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Questions about the Healthy Plus, Healthy, and Healthy PA PCO Benefits Plans?

Public Benefits

Questions about the Healthy Plus, Healthy, and Healthy PA PCO Benefits Plans?

Date Posted: 
11/06/2014

In February 2015, Governor Tom Wolf announced that Pennsylvania would shift away from the Healthy Pennsylvania program toward more traditional Medicaid expansion.  As of September 1, 2015, all adult Medicaid, or Medical Assistance, recipients are receiving the same Adult Benefits Package, which provides comprehensive health coverage, including dental coverage and rides to doctors.  Medicaid recipients who were enrolled in a Healthy Pennsylvania Private Coverage Option health plan in 2015 have been moved to a health plan in Pennsylvania’s Health Choices system.

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On November 5, 2014, the Pennsylvania Department of Welfare (DPW) sent the following letter to adult Medical Assistance (MA) recipients in Pennsylvania, explaining upcoming changes to current health benefits:

      Here are some frequently asked questions about DPW's letter:

Q.   Why did I get this letter about my Medical Assistance?

A.   You are not going to lose your Medical Assistance (MA)!  But on January 1, 2015, DPW is going to reduce medical benefits for every adult who gets MA.  You may not be able to get all of the kinds of medical treatment you need, and the number of doctor visits or tests may be limited.  Some people’s benefits will be cut a little.  Some people’s benefits will be cut a lot.  Benefits for children under 21 will not change at all. 

Q.   How can I tell if my benefits will be cut a little or a lot?

A.   Your benefits package is in the middle of the letter, in bold print.  The bold print will tell you if you are getting the Healthy Plus, Healthy, or Healthy PA PCO benefits package.

  • Healthy Plus:  The Healthy Plus benefits package will be the best MA plan.  Healthy Plus benefits will cover less than the MA benefits you have now, but maybe not much less.  Healthy Plus is for pregnant women, seniors, and people with disabilities or health problems.  If the letter says that you will get Healthy Plus, you do not have to do anything!
  • Healthy:  The Healthy benefits package will have big cuts in benefits.  It will not cover as much as the MA coverage you have now.  There will be limits on services like doctor’s visits, blood tests and other lab work, and x-rays.  If you have health problems, you should ask for Healthy Plus right away!
  • Healthy PA PCO Benefits:  The Healthy PA PCO Benefits package will cover less than the MA benefits you have now, but maybe not much less.  But it does not cover all of the same doctors or mental health providers.  It also does not cover rides to the doctor (Logisticare or MATP).   If you need to see the same doctors or mental health providers, or if you need rides to the doctor, you should ask for Healthy Plus right away!

Q.   How can I ask for Healthy Plus?

A.   If your letter does not say you will get the Healthy Plus benefits package, you can still ask for it.  You must fill out a survey by November 26, 2014.  You can fill out the survey online through a My COMPASS account (www.compass.state.pa.us) or you can call (844) 290-3448.  You should answer all of the questions.  DPW will only use your answers to decide if you will get Healthy Plus.  DPW will ask for your doctor’s phone number.  DPW may call your doctor to ask about your health problems.  DPW will send you a notice in December, telling you if you will get Healthy Plus.

Q.  If I ask for Healthy Plus and get turned down, what can I do?

A.  If you get turned down for Healthy Plus, you can file an appeal.  When you get a notice in December, fill out the appeal form that comes with the notice and take it to your welfare office.  Keep a copy and get a receipt.  Community Legal Services may be able to help.  You can come to 1410 West Erie Avenue, at the corner of Broad Street and Erie, on Mondays and Wednesdays between 9 am and 12 pm.

Q.   Can I ask for Healthy Plus later?

A.   If you need Healthy Plus, you should fill out the survey by November 26, 2014.  If you have not filled the survey by then, or you have new health problems later, you can ask your doctor to fill out the Employability Assessment Form.  That is the same form that DPW uses to find out if people have disabilities.  Ask your doctor to check box 1 or box 2 on the form, and take the form to your welfare office.  If DPW turns you down for Healthy Plus, you can appeal. 

Q.   Is anything else changing about my Medical Assistance?

A.   If you get the Healthy PA PCO Benefits package, your insurance company may change on January 1, 2015.  In December, you will get a letter telling you which insurance company you will have.  If you want to pick your insurance company, you can call (844) 465-8137 to switch.  Your insurance company will not change if you get the Healthy or Healthy Plus package.