Pennsylvania Medicaid Expansion: Can I Use Medicaid to Satisfy the Health Insurance Requirement?
One way to satisfy Obamacare’s health insurance requirement is to obtain coverage under Medicaid. If you qualify for Medicaid and enroll in Pennsylvania's Medicaid program, you do not have to sign up for another insurance plan.
It’s Now Easier to Qualify for Medicaid in Pennsylvania
The Affordable Care Act expanded Medicaid eligibility to cover more people who can’t afford health insurance. The U.S. Supreme Court later decided that it was up to individual states to decide whether or not to expand Medicaid.
Pennsylvania did decide to expand its Medicaid program, but it has done so in a way that differs from most states. Beginning January 1, 2015, Pennsylvania will use federal Medicaid funds to buy private health insurance coverage for low-income individuals and families. Pennsylvania residents who need health coverage and are newly eligible for Medicaid -- those who earn less than 138% of the federal poverty level -- will be able to enroll in a health plan offered by a private insurance company. (For 2017, 138% of poverty level is about $16,643 for an individual or $33,948 for a family of four.) They will not use the online health insurance exchange to get coverage.
Enrollment for the new Medicaid option, called "Healthy Pennsylvania," began December 1, 2015. There is no deadline to apply.
Those with an annual income greater than 100% of the Federal Poverty level (currently $12,060 for an individual or $48,240 for a family of four) will have to pay monthly premiums of up to 2% of household income. Those who don't or can't pay the premiums will be disenrolled from the Medicaid plan.
An estimated 500,000 low-income Pennsylvania residents will be eligible for the new Medicaid coverage. Those who qualify for Medicaid under the old Pennsylvania rules will continue to be enrolled in the traditional Medicaid program rather than a state-subsidized private insurance plan. To find out whether you're eligible, contact the Pennsylvania Medicaid office or fill out an application at HealthCare.gov.
The Medicaid Expansion Threshold: 133% or 138%?
If you have been reading about Medicaid eligibility, you may have noticed that some sources say the threshold has been raised to 133% of the federal poverty level, while others say 138%. It seems confusing, but both are true. The text of the Obamacare law says 133%, but a new way of calculating income means that the practical outcome is you will qualify if you fall below a threshold of 138%. For a full explanation, see the Affordable Care Act FAQs from the American Public Health Association.
If You Don’t Qualify for Medicaid
If you make more than 133% of the federal poverty level but your income is still low, you can investigate the health insurance plans available to you at HealthCare.gov. You will probably be eligible for cost-saving subsidies based on your income and family size.
For more information, see Ways to Save Money on Obamacare in Pennsylvania.
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