Did you know 2 million Pennsylvanians were enrolled in Medicare in 2018?
Did you know that in 2018, more than 2 million Pennsylvanians were enrolled in Medicare? As a Medicare beneficiary, you can choose from a variety of Medicare coverage options in your state. Let’s start by looking at the components that comprise Medicare coverage. Medicare includes Part A, Part B, Part C, and Part D.
Did Pennsylvania expand Medicaid under the ACA?
The state of Pennsylvania expanded Medicaid under the ACA in 2015. Nearly 700,000 people are covered under Pennsylvania’s Medicaid expansion. Medicaid expansion has played a significant role in the declining uninsured rate in Pennsylvania. According to U.S. Census data, the uninsured rate fell from 9.7 percent in 2013 to 5.5 percent in 2017.
What kind of Medicare do I need in Pennsylvania?
About Medicare in Pennsylvania. Medicare beneficiaries in Pennsylvania may enroll in Original Medicare, Part A and Part B, and then supplement that coverage with a stand-alone Medicare Part D Prescription Drug Plan and/or a Medigap policy.
Are you eligible to sign up for Medicare Advantage in Pennsylvania?
You are eligible to sign up for a Medicare Advantage plan in Pennsylvania if you have Original Medicare, Part A and Part B; do not have end-stage renal disease (ESRD, or permanent kidney failure) with some exceptions; and you live in the Medicare Advantage plan’s service area.
What year did they start taking out Medicare?
President Johnson signs the Medicare bill into law on July 30 as part of the Social Security Amendments of 1965. 1966: When Medicare services actually begin on July 1, more than 19 million Americans age 65 and older enroll in the program.
Does Pennsylvania have Medicare?
More than 2.7 million Pennsylvania residents receive Medicare benefits as of 20201. That's approximately 21% of the state's population who are enrolled in some form of Medicare2. HealthMarkets can help you learn about Medicare eligibility in Pennsylvania to access the coverage you need.
What is Medicare called in Pennsylvania?
The federal Medicare program is the same nationwide – in Pennsylvania and all states. The traditional program is called Original Medicare (Part A and Part B).
Who is eligible for Medicare in PA?
Original Medicare in Pennsylvania You are eligible for Original Medicare if you are 65 years old or older and either an American citizen or a permanent legal resident who has lived in the United States at least five continuous years.
Is Medicare free in Pennsylvania?
Most people have premium-free Part A but, if you have to buy it, the cost can reach up to $499 per month in 2022. Part B costs $170.10 per month but can be more if you have higher income. There are 160 Medicare Advantage Plans in the state that are an alternative to Original Medicare.
Does Pa pay for Medicare Part B?
Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through a Medicare Savings Program (MSP). In Pennsylvania, these programs pay for Medicare Part B premiums, Medicare Part A and B cost-sharing, and – in some cases – Part A premiums.
How much does Medicare Part B cost in Pennsylvania?
Medicare Part B In 2020, the standard premium will be $144.60/month. Most people will pay this amount.
How much does Medicare cost in Pennsylvania?
The average cost for a Medicare Advantage plan in Pennsylvania in 2021 is $38.97, which is significantly higher than the national average of $21.
Is Medicare Part A free at age 65?
You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if: You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
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. (Identified for Medical Assistance purposes as SSI-related) Families with children under age 21.
What is the maximum income to qualify for Medicaid in PA?
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 both Medicare and Medicaid in Pennsylvania?
Partial dual eligibles are people that have Medicare and who receive limited benefits through Medicaid (called Medical Assistance or “MA” in Pennsylvania). Often, the only benefit partial dual eligibles get is MA payment of their monthly Part B premium-known as the Medicare Savings Programs or “buy-in”.
About Medicare in Pennsylvania
One of your choices as a Pennsylvania resident (as in any state) is Original Medicare, Part A and Part B, the federally-run health care program. Me...
Types of Medicare Plans in Pennsylvania
Many types of Medicare plans are only available through private Medicare-approved insurance companies. As a Pennsylvania beneficiary, here are some...
Local Medicare Resources in Pennsylvania
Medicare Savings Programs in Pennsylvania: Each state offers programs that help beneficiaries with limited income. These programs pay for some out-...
How to Apply For Medicare in Pennsylvania
To qualify for Medicare, you must be either a United States citizen or a legal permanent resident of at least five continuous years.In Pennsylvania...
Overview of Medicare in Pennsylvania
Did you know that in 2018, more than 2million Pennsylvanians were enrolled in Medicare? As a Medicare beneficiary, you can choose from a variety of...
Original Medicare in Pennsylvania
You are eligible for Original Medicare if you are 65 years old or older and either an American citizen or a permanent legal resident who has lived...
