covered when medically necessary.
What is Medicare and Medicaid?
Differentiating Medicare and Medicaid. Persons who are eligible for both Medicare and Medicaid are called “dual eligibles”, or sometimes, Medicare-Medicaid enrollees. Since it can be easy to confuse the two terms, Medicare and Medicaid, it is important to differentiate between them. While Medicare is a federal health insurance program ...
How much does Medicare Part B cost?
For Medicare Part B (medical insurance), enrollees pay a monthly premium of $148.50 in addition to an annual deductible of $203. In order to enroll in a Medicare Advantage (MA) plan, one must be enrolled in Medicare Parts A and B. The monthly premium varies by plan, but is approximately $33 / month.
What is the CMS?
The Centers for Medicare and Medicaid Services, abbreviated as CMS, oversees both the Medicare and Medicaid programs. For the Medicaid program, CMS works with state agencies to administer the program in each state, and for the Medicare program, the Social Security Administration (SSA) is the agency through which persons apply.
What is the income limit for Medicaid in 2021?
In most cases, as of 2021, the individual income limit for institutional Medicaid (nursing home Medicaid) and Home and Community Based Services (HCBS) via a Medicaid Waiver is $2,382 / month. The asset limit is generally $2,000 for a single applicant.
How old do you have to be to apply for medicare?
Citizens or legal residents residing in the U.S. for a minimum of 5 years immediately preceding application for Medicare. Applicants must also be at least 65 years old.
What are home modifications?
Home Modifications (widening of doorways, installation of ramps, addition of pedestal sinks to allow wheelchair access, etc.)
Is Medicare the first payer?
For Medicare covered expenses, such as medical and hospitalization, Medicare is always the first payer (primary payer). If Medicare does not cover the full cost, Medicaid ...
Does Medicaid cover cost sharing?
If you are enrolled in QMB, you do not pay Medicare cost-sharing, which includes deductibles, coinsurances, and copays.
Does Medicare cover medicaid?
If you qualify for a Medicaid program, it may help pay for costs and services that Medicare does not cover.
Does Medicaid offer care coordination?
Medicaid can offer care coordination: Some states require certain Medicaid beneficiaries to enroll in Medicaid private health plans, also known as Medicaid Managed Care (MMC) plans. These plans may offer optional enrollment into a Medicare Advantage Plan designed to better coordinate Medicare and Medicaid benefits.
Does Medicare pay for home care?
Medicaid can provide secondary insurance: For services covered by Medicare and Medicaid (such as doctors’ visits, hospital care, home care, and skilled nursing facility care), Medicare is the primary payer. Medicaid is the payer of last resort, meaning it always pays last. When you visit a provider or facility that takes both forms of insurance, Medicare will pay first and Medicaid may cover your Medicare cost-sharing, including coinsurances and copays.
What is Medicaid eligibility based on?
Most Medicaid eligibility and all CHIP eligibility is based on modified adjusted gross income (MAGI). Income eligibility levels are tied to the federal poverty level (FPL).
What is the source of information for Medicaid?
Medicaid and CHIP agencies now rely primarily on information available through data sources (for example, the Social Security Administration, the Departments of Homeland Security and Labor) rather than paper documentation from families for purposes of verifying eligibility for Medicaid and CHIP.
How many people are in Medicaid in 2019?
As of December 2019, has enrolled 985,201 individuals in Medicaid and CHIP — a net increase of 57.29% since the first Marketplace Open Enrollment Period and related Medicaid program changes in October 2013. has adopted one or more of the targeted enrollment strategies outlined in guidance CMS issued on May 17, 2013, designed to facilitate enrollment in Medicaid and CHIP.
What percentage of Pennsylvania Medicaid is funded by the elderly?
[11] During 2017, 34.2 percent of Pennsylvania’s 137,771 births were funded by Medicaid. [12],[13]
How many people are covered by Medicaid in Pennsylvania?
Two-thirds of all nursing home residents are covered by Medicaid. [14] As of December 2018, approximately 2.8 million people were enrolled in Medicaid in Pennsylvania. [15] More than 750,000 Pennsylvanians have benefited from health insurance coverage under Medicaid expansion, as of November 2018.
What is Medicaid?
Medicaid is a jointly funded, federal-state health insurance program for low-income populations. Of the roughly $614 billion spent on Medicaid nationally during 2019, [1] the federal share was 63 percent. [2] Each state government’s share varies; in Pennsylvania, it has been 52 percent annually from fiscal year 2015 through fiscal year 2021. [3]
What percent of people on Medicaid have a cardiovascular condition?
17 percent had a cardiovascular condition; 5% had Type 2 Diabetes [23] 130,000 newly eligible Medicaid enrollees suffer from substance use disorder, and during 2017, more than 72,000 were diagnosed with opioid use disorder.
What is the FPL for Medicaid in 2021?
The Affordable Care Act (ACA) extended Medicaid eligibility to non-elderly adults with incomes at or below 133 percent of the federal poverty limit (FPL) [5] —during 2021, that is $35,245 for a family of four. [6] States that choose to participate in this expansion receive enhanced federal matching payments. Pennsylvania opted to expand its Medicaid coverage during 2015. [7]
What percent of adults have access to Medicaid?
