Please feel free to add or edit resources or to comment on your experiences using the resources listed by using the comments function underneath each section. This site is meant to be a community resource. Our hope is that we can support each other in being active, informed healthcare consumers.
LOST ADULTBASIC? SEE RESOURCES HERE:
http://bewellpgh.org/category/lost-adultbasic/
PA HEALTH LAW PROJECT QUICKSCREEN
Answer a few questions to find out if you may be eligible for free or low-cost health care:
http://www.phlp.org/quickscreen-questionnaire
MEDICAL ASSISTANCE
Consumer Health Coalition at 412-456-1877 can help with filling out medical assistance forms and navigating that system. Pennsylvania Health Law Project has some very useful information on Medical Assistance in their health care guide at www.phlp.org. Call them for legal assistance at 1-800-274-3258.
The best way to know if you qualify for medical assistance is to apply. Some programs e.g. Charity Care programs at hospitals, require you to apply for and be turned down for medical assistance before they will consider you for their programs. To apply, call your local County Assistance Office for an application. The Allegheny County Assistance Office can be reached at 412-565-2146. For the phone number for the County Assistance Office in other counties, look in the Blue Pages of your local phone book under State Government and then under Public Welfare Department.
You can also apply online for medical assistance (as well as food stamps, cash benefits…) through the COMPASS website at:
http://www.compass.state.pa.us
MEDICAL ASSISTANCE for WORKERS with DISABILITIES (MAWD)
What is MAWD?
Medical Assistance for Workers with Disabilities (also called “MAWD”) is a health insurance program for individuals who are disabled and who are working. Persons who are accepted into this program get full Medical Assistance benefits, including full prescription coverage, by paying a monthly premium of 5% of their countable income. MAWD can be your only insurance (if you have no coverage now), or it can be a secondary insurance (if you are already on Medicare or have some coverage through your job but it does not cover all your health care needs).
Who is Eligible for MAWD?
Persons who:
- are ages 16 through 64 and
- have an illness or condition that meets Social Security’s definition of “disability” which you can show by either
1. being a recipient of Social Security disability benefits (SSDI), or
2. submitting medical records to Medical Assistance so that they can find you disabled
and
- are working and earning wages and
- have countable income less than 250% of the federal poverty guidelines (see next page) and
- have countable assets valued at less than $10,000
Workers with a Medically-Improved Disability (who are no longer receiving SSDI) are also eligible but they must first have been on MAWD as a Worker with a Disability under the above criteria.
Do I Need to Work a Certain Number of Hours to Get MAWD?
No. There is no minimum requirement for how many hours you must work or how much you must earn. You could work just a few hours a month and still qualify! Remember, though, you must be paid for your work and you must be able to provide written verification of your wages to DPW.
Does Social Security Allow Me To Work if I Am Getting SSDI?
Yes, you can work and still get SSDI as long as you continue to be disabled. Social Security provides a “trial work period” of 9 months (not necessarily consecutive) during which you can receive full SSDI benefits regardless of how much you earn. Each month that you earn more than $720 counts as one trial work month. At the end of the trial work period, you can receive SSDI for another 36 months as long as you earn less than $1000 monthly. In 2011, $1000 is the amount SSA considers to be “substantial gainful activity”.
What Does Countable Income Mean?
DPW will ask you to report all of your income when you apply – including gross wages, disability benefits, income from investments, as well as your spouse’s income (whether or not he or she is applying for MAWD). Some of your income will not be counted.
For example, from your earnings DPW will:
- not count the first $65 and
- not count half of the remainder and
- deduct your impairment-related work expenses and any transportation costs you have going to and from work.
After DPW subtracts all disregards and deductions from your total income, the amount that is left is your countable income. To get MAWD your countable income must be less than 250% of the federal poverty guidelines (f.p.g.) for a household of your size.
Household Size 250% f.p.g.
1 $2269.00 a month
2 $3065.00 a month
How Does the Premium Work?
Your premium is what you must pay every month to receive MAWD. If your countable income meets the income limit for your household size, then DPW will determine your premium based only on your countable income (here your spouse’s income will not count). You will be required to pay a monthly premium of 5% of your countable income.
Example: if your countable monthly income is $1000, your monthly premium will be just $50!
You can pay your premium directly to DPW or do it through a payroll deduction (if your employer is willing).
What Assets Count?
Assets are things like property or bank accounts. DPW will look at your and spouse’s total assets. Some things will not be counted – your home and one motor vehicle, for example. Your remaining assets, including bank accounts, other vehicles, stocks, IRAs, etc. must equal no more than $10,000 to qualify for MAWD.
How Do I Apply?