Medicare Part D Prescription Drug Coverage in Pennsylvania
To be eligible for Medicare prescription drug coverage (Medicare Part D), you must have Medicare Part A and/or Part B and live in the service area...
Medicare Advantage Plans in Pennsylvania
You are eligible to sign up for a Medicare Advantage plan in Pennsylvania if you have Original Medicare, Part A and Part B; do not have end-stage r...
Medicare Resources in Pennsylvania
Pennsylvania Department of Aging – This state office offers a wide range of information and services designed to improve the quality of life and in...
Medicare Statistical Trends in Pennsylvania According to The Medicare Enrollment Dashboard and 2018 MA Part D State by State Report.
As you consider Medicare coverage in your home state, you are likely to be impressed with the options available to you. For 2018, some points of in...
What is Medicare in Pennsylvania?
One of your choices as a Pennsylvania resident (as in any state) is Original Medicare, Part A and Part B, the federally-run health care program. Medicare Part A provides beneficiaries with inpatient hospital care while Medicare Part B includes physician services, some preventive care, ...
How long do you have to be a resident of Pennsylvania to qualify for Medicare?
How to apply for Medicare in Pennsylvania. To qualify for Medicare, you must be either a United States citizen or a legal permanent resident of at least five continuous years.
How long do you have to be on Medicare to qualify for it?
You are eligible for the program before reaching age 65 if you have certain qualifying disabilities or conditions; you’re automatically enrolled in Medicare after receiving disability benefits for 24 consecutive months.
How many Medigap policies are there in Pennsylvania?
Most states, Pennsylvania included, can offer up to 10 standardized Medigap policy options, each one labeled with a letter. Different Medigap plans include different coverage details, but all plans of the same letter are guaranteed to offer the same benefits, regardless of insurance company.
How to apply for Social Security if you worked at a railroad?
Apply in person at a Social Security office near you. Apply through the Railroad Retirement Board if you worked at a railroad, by calling 1-877-772-5772 (TTY users call 312-751-4701), Monday through Friday, 9AM to 3:30PM. 1-800-MEDICARE (TTY users call 1-877-486-2048), 24 hours a day, seven days a week.
Do you have to pay Medicare Part B premiums?
People who enroll in a Medicare Advantage plan are still responsible for paying the Medicare Part B premium. These plans cover “gaps” in Original Medicare coverage, such as deductibles, copayments, coinsurance, and possibly some foreign travel emergency health care coverage.
Is Medicare available in Pennsylvania?
Many types of Medicare plans are only available through private Medicare-approved insurance companies. As a Pennsylvania beneficiary, here are some of your Medicare plan options:
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 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 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.
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.
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 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).
What Pennsylvania Medicare Plans Are Available?
If you are nearing the age of retirement and live in Pennsylvania, you might be wondering what Medicare plans will be available to you. Social Security will subsidize the cost of your medical care to help make it more affordable, but you do need to be aware of your own financial responsibility for your health care so that you may plan ahead.
Who Is Eligible for Pennsylvania Medicare?
The only reasons you would not be enrolled automatically are that you did not contribute enough to Social Security or you have not been collecting your benefits for at least four months before your 65th birthday. Everyone is eligible to enroll in Medicare at 65 years of age, but some people may need to pay more for their benefits.
What is Medicare Supplement Plan?
Medicare Supplement Plans. A Medicare supplement plan can cover the cost of your copayments and other out-of-pocket expenses. For example, if you receive certain care that's covered under Medicare Part B, you typically will be responsible for 20% of your bill after meeting your deductible for the year. A Medicare Supplement plan can help cover ...
How much does Medicare Part B cost?
Medicare Part B does charge a premium of up to $150 at the moment, but this premium could rise in the future. Your Medicare Part B premiums are taken from your retirement benefits so that you do not need to pay a monthly bill.
What is Medicare Part A?
This is considered Original Medicare and is used to cover the cost of your inpatient care, such as the need to stay at a hospital, be admitted into a nursing facility or receive hospice care. It will also cover home health care services. Medicare Part B.
Why is Medicare Advantage so popular?
Medicare Advantage gives you more options because you are able to be insured by a private company instead of the government. You can also add options to your plan that are not available with traditional Medicare plans.
Does Medicare Supplement cover coinsurance?
A Medicare Supplement plan can help cover coinsurance or copay costs, as well as certain other Medicare out-of-pocket costs. Medicare Advantage is almost as popular as Medicare Part A and B in Pennsylvania. In 2020, about 1.2 million residents enrolled in an Advantage plan compared to 1.5 million who enrolled in traditional Medicare coverage.
How many Medicare Advantage plans are there in Pennsylvania?
