How to Get Medicaid Coverage for You & Your Family | Health Insurance Basics

Health Insurance Basics

Medicaid 101 – How to Get You & Your Family Covered

Medicaid is a  health insurance program for low-income adults, pregnant women and children. It provides people access to needed health care and medical care.

It covers a range of people who are eligible to receive federally-assisted income. Medicaid has helped millions of Americans by improving access to preventive and primary care, as well as caring for and protecting against serious diseases.


Before you apply, ask yourself if you fit into one of these categories:

  • Adults age 19-64 with incomes at or below 133% of the Federal Income Poverty Guidelines. 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.

  • Individuals aged 65 and older, blind and disabled.

  • Families with children under age 21.

  • Single and married individuals with a temporary disability, age 59 – 64, limited income or special circumstances such as:
    • Undergoing drug and alcohol treatment
    • Victims of domestic violence
    • Caring for a child or disabled person
    • Special Medical Assistance conditions


Medicaid programs are established and administered by States. They determine the type, amount, length of and scope of services. These must fall within broad federal guidelines. Federal law requires certain mandatory benefits, including:

  • Doctor visits
  • Inpatient and outpatient hospital services
  • Mental health services
  • Medications
  • Prenatal and maternity care
  • Preventative care, like immunizations, colonoscopies and mammograms


For a full list of benefits click here:

Learn More


Keep in mind that Medicaid is different than Medicare. Medicaid is a state and federal program that provides coverage for low-income individuals and families. Medicare is a federal program that provides coverage for people 65 and older or have certain disabilities. A person can be eligible for both Medicaid and Medicare. These programs can work together to provide comprehensive healthcare coverage.

If you’re ready to apply, visit the PA Compass website here.

Gateway Health Offers Medical Assistance (Medicaid) managed care plans for those eligible and in need. As a member, you’ll have the right to choose your primary care provider (PCP) and pharmacy to participate in programs that help you stay healthy.


Toll Free Numbers

Pennsylvania 1-800-685-5209

Ohio: 1-888-447-4505

North Carolina: 1-855-847-6430

TDD/TTY: 711


8:00 AM – 8:00 PM Eastern Time

7 Days a week from October 1 through March 30.

*From April 1 through September 30 our business hours are 8 a.m. – 8 p.m., Monday through Friday.

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