Applications for MAWD are made through the County Assistance Office (CAO) nearest to you. You can call and ask them to mail you a MAWD application. Once you have filled it out, you can mail your application (along with the documents they request) or take your materials directly to your local CAO. If you are already on Medical Assistance under a different program (i.e. a spenddown) and want to be considered for MAWD, you should talk to your caseworker about how to change over to this new program. You can also apply online at www.COMPASS.state.pa.us
If you have questions about MAWD, or if you are denied and want help with an appeal, you can call the PENNSYLVANIA HEALTH LAW PROJECT for free advice or assistance at 1-800-274-3258.
© PENNSYLVANIA HEALTH LAW PROJECT February, 2011
PA FAIR CARE – HEALTH INSURANCE FOR PEOPLE WITH PRE-EXISTING CONDITIONS
From PA Health Law Project Sept 2010 Newsletter:
The Pennsylvania Insurance Department reports that it has approved 1700 applications for October 1st enrollment in PA Fair Care, and that it is still enrolling eligible individuals. PA Fair Care is the health insurance program for uninsured adults with pre-existing conditions. It is operated by the state and funded by the Affordable Care Act, the federal health care reform legislation enacted earlier this year. The program has a monthly premium of $283.20 per month and has certain co-pays and co-insurance. To qualify for PA Fair Care, an individual must (i) have been uninsured for at least six months, (ii) have a qualifying pre-existing condition, and (iii) be a citizen or national of the United States, or lawfully present in the United States.
As we discussed in the July issue of Health Law PA News, funding is limited for PA Fair Care and the state will initially limit enrollment to 3500 individuals and later expand to approximately 5600 individuals. Applicants are enrolled on a first-come, first-served basis.
For more information or to apply, visit www.PAFairCare.com or call 1-888-767-7015.
CHIP – PA CHILDREN’S HEALTH INSURANCE PROGRAM
1-800-986-543
http://www.chipcoverspakids.com/
CHIP covers all uninsured kids and teens up to age 19 who are not eligible for Medical Assistance. No family makes too much money for CHIP because there is no income limit.
Coverage is free for families that meet income requirements.
Income and premium table is here (or call number above for this info):
http://www.chipcoverspakids.com/assets/media/pdf/income_chart.pdf
Children of single parents who make under $21,780 are eligible for free coverage, doctor’s visits, prescriptions, specialist and ER visits. Premiums where the parent/s make more than this generally range from $43 to $70 per month per child, with $5 doctor visit copays, $6-9 for prescription copays, $25 for an ER visit copay.
HIGHMARK BLUE CROSS BLUE SHIELD SPECIAL CARE
1-866-442-8235
“If you are an adultBasic member who lost adultBasic coverage on February 28, 2011, and you want to enroll in SpecialCare under the special offer for adultBasic members ONLY, please call 1-800-544-6679. This phone number is only for adults who lost coverage in adultBasic”
Basic health coverage for those who meet income requirements.
Maximum Income* 1 family member – $21,780 2 family members – $29,420 3 – $37,060 4 – $44,700 5 -$52,340
Monthly Premiums:
| Individual | Parent & Child | Parent & Children |
| $162.00 | $241.30 | $320.75 |
| Husband & Wife | Two Parents & Child* | Two Parents & Children* |
| $324.00 | $403.30 | $482.75 |
SpecialCare covered benefits include:
- 4 doctor visits each year for preventive care, illness or injury with a copayment per visit
- Emergency care with a copayment per visit
- 21 inpatient hospital days per benefit period (90 days must elapse before the benefit period resets and another 21 days are available)
- Outpatient surgery
- Maternity care
- Newborn care (first 31 days from birth*)
- Diagnostic testing and lab work
- Preventive care including annual routine mammogram, gynecological exam and Pap test, pediatric immunizations, pediatric care and adult care
- Vision exam once every 24 months and a 50% discount on eyewear
SpecialCare does not include a prescription drug plan but does offer discounts on prescription drugs that members buy at participating Premier-Gold network pharmacies.
Covered services are paid-in-full when performed by SpecialCare participating doctors and hospitals.
SpecialCare does not require the completion of a medical questionnaire.
This health care program may not cover all of your health care expenses. Read your contract carefully to determine which health care services are covered.
*To continue coverage beyond the first 31 days from birth, you must apply for newborn coverage as a dependent or as an individual within the initial 31-day period in order for the pre-existing condition waiting period to be waived.
HEALTH INSURANCE FOR PENNSYLVANIA RESIDENTS
Information for consumers on insurance in PA. Terms, tips, etc. You can also file a complaint against a PA insurance provider on this site.
HEALTHINSURANCE.ORG
Provides info and offers quotes on various health insurance plans. Does not include Highmark Blue Cross Blue Shield plans.
http://www.healthinsurance.org/
GLOSSARY OF HEALTH INSURANCE TERMS
