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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
CHIP
AdultBasic
adultBasic was launched in 2002 to cover the basic healthcare needs of Pennsylvanians age 19-64 who have no health insurance and who meet certain eligibility requirements.
The adultBasic Program is designed to provide basic insurance benefits, including:
- Hospitalization (unlimited days)
- Physician Services (primary care and specialists)
- Emergency Services
- Diagnostic Tests (e.g. x-rays, mammograms and laboratory tests)
- Maternity care
- Rehabilitation and skilled care (in lieu of extended hospitalization)
Any costs/co-pays involved?
A monthly premium of $30.00 must be made prior to enrollment and each month thereafter for coverage to continue.
Modest co-pays for certain benefits are required. They are:
- Doctor Visit- $5.00
- Emergency Room-$25.00 (waived if admission occurs)
- Specialists – $10.00
Participation in the adultBasic Program is based on certain eligibility requirements, which include:
- You are between the ages of 19 and 64;
- You do not have any other healthcare coverage (including Medicaid or Medicare;
- You have been without health insurance for 90 days prior to enrollment, except if you or your spouse lost health insurance coverage because you are no longer employed;
- Your family income is below certain income limits (see table below)
- You are a resident of Pennsylvania for at least 90 days prior to enrollment; and
- You have U.S. citizenship or permanent legal alien status.
Maximum Income* 1 family member – $21,660 2 family members – $29,140 3 – $36,620 4 – $44,100 5 -$51,580
* based on 2009 Federal Poverty Income Guidelines
How Do I Apply to the adultBasic Program?
Option 1. Apply via the web. www.compass.state.pa.us COMPASS is the Commonwealth of Pennsylvania Access to Social Services. The secure, online application process is accessible 24 hours a day, seven days a week.
Option 2. Apply over the phone. Call 1-800-GO-BASIC and our counselors will start the application process for you over the phone.
Option 3. Apply through the mail! Call 1-800-GO-BASIC to receive a paper application that can be returned in an enclosed postage-paid envelope.
Since there is a waiting list for the adultBasic Program – THE WAIT FOR ADULTBASIC CAN BE VERY LONG – this insurance can be purchased while you wait for approximately $320 per month. (Note – see Special Care information below).
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.
http://www.ins.state.pa.us
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
http://www.cahi.org/cahi_contents/consumerinfo/glossary.asp
HIGHMARK BLUE CROSS BLUE SHIELD SPECIAL CARE
Low-cost, basic health coverage for those who meet income requirements. Information is very difficult to find online, call for information: 1-800-876-7639.
Maximum Income* 1 family member – $21,660 2 family members – $29,140 3 – $36,620 4 – $44,100 5 -$51,580
Monthly Premiums:
| Individual |
Parent & Child* |
Parent & Children* |
| $134.70 |
$200.65 |
$266.65 |
|
| Husband & Wife |
Two Parents & Child* |
Two Parents & Children* |
| $269.30 |
$335.30 |
$401.30 |
Does not cover prescriptions or mental health care. 12-month pre-existing condition clause. No deductible. $10 copy per doctor visit, covers 4 visits per year, covers emergency care, 21 days inpatient hospital stay, maternity care. Call for additional info.
GREATER PITTSBURGH ARTS COUNCIL’S HEALTH COVERAGE FOR THE ARTS
http://pittsburghartscouncil.org/healthcare.htm
The Greater Pittsburgh Arts Council is proud to announce the arrival of health coverage for local individual artists, part-time or seasonal employees of local cultural organizations and full-time employees of small cultural organizations currently unable to offer coverage. This is not a traditional health insurance program, but a limited benefit medical plan that was designed based on input from the arts community about desired benefits and pricing. All eligible Arts Council members qualify for the plan. You can’t be turned down for coverage, and there are no medical questions to answer.
The HM Care Advantage plan, underwritten by HM Life Insurance Company, starts at under $60 a month. The plan offers three tiers of coverage that include benefits for physician office visits, annual wellness tests and screenings, ambulance and emergency room coverage, and discounts for pharmacy, vision, fitness and wellness products and services. Some plans also include an additional critical illness component.
