During the COVID-19 pandemic, we are facing not only a health crisis but also an economic one. This has been hard on Pennsylvania families, especially for those who have experienced loss of income through lay-offs or reduced hours leading to loss of employer-sponsored health care coverage or no longer being able to afford their current health insurance. These families may be wondering where to turn to protect their children’s – and their families’ – health and well-being. During this difficult time, we want you to know that there are health insurance options and we share the following information to help you obtain coverage.
Medicaid provides comprehensive health care coverage for approximately 1.2 million children in Pennsylvania – these include children with disabilities, children living in low-income families and children living in and aging out of foster care.
Special Note: Thanks to the federal Families First Coronavirus Response Act, there is a disenrollment freeze in Medicaid. All beneficiaries – this includes children and postpartum women beyond 60 days – enrolled in Medicaid as of March 18, 2020 remain continuous eligible during the national emergency period.
How to enroll?
- You can apply for or renew your Medical Assistance benefits online by using COMPASS. With COMPASS, you can also check your eligibility before you apply.
- You can apply by telephone for health care coverage by calling the Consumer Service Center for Health Care Coverage at 1-866-550-4355.
- You can also apply for Medical Assistance by contacting your local county assistance office.
- Or, you can download an application form to send to your county assistance office. If you need help completing the application form, a county assistance office staff member can help you. Click on the link to download an application.
Children’s Health Insurance Program (CHIP)
CHIP is available to uninsured kids regardless the level of family income. Income, as based on the federal poverty level or “FPL,” simply determines whether a child would be covered under Free CHIP or Low Cost or Full Cost CHIP with cost-sharing on a sliding scale. For most families CHIP is free which means no copays or monthly premiums. Incomes below the FPL of Free CHIP are likely eligible for Medicaid. There are nearly 200,000 children in Pennsylvania currently enrolled in CHIP.
Special Note: Premium-paying families already enrolled should contact their CHIP MCO’s immediately if they experienced a change in income (loss of job or reduced hours due to COVID-19). You may qualify for a lower or no premium payment, or even qualify for Medicaid coverage.
How to enroll?
There are three ways to apply:
- Apply online with COMPASS. The online application walks you through all the questions you’ll need to answer. Completed applications are submitted immediately and directly.
- Apply by phone via the CHIP helpline at 1-800-986-KIDS (5437) and select prompt No. 2, then prompt No. 1 for application assistance.
- Apply by mail. Download a paper application in English or download a paper application in Spanish.
Marketplace Coverage (Healthcare.gov)
During the 10 years since the passage of the Affordable Care Act (ACA), we have seen significant gains in reducing the number of Americans without health insurance – Pennsylvania is no exception. The creation of the insurance marketplace and its subsidies was among the many provisions within the ACA that propelled affordable access to health insurance. In fact, more than three-quarters of individuals enrolled in the marketplace receive financial assistance.
- While Governor Wolf is seeking a federal approval to open a COVID-19 Special Enrollment Period (SEP) for uninsured or underinsured Pennsylvanians, existing SEPs are available and include loss of employer-sponsored health coverage. The Department of Insurance is urging Pennsylvanians to seek care for COVID-19 with or without coverage.
- Thanks to the ACA, all Marketplace plans cover pre-existing conditions and can’t be terminated due to a change in health status, including diagnosis or treatment of COVID-19. Read this comprehensive FAQ about Marketplace coverage and Coronavirus.
How to enroll?
Individuals looking to purchase insurance for themselves and their families should visit healthcare.gov.
Additionally, the Pennsylvania Department of Insurance is ready to help answer any questions. Contact the department at 1-877-881-6388.