Health Options



HEALTH CARE SAFETY NETS FOR PENNSYLVANIANS:

 

For you or your family:

Young adult children - Pennsylvania law allows uninsured, single adults, up to age 30, who either live in Pennsylvania or are full-time students, to continue receiving coverage and care through their parents’ employer-based health plans (if the employer chooses to offer that coverage).

 

CHIP -- the Children’s Health Insurance Program -- covers children and teens up to age 19 who don’t have family health insurance and are not eligible for Medical Assistance. Comprehensive coverage is available for free, low-cost or full cost depending upon family size and income. Visit www.chipcoverspakids.com.

 

Medical Assistance - You may apply for health care coverage at www.compass.state.pa.us to see if you qualify for Medical Assistance (MA). Visit that website and click on “Do I Qualify?” to find out if you may be eligible or call the PA DPW Helpline at 1-800-692-7462.

 

PA Fair Care - PA Fair Care is Pennsylvania’s health insurance program for uninsured people with pre-existing medical conditions. To be eligible, the federal Affordable Care Act says you must be uninsured for six months and have a pre-existing condition. For information of PA Fair Care visit www.PAFairCare.com or call 1-888-767-7015.

 

Medicare - If you have turned 65, are disabled or meet other eligibility requirements, you may qualify for Medicare. For more information, go to www.medicare.gov or call the PA Department of Aging’s Apprise counselors at 1-800-783-7067.   

 

Guaranteed Issue and SpecialCare Health Insurance - Pennsylvania’s Blue Cross and Blue Shield plans cannot turn away any health insurance applicant. Additionally, they offer SpecialCare, a subsidized health insurance plan for individuals and families. 

 

For more information contact the plan that provides services in your county.

 

·         Blue Cross of Northeastern Pennsylvania, 1-800-829-8599 http://www.bcnepa.com/ohpSpecialCare.aspx

·         Capital BlueCross, 1-800-962-2242 https://www.capbluecross.com/OpenEnrollment/Individual/SpecialCare

·         Highmark Blue Cross Blue Shield (Western PA)1-800-544-6679, TTY 1-800-452-8086  www.highmarkbcbs.com/SpecialCare

·         Highmark Blue Shield (Central PA)1-877-986-4571, TTY 1-800-562-0591 www.highmarkblueshield.com/SpecialCare

·         Independence Blue Cross1-866-282-2702, TDD/TTY: 215-241-2622 http://www.ibx.com/health_plans/low_income/special_care.html

Prescription Drug Assistance:

PACE, PACENET and PACE plus Medicare are Pennsylvania's prescription assistance programs for older adults, offering low-cost prescription medication to qualified residents, age 65 and older. For information, call 1-800-225-7223 or visit www.aging.state.pa.us.

 

Prescription Drug Financial AssistancePennsylvanians who do not participate in any other state or federally funded prescription program may be able to receive free or low-cost prescription drug assistance. Call 1-800-955-0989 for The Pennsylvania Patient Assistance Program Clearinghouse or go to www.aging.state.pa.us, “Prescription Assistance” and “Other Pharmaceutical Programs.” The Clearinghouse will help you apply for free or low-cost prescription medicines available from drug manufacturing companies and other sources.

 

Special Pharmaceutical Benefits Program—Mental Health—This program provides prescription drug assistance to individuals with schizophrenia who do not respond to first-line drug therapies and who are not eligible for pharmaceutical coverage under the MA Program. For more information go to www.dpw.state.pa.us – click on “For Adults,” then Health Care.

 

Special Pharmaceutical Benefits Program—HIV/AIDS—This program provides pharmaceutical assistance and specific lab services for low to moderate income individuals living with a diagnosis of HIV/AIDS who are not eligible for pharmacy services under the Medical Assistance (MA) Program. Applicants must be a resident of Pennsylvania, have a gross annual income of less than or equal to 337 percent of the Federal Poverty Level, and have a diagnosis of HIV/AIDS to qualify for the program. SPBP-HIV/AIDS is the payer of last resort, and third party resources must be used before payment is made by the program. For more information go to www.dpw.state.pa.us – click on “For Adults,” then Health Care.

Services for Women:

SelectPlan for Women—Pennsylvania’s SelectPlan for Women is free, confidential health insurance for women between the ages of 18 and 44 that pays for family planning services and related preventive health screens provided by participating health care professionals. Family planning-related prescriptions are free at any participating pharmacy. For more information and to see if you are eligible, call 1-800-842-2020 or go to www.selectplanforwomen.com.

