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  • March 1, 2013 - February 28, 2014

    Medical Assistance for Older People and People with Disabilities

    Pennsylvania's Medical Assistance program provides health care benefits for older people and people with disabilities. Information on this page describes general eligibility requirements and benefits.

    Categorically Needy

    • SSI recipients
    • SSI-related (age 65 or older, disabled and blind) persons
    Number of
    People
    NMP Categories
    Net Monthly
    Income Limit
    1$743.10
    2 $1115.30

    Medically Needy Only

    SSI-related (aged, disabled and blind)

    Number of
    People
    MNO Categories
    Net Monthly
    Income Limits
    MNO Categories
    Net 6-Month
    Income Limits
    1$ 425$ 2,550
    2$ 442$ 2,650
    3$ 467$ 2,800
    4$ 567$ 3,400
    5$ 675$ 4,050
    6$ 758$ 4,550
    7$ 850$ 5,100
    8$ 942$ 5,600
    Each Additional Person$ 92$ 550

    State Blind Pension

    State-funded program for persons who meet visual and other eligibility requirements.

    Healthy Horizons

    Eligible persons may be eligible to receive help to pay their Medicare premiums. The Medical Assistance program (also referred to as Medicaid) includes a coverage plan designed to help elderly individuals or individuals with disabilities who are eligible for Medicare to pay some or all of their Medicare premiums. Individuals must meet the income and resource limits. Income limits are based on a percentage of the Federal Poverty Income Guidelines (FPIGs), which are revised annually.

    Healthy Horizons includes the following:

    Qualified Medicare Beneficiary (QMB) - Categorically Needy Program

    Also referred to as Healthy Horizons in Pennsylvania, individuals who qualify for these benefits are eligible for Medical Assistance payment of their Medicare Part A and Part B premiums and payment of Medicare deductibles and coinsurance. They are also eligible for medical coverage through the Medical Assistance program. Income and resource limits are as follows:

    Number of
    People
    2014 Federal
    Poverty Level (FPIG)
    Monthly Income Limit
    (FPIG + $20 Deductible = Limit
    Resource
    Limit
    1100% or less$973 + $20 = $993$2,000
    2100% or less$1,311 + $20 = $1,331$3,000

    Qualified Medicare Beneficiary (QMB)-Medicare Cost-Sharing Program

    Also referred to as Healthy Horizons-Medicare Cost-Sharing in Pennsylvania, individuals who qualify for these benefits are eligible for payment of their Medicare Part A and Part B premiums and payment of Medicare deductibles and coinsurance. Income and resource limits are as follows:

    Number of
    Persons
    2014 Federal
    Poverty Level (FPIG)
    Monthly Income Limit
    (FPIG + $20 Deductible = Limit)
     
    Resource
    Limit
    1100% or less$973 + $20 = $993$7,160
    2100% or less$1,311 + $20 = $1,331$10,750

    Specified Low-Income Medicare Beneficiary (SLMB) Program

    Individuals who qualify for these benefits are eligible for payment of their Medicare Part B premium only. Income and resource limits are as follows:

    Number of
    Persons
    2014 Federal
    Poverty Level (FPIG)
    Monthly Income Limit
    (FPIG + $20 Deductible = Limit)
    Resource
    Limit
    1At least 100% but less than 120%$973 + $20 = $993
    Less than $1,167 + $20 = $1,187
    $7,160
    2At least 100% but less than 120%$1,311 + $20 = $1,331
    Less than $1,573 + $20 = $1,593
    $10,750

    Qualifying Individuals Group 1 (QI-1)

    Individuals who qualify for these benefits are eligible for payment of their Medicare Part B premium only. Income and resource limits are as follows:

    Number of
    People
    2014 Federal
    Poverty Level (FPIG)
    Monthly Income
    Limit (FPIG + $20 Deductible)
    Resource
    Limit
    1At least 120% but
    less than 135%
    $ 1,167 + $20 = $1,187
    Less than $ 1,313 + $20 = $1,333
    $7,160
    2At least 120% but
    less than 135%
    $1,573 + $20 = $1,593
    Less than $1,770 + $20 = $1,790
    $10,750