This section of PALawHelp.org has information and resources about Medicare issues in Pennsylvania.
Click on a resource category listed below to see information related to that category.
Community HealthChoices Toolkit
Community HealthChoices (CHC) is a new waiver program for individuals over 21 years old with a disability who previously received services through the Independence, CommCare, or Aging Waivers. This toolkit was developed by the Pennsylvania Assistive Technology Foundation, in collaboration with the Pennsylvania Health Law Project to provide information on CHC.
Community HealthChoices (Video)
This video from the Pennsylvania department of Human Services explains the new Community HealthChoices program. Community HealthChoices will coordinate your health care coverage to improve the quality of your health care experience — serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life.
Frequently Asked Questions: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency
Answers to some frequently asked questions about medical coverage from the Centers for Medicare and Medicaid Services related to the End of the COVID-19 Public Health Emergency. While some FAQs are relevant for all programs, including Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and private insurance, other questions are program specific as indicated.
PA Health Law Project Toll-Free Helpline - Call: 1-800-274-3258
The PA Health Law Project provides free legal services and advocacy to Pennsylvanians having trouble accessing publicly funded health care coverage or services. For assistance, call the PHLP Helpline at 1-800-274-3258 or 1-866-236-6310 TTY or e-mail the PHLP at staff@phlp.org. Information from the PHLP is also available online at www.phlp.org.
Need Help with Medicare? Call PA MEDI!
Information on Pennsylvania Medicare Education and Decision Insight (PA MEDI, formerly called APPRISE), an agency that helps people of any age to make informed health insurance decisions regarding Medicare.
Medicare Drug Plan Finder
The Medicare Drug Plan Finder from the Centers for Medicare & Medicaid Services can help you find and compare Medicare prescription drug plans in your area.
Medicare Eligibility & Premium Calculator
Use this calculator from the Centers for Medicare & Medicaid Services to get an estimate of when you’re eligible for Medicare and your premium amount. This calculator provides information for many but not all situations. If your situation isn’t in this calculator, contact Social Security to see if you’re eligible to enroll.
Application for Payment of Medicare Premiums, Coinsurance and Deductibles [PDF]
The PA 600M is a mail-in application for payment of the Medicare Part B premium only. It is used to help elderly individuals or individuals with disabilities who are eligible for Medicare to pay some or all of their Medicare Part B premium. A face-to-face interview is not required when using this application. The application cannot be used to apply for Medicaid (Medical Assistance), cash assistance or food stamps. (PA 600 M (AS) 8/19)
Benefits Eligibility Screening Tool (B.E.S.T.)
The Social Security Adminisitration's Benefit Eligibility Screening Tool (BEST) is an online tool that you can use to find out if you could be eligible for benefits from any of the programs Social Security administers. This tool will give you eligibility information based on answers you give on the online form.
Benefits.gov
Benefits.gov is the official benefits website of the U.S. government whose mission is to increase citizen access to benefit information, while reducing the expense and difficulty of interacting with the government. It is a free, online confidential tool that helps you find government benefits you may be eligible to receive.
Pennie - Pennsylvania's Health Care Marketplace
Pennie provides information on health care coverage available and how to sign up. All Pennsylvanians can search and choose coverage from November to January 15. After January 15th, folks who experience a Qualifying Life Event are still eligible to apply for financial assistance and shop for health insurance. Visit their website to learn more on qualifying life events.
Social Security Benefit Application - Medicare
Online Medicare application from the Social Security Administration.
Application for Payment of Medicare Premiums, Coinsurance and Deductibles [PDF]
The PA 600M is a mail-in application for payment of the Medicare Part B premium only. It is used to help elderly individuals or individuals with disabilities who are eligible for Medicare to pay some or all of their Medicare Part B premium. A face-to-face interview is not required when using this application. The application cannot be used to apply for Medicaid (Medical Assistance), cash