 

HealthyWoman Breast and Cervical Screening Program (HWP)—HWP offers breast and cervical exams at no cost for eligible women. These exams include mammograms, clinical breast exams, pelvic exams and Pap tests. You qualify if you are 40 to 64 years old; have limited or no insurance; and have low to moderate household income. For more information and to find the HWP check-up site near you, call 1-800-215-7494 or go to www.pahealthywoman.org.

 

Breast and Cervical Cancer Prevention and Treatment Program (BCCPT)—If you have been diagnosed with breast or cervical cancer or a pre-cancerous condition of the breast or cervix, you may be eligible for free health insurance for women through BCCPT. The care covers breast or cervical cancer treatment, as well as any other unrelated conditions while receiving your cancer treatment. You qualify if you are female; under age 65; meet the income requirements; and have limited or no insurance. For more information, call 1‑800-215-7494 or visit www.dpw.state.pa.us for more information.

 

Pregnancy/High-Risk Pregnancy (Healthy Beginnings/Healthy Beginnings Plus)—If you are pregnant, you may be eligible for Healthy Beginnings or Healthy Beginnings Plus—free programs that provide comprehensive maternity health insurance coverage to pregnant women and their babies for a full year. Call 1-800-842-2020 or www.dpw.state.pa.us for more information on how to apply and for locations near you.

Other Services and Programs:

Community Health Centers - There are about 200 community health centers across the state that provide free or low-cost comprehensive, high quality medical health care for all ages on an ability-to-pay basis. In some locations, a full range of services such as dental care and prescription drugs may be available. Services may be free or low-cost, based on your household income. To find the health centers nearest you, call the PA Association of Community Health Centers, Monday through Friday, 8:30 a.m. to 5 p.m., at 1-866-944-CARE (2273), or go to www.pachc.com for a list of centers.

 

Financial Assistance with Hospital Bills - Most hospitals offer financial assistance for uninsured patients who need treatment but cannot afford to pay their bills. Patients who qualify will have their bills reduced or eliminated. If you have hospital bills that you cannot afford to pay, call the hospital’s billing department and ask how you may apply for financial assistance.

 

Health Coverage Tax Credit—The Health Coverage Tax Credit (HCTC) was created to help pay for private health insurance for displaced workers receiving certain Trade Adjustment Assistance (TAA) benefits and individuals receiving benefits from the Pension Benefit Guaranty Corporation (PBGC). HCTC is a tax credit that covers 72.5 percent of the premium amount paid by eligible individuals for qualified health insurance coverage. For more information, call the HCTA Customer Contact Center’s toll-free number at 1-866-628-HCTC (4282) or go to http://www.irs.gov/individuals/article/0,,id=187948,00.html.

 

Medical Assistance for Workers with Disabilities (MAWD)—MAWD is a health insurance program for working individuals with a disability. There is no set requirement for how many hours you must work or how much you must earn, but you must work and receive wages to qualify. For more information, call 1-800-692-7462 or go to www.dpw.state.pa.us and type in “MAWD” in the Site Search box in the top right corner, then click on the first link to “Medical Assistance Benefits for Workers with Disabilities.”

 

Special Kids Network System of Care (SKN/SOC)—The mission of the Special Kids Network System of Care is to improve access to services, provide comprehensive information for those seeking to identify services, and to foster the improvement or development of local services for children with special health care needs and their families. The SKN/SOC helpline connects individuals to resources and programs specific to their needs by making access to these resources easier for Pennsylvania families and providers. For more information, call 1-800-986-4550 or go to the Special Kids Network via the PA Department of Health web portal.

 

Safety Net Dental Clinics—Safety net clinics are most often non-profit, community-sponsored dental clinics that usually see patients without other access to dental care.  These are usually low-income people who can't afford dental care, or are patients on public insurance who cannot find a private dentist willing to see them.  The dental treatment is either done for free or a sliding scale is offered.  Each program has its own limitations and availability of appointments, so call first to find out the specifics of a clinic near you. Visit www.padental.org to identify nearby clinics in your county. 

 

Mental Health Treatment – Mental Health services are administered through county MH/MR program offices.  The county MH/MR office determines a person’s eligibility for service funding, assesses the need for treatment or other services, and makes referrals to appropriate programs to fit treatment and/or other service needs.  For a list of county MH/MR office locations and contact information visit MH/MR Program Administrators Association of Pennsylvania at: www.mhdspa.org.