Health Insurance Basics
How to Apply for Medicaid
First, you’ll need to determine if you’re eligible. You can ask yourself these questions:
- Do you live below the poverty line? The exact amount varies depending on how many people are in your household, but could be $12,140 for a household of one or $25,100 for a family of four.
- Are you aged 65+ AND blind or disabled?
- Do you have children under the age of 21?
- Do you have a temporary disability, are aged 59-64, have a limited income or are impacted by the following special circumstances?
- Undergoing drug and alcohol treatment
- Victims of domestic violence
- Caring for a child or disabled person
- Special Medical Assistance conditions
If the answer is yes, you may qualify for Medicaid. Check for sure through the COMPASS website: https://www.compass.state.pa.us/Compass.Web/Screening/SystemCompatibility?Origin=DoIQualify
Once you’ve confirmed that you are eligible for Medicaid, gather the necessary information to fill out the application:
- Proof of age (this includes your birth certificate or driver’s license)
- Proof of U.S. citizenship or alien status
- Proof of all sources of income (this includes your pay stubs, tax returns, Social Security benefits, Supplemental Security Income, Veterans Benefits, retirement accounts and any other source of income you might have)
- Proof of disability (this is necessary if you think you’re qualified because you’re disabled)
- Proof of residence (you’ll need receipts or a statement from your landlord if you rent, or a copy of your mortgage if you own your home)
- Proof of other insurance, if you have it
There are two ways that you can apply for Medicaid:
- You can apply through the federal Health Insurance Marketplace: https://www.healthcare.gov/create-account
- Or you can apply directly through COMPASS, the state Medicaid agency: https://www.compass.state.pa.us/Compass.Web/AFS/SystemCompatibility?Origin=Apply%20for%20Any%20Benefits
The state must respond to your Medicaid application within 45 days (or 90 days if you’re applying under disability coverage). If your application isn’t approved, you do have the right to appeal.
Gateway Health offers Medical Assistance (Medicaid) managed care plans for those eligible and in need. If you need help getting started, we offer the resources to get the most out of your Medicaid coverage. Visit the website here: https://www.gatewayhealthplan.com/medicaid/member-tools or contact the below phone numbers:
MEDICAID MEMBER CONTACT INFORMATION
Toll Free Numbers
Member and Provider Services 1-800-392-1147
Family Health Council 1-800-532-9465
Health Choices 1-800-440-3989
8:00 AM – 8:00 PM Eastern Time
7 Days a week from October 1 through March 31.
*From April 1 through September 30 our business hours are 8 a.m. – 8 p.m., Monday through Friday.