And if you decide Medicare Part C is an attractive coverage option for you, you likely enjoy choice in your selection of Medicare Advantage plans. There are 220 Medicare Advantage plans available statewide. In addition, 26 Medicare Prescription Drug Plans are available in Pennsylvania.
How old do you have to be to get Medicare in Pennsylvania?
Original Medicare in Pennsylvania. You are eligible for Original Medicare if you are 65 years old or older and either an American citizen or a permanent legal resident who has lived in the United States at least five continuous years.
What happens if you select a Medicare Advantage HMO?
If you select a Medicare Advantage HMO, you will choose a primary care physician who provides or coordinates your care and may refer you to other participating providers . Except for emergencies, out-of-network providers’ services are not covered unless approved in advance by the Medicare Advantage HMO plan.
What is Medicare Part A?
Medicare Part A covers inpatient hospital care, inpatient skilled nursing care (for circumstances such as nursing care in transition from inpatient hospital care to home), some home health care, and hospice care. Complementing Part A, Medicare Part B covers outpatient services, including lab tests, doctor visits for diagnosis and treatment of illnesses, injuries, and preventive care. Medicare Part B also covers durable medical equipment and some home health care.
What is Medicare Supplement?
Medigap (Medicare Supplement) insurance is also offered by private insurance companies. These insurance plans can help you pay for certain out-of-pocket costs not covered under Original Medicare.
What is the Pennsylvania Department of Aging?
Pennsylvania Department of Aging – This state office offers a wide range of information and services designed to improve the quality of life and independence for seniors living in the state. Assistance with Medicare plans in Pennsylvania is available through the following programs:
What are the components of Medicare?
Let’s start by looking at the components that comprise Medicare coverage. Medicare includes Part A, Part B, Part C, and Part D.
How does Medicaid provide financial assistance to Medicare beneficiaries in Pennsylvania?
Many Medicare beneficiaries receive Medicaid’s help with paying for Medicare premiums, affording prescription drug costs, and covering expenses not reimbursed by Medicare – such as long-term care.
What would happen if Pennsylvania didn't expand Medicaid?
If Pennsylvania had not opted to expand Medicaid, the state would have lost out on $37.8 billion in federal funding over the next ten years.
How do I enroll in Medicaid in Pennsylvania?
Medicaid is called Medical Assistance in Pennsylvania. You can apply online, by phone, or by mail, fax, or in person .
How many states have not changed their Medicaid eligibility guidelines?
Then in 2012, the Supreme Court ruled that states could not be penalized for choosing to not expand Medicaid, and 19 states have not yet changed the eligibility guidelines for their Medicaid programs.
What percentage of FPL is eligible for medicaid?
Eligibility: Adults with income up to 138 percent of FPL are eligible for Medicaid. Children in households with incomes up to 319% of FPL are eligible for Medicaid or CHIP.
How many people were in the Pennsylvania health insurance coverage gap in 2014?
For adults, the change in eligibility rules was particularly beneficial for those with household incomes below 100 percent of poverty. In 2014, approximately 281,290 Pennsylvania residents – roughly a quarter of the state’s uninsured adult population – were in the coverage gap and had no realistic access to health insurance. That changed in 2015 when Medicaid became available for them.
What is the poverty level for Medicaid in Pennsylvania?
Since January 1, 2015, all legally present non-disabled adults under age 65 in the Commonwealth of Pennsylvania – parents or not – are eligible for Medicaid with household incomes up to 138 percent of poverty, as long as they meet Medicaid’s immigration requirements. Children are still eligible for Medicaid or CHIP if their household income doesn’t exceed 319 percent of poverty level.
When did Pennsylvania expand Medicaid?
Pennsylvania Medicaid Expansion Update. The state of Pennsylvania expanded Medicaid under the ACA in 2015. Nearly 700,000 people are covered under Pennsylvania’s Medicaid expansion. Medicaid expansion has played a significant role in the declining uninsured rate in Pennsylvania.
How many people are covered by Medicaid in Pennsylvania?
As of 2020, the program, along with the Children’s Health Insurance Program (CHIP) covered 3.2 million people. This includes about 1.5 million children as shown by the image below.
What does Medicaid Cover in Pennsylvania?
Pennsylvania Medicaid covers a variety of medical services. However, the type and amount of services depends on the age of the beneficiary, the type of Medicaid program in which the beneficiary is enrolled.
What is Medicaid?
Medicaid is a federal and state health insurance program for people with a low income.
What do you need to do after applying for medicaid in Pennsylvania?
After you submit your Pennsylvania Medicaid application, you may be required to attend an interview with a Department of Human Services (DHS) caseworker.
Is Medicaid available in Pennsylvania?
There are several Medicaid programs that people in Pennsylvania can be eligible for. Each program has its own income and asset requirements.
Does Medicaid cover dental care in Pennsylvania?
