Health Insurance (Updated 6/2017)

Affordable Care Act (ACA)

What is it?
The ACA expands Medicaid coverage to millions of low-income Americans and makes numerous improvements to both Medicaid and the Children's Health Insurance Program (CHIP), allowing for an increase in the quality and affordability of health insurance in America. Applicants must enroll within the yearly Open Enrollment Period.

The Health Insurance Marketplace is a resource where individuals, families, and small businesses can learn about their health coverage options; compare health insurance plans based on costs, benefits, and other important features; choose a plan; and enroll in coverage. The Marketplace also provides information on programs such as Medicaid and CHIP.

Do I qualify?
You qualify for Marketplace based on your family size and income. You can see income and family size guidelines here. Due to Healthy PA Medicaid Expansion, if you have low or no income, you may qualify for Medicaid - even if you've been denied in the past. Certain life changes, like getting married, having or adopting a child, moving out of your current plan's service area, or losing job-based coverage, give you a Special Enrollment Period to get a plan in the Marketplace.

You can call Pennsylvania Health Access Network's (PHAN) enrollment specialists for questions at (1-877) 570-3642.

How do I apply?
You must apply during the Open Enrollment Period, unless you have a qualifying life change. You can apply for Marketplace health coverage online, by phone (1-800 318-2596 / TTY: 1-855 889-4325), with a paper application, or with the help of a trained assister in your community.


The Breast and Cervical Cancer Prevention and Treatment Program (BCCPT)

What is it?
If you have been diagnosed with breast or cervical cancer, you may be eligible for free treatment through BCCPT, a program administered by the Department of Human Services. Women can receive free healthcare (except for nominal copayments), including care for medical needs unrelated to cancer, throughout their course of treatment for cancer or a pre-cancerous condition of the breast or cervix.

Do I qualify?
To be eligible, you must be a woman under 65 living in Pennsylvania who is a U.S. citizen or an eligible alien.
You must also have been screened and diagnosed under the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program and be uninsured or have no creditable insurance.


How do I apply?
Call the HealthyWoman Program at 1-800-215-7494. The HealthyWoman Program, administered by the Pennsylvania Department of Health, provides free services for low income, uninsured, or underinsured women such as:

  • Clinical breast examination
  • Mammogram
  • Pelvic examination and pap smear
  • Follow-up diagnostic care for an abnormal result 


Children’s Health Insurance Program (CHIP)

What is it?
CHIP is a public health insurance program for children in Pennsylvania that covers uninsured children and teens who are not eligible for or enrolled in Medical Assistance. Coverage includes immunizations, routine check-ups, prescription drugs, dental care, maternity care, mental health benefits, up to 90 days of hospitalization, durable medical equipment, substance abuse treatment, partial hospitalization for mental health services, rehabilitation therapies and home health care.
For most families, cost for CHIP coverage is free; families with incomes above the free CHIP limits will pay low monthly premiums and co-pays for some services.

Do my children qualify?
To qualify, children must be under age 19, U.S. citizens, Pennsylvania residents, uninsured, and ineligible for Medical Assistance. There are no income eligibility guidelines. Pre-existing conditions are covered.

How do I apply?
To apply, you can use the online COMPASS system or apply by mail with a paper application.


Consolidated Omnibus Budget Reconciliation Act (COBRA)

What is it?
COBRA gives workers and their families who lose their health benefits the right to choose to continue their group health plan for limited periods of time under certain circumstances.

Do I qualify?
You or your family may qualify if you were covered by a group health plan maintained by a private-sector employer on the day before a qualifying event.
Qualifying events are events that cause an individual to lose health coverage, such as termination, reduction of hours, dependent child ceasing to be dependent, divorce/legal separation, or death of the covered employee. Federal COBRA covers businesses with 20+ full-time employees, but Pennsylvania offers Mini-COBRA for small businesses (2-19 employees).

How do I apply?
Claims are filed with the individual benefits company. Contact your plan’s administrator for more information. If you have questions about COBRA or Mini-COBRA, call the PA Department of Insurance at 1-877-881-6388.


Discount Prescription Program

What is it?
The Discount Prescription Program is a free card that discounts the regular cost of most prescription and over-the-counter medicine for you, your family, and even your pets at more than 63,000 pharmacies nationwide.

Do I qualify?
Anyone can use this card, but we recommend that it be used by people without prescription coverage for the items they need and seniors in the Medicare Part D coverage gap. Check with your pharmacist for the lowest possible cost—if you already have drug coverage or other services, you cannot combine them with this card.

How do I apply?
There is no application; just visit here to get your own card.


Healthy Beginnings

What is it?
Healthy Beginnings provides Medical Assistance coverage for pregnant women and children of low income familes up to age 18.

Do I qualify?
To qualify, you must be pregnant. Your children qualify if they fall into the following income guidelines.


How do I apply?
To apply, you can use the online COMPASS system, or call your local County Assistance Office (CAO). You can also download an application form here to send to the CAO. Your doctor’s office or health clinic may also be able to provide you with a temporary eligibility form.


Family Planning Services

What is it?
A family planning service is an organization that offers contraception, testing, treatment, and counseling for sexually transmitted diseases (STDs) and pregnancy testing. They also offer breast and cervical cancer screenings.

Do I qualify?
If you are uninsured, you are charged a small fee based on family size and income. Some people can even get services for free, including those under 18.

How do I apply?
Use the chart below to find the clinic in your area.

Medical Assistance (Medicaid)

What is it?
Medicaid is health insurance that helps many people, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities who can't afford medical care, pay for some or all of their medical bills. Medicaid does not pay money to you; it sends payments directly to your health care providers.

Do I qualify?
Many groups of people are covered by Medicaid, but within these groups certain requirements must be met. The rules for counting income and resources vary from group to group. In general, you should apply for Medicaid if you have limited income and if someone in your family needs health care.

How do I apply?
To apply, you can use the online COMPASS system, or visit your local County Assistance Office (CAO). The number for the CAO office can be found in the County Help Chart.


Medical Assistance Benefits for Workers with Disabilities (MAWD)

What is it?
MAWD lets Pennsylvanians with disabilities keep their full medical coverage (Medicaid) with little cost even if their earnings increase above the limits for other Medicaid programs.

Do I qualify?
To be eligible, you must be between ages 16 and 65. You must be employed and receiving compensation, and must have a disability that meets the Social Security Administration’s standards. You cannot have more than $10,000 in countable resources (not including your home and one car).


How do I apply?
To apply, you can use the online COMPASS system, contact your local County Assistance Office (CAO), or call the Department of Human Services HelpLine at (800) 692-7462 for more information. TTY/TTD users can call (800) 451-5886.


SelectPlan for Women

What is it?
SelectPlan for Women is a free and confidential plan covering reproductive health services, birth control and family planning.

Do I qualify?
To qualify, women must be income eligible; between ages 18-44; not pregnant or sterilized; PA residents; U.S. citizens (or have satisfactory immigration status and identification) and have no, or limited, health insurance.

How do I apply?
To apply, use the online COMPASS system, download an application at www.selectplanforwomen,com or call your local County Assistance Office (CAO). The number for the CAO can be found in the County Help Chart.


PathWays PA no longer offers information on the programs PA Fair Care or Pre-existing Condition Insurance Plan (PCIP), because as of 2014 you can no longer be discriminated against based on a pre-existing condition.