FACT: 2018 Medicaid surveys and program measures validate that consumers have access to care—82 percent of adults and nearly 92 percent of children report getting an appointment for routine care “usually or always.” [30]
How much higher is private insurance than medicaid?
For example, one study found that Medicaid provides access to comparable care at significantly lower costs and calculated that private insurance costs would be 25 percent higher than Medicaid costs for the same low-income adult. [18],[19]
How to Apply
There are different ways to apply for MA. Please choose the option that suits you best. If you do not know if you are eligible, you can still apply.
What if I am not eligible?
Contact your CAO and a trained staff member will determine what programs might be available to you. You can explore these links to learn about additional health care programs available in Pennsylvania.
Where can I find information about providers accepting MA patients?
If you are eligible for MA, you may call the Fee-for-Service Recipient Service Center at 1-800-537-8862. They will provide you with a list of enrolled providers for MA patients.
How does Original Medicare work?
Original Medicare covers most, but not all of the costs for approved health care services and supplies. After you meet your deductible, you pay your share of costs for services and supplies as you get them. There’s no limit on what you’ll pay out-of-pocket in a year unless you have other coverage (like Medigap, Medicaid, or employee or union coverage). Get details on cost saving programs.
What is Medicare Advantage?
Medicare Advantage bundles your Part A, Part B, and usually Part D coverage into one plan. Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.
Why buy Medicare Supplement Insurance?
Buy a Medicare Supplement Insurance (Medigap) policy to help lower your share of costs for services you get.
Is Medicare a private insurance?
Medicare is different from private insurance — it doesn’t offer plans for couples or families. You don’t have to make the same choice as your spouse.
Does Medicare cover urgent care?
Plans must cover all emergency and urgent care, and almost all medically necessary services Original Medicare covers. Some plans tailor their benefit packages to offer additional benefits to treat specific conditions.
What is Medicare insurance?
Medicare. Medicare is an insurance program. Medical bills are paid from trust funds which those covered have paid into. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients. Patients pay part of costs through deductibles for hospital and other costs.
Do you pay for medical expenses on medicaid?
Patients usually pay no part of costs for covered medical expenses. A small co-payment is sometimes required. Medicaid is a federal-state program. It varies from state to state. It is run by state and local governments within federal guidelines.
Is Medicare a federal program?
Small monthly premiums are required for non-hospital coverage. Medicare is a federal program. It is basically the same everywhere in the United States and is run by the Centers for Medicare & Medicaid Services, an agency of the federal government.
What is Medicaid in Pennsylvania?
Pennsylvania Medicaid Definition. Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. However, this page is focused on Medicaid eligibility, specifically for Pennsylvania residents, aged 65 and over, and specifically for long term care, whether that be at home, ...
How long is the Medicaid spend down period in Pennsylvania?
Pennsylvania has a six-month “spend-down” period, so once an individual / couple has paid their excess income down to the Medicaid eligibility limit for the period, they will qualify for the remainder of the period.
How much can a spouse retain for Medicaid in Pennsylvania?
For married couples, in 2021, the community spouse (the non-applicant spouse of a nursing home Medicaid applicant or a HCBS Medicaid waiver applicant) can retain half of the couple’s joint assets up to a maximum of $130,380, as the chart indicates above. If the couple’s total assets are $26,076 or less, the community spouse is entitled to 100% of it. This, in Medicaid speak, is called the Community Spouse Resource Allowance (CSRA), and in Pennsylvania is also known as the non-applicant spouse’s “protected share”. Like the spousal income allowance, this resource allowance is intended to prevent community spouses from becoming impoverished and does not extend to non-applicant spouses of regular Medicaid applicants.
When only one spouse of a married couple is applying for nursing home Medicaid or a Medicaid waiver, is the income?
When only one spouse of a married couple is applying for nursing home Medicaid or a Medicaid waiver, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded.
What are countable assets for Medicaid?
Countable assets include stocks, bonds, investments, savings, and checking accounts. However, for Medicaid eligibility, there are many assets that are considered exempt (non-countable). For instance, Pennsylvania allows an extra $6,000 exemption, which is in addition to the asset limits listed above, for a total asset limit of $8,000. ...
How long is the look back period for Medicaid in Pennsylvania?
It’s important to be aware that Pennsylvania has a 5-year Medicaid Look-Back Period. This is 5 years immediately preceding one’s Medicaid application date in which Medicaid checks to ensure no assets were sold or given away under fair market value. If this rule has been violated, it is assumed it was done in order to meet Medicaid’s asset limit. Violating the look back period results in a penalty period of Medicaid ineligibility.
How to apply for long term care in Pennsylvania?
To apply for long-term care Medicaid, elderly Pennsylvania residents can do so online at COMPASS or fill out a paper application, “ Medical Assistance (Medicaid) Financial Eligibility Application for Long Term Care, Supports and Services ” and either drop it off or mail it to their local County Assistance Office (CAO).