Medicaid in Pennsylvania covers all medically necessary dental services for enrolled children. This includes teeth cleaning, x-rays, cavity fillings, crowns and other services.
When did Medicare become law?
In the summer of ‘65, President Lyndon Johnson signed Medicare into law, establishing the age of eligibility at 65. The eligibility age for Medicare remains the same to this day.
When do you get Medicare?
Some people automatically get Medicare at age 65, but those numbers have declined as the Medicare and Social Security ages have continued to drift apart.
Why do people not get Medicare at 65?
These days, fewer people are automatically enrolled in Medicare at age 65 because they draw Social Security benefits after 65. If you do not receive Social Security benefits, you will not auto-enroll in Medicare.
What is the age limit for Medicare?
Most older adults are familiar with Medicare and its eligibility age of 65. Medicare Part A and Medicare Part B are available based on age or, in some cases, health conditions, including:
How long do you have to be on Social Security to get Medicare?
Individuals under 65 and already receiving Social Security or Railroad Retirement Board benefits for 24 months are eligible for Medicare. Still, most beneficiaries enroll at 65 when they become eligible for Medicare.
How old do you have to be to get medicare?
While some specific circumstances can impact at what age you are eligible for Medicare, most people must wait until 65 as things currently stand.
Does Medicare Part B have a premium?
While Medicare Part B has a standard monthly premium, 99 out of 100 people don’t have to pay a premium for Medicare Part A. Still, no part of Medicare can genuinely be called “free” because of associated costs you have to pay, like deductibles, coinsurance and copays.
What is SSI age?
Individuals who are aged (age 65 and older), blind and disabled. (Identified for Medical Assistance purposes as SSI-related)
What is the SSN for medical assistance?
Identity — Identity can be verified by a driver's license, state identification card or another piece of identification. Social Security Number (SSN) — A SSN must be provided for each person applying for Medical Assistance. County Assistance Office staff will help you apply for an SSN for anyone who does not have one.
How is medical assistance determined?
Medical Assistance eligibility is determined using income and household size in comparison to income limits. Age and disability are also factors in determining which income limits apply. (Income limits for the various eligibility groups are listed below.) Examples of income counted in determining eligibility include:
Who determines who is mandatory in the County Assistance Office?
Household Composition — County Assistance Office staff will determine who are mandatory or optional budget group members in the Medical Assistance application based upon household relationships and individual needs for Medical Assistance.
Does Pennsylvania require residency?
There is no requirement regarding the length of time that a person must live in Pennsylvania.
Do medical assistance groups have resource limits?
Some Medical Assistance eligibility groups have resource limits. The charts below provide specific details:
When did Medicare start providing prescription drugs?
Since January 1, 2006, everyone with Medicare, regardless of income, health status, or prescription drug usage has had access to prescription drug coverage. For more information, you may wish to visit the Prescription Drug Coverage site.
How long do you have to be on disability to receive Social Security?
You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months. ( Note: If you have Lou Gehrig's disease, your Medicare benefits begin the first month you get disability benefits.)
Summary
- 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, in a nursing home or in assisted living. Make note, M...
Healthcare
- There are several different Medicaid long-term care programs for which Pennsylvania seniors may be eligible. These programs have slightly different eligibility requirements and benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that Pennsylvania offers multiple pathways towards eligibility.
Participants
- 2) Medicaid Waivers / Home and Community Based Services (HCBS) Limited number of participants, which means there may be waitlists to receive services. Provided at home, adult day care, or in assisted living.
Programs
- 3) Regular Medicaid / Aged Blind and Disabled is an entitlement (fulfilling the eligibility requirements ensures one will receive assistance) and is provided at home or adult day care. Eligibility for these programs is complicated by the facts that the criteria vary with marital status and that Pennsylvania offers multiple pathways towards eligibility. The table below provides a q…
Components
- Countable assets include stocks, bonds, investments, and 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. However, there is an exception. If t…
Ownership
- For married couples, as of 2019, the community spouse (the non-applicant spouse) can retain half of the couples joint assets up to a maximum of $126,420, as the chart indicates above. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA). If the couples total assets are $25,284 or less, the community spouse is entitled to 100% of it.
Qualification
- For Pennsylvania residents, 65 and over who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
Example
- Unfortunately, the Medically Needy Pathway does not assist one in spending down extra assets for Medicaid qualification. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above program cannot assist one in spending down extra assets. However, one can spend down assets by spending excess assets on non-countabl…
Issues
- 2) Medicaid Planning the majority of persons considering Medicaid are over-income or over-asset or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Benefits
- 2) Services My Way This program provides many of the same benefits as the PDA Waiver, but allows beneficiaries to choose their own care providers. Some family members can be hired as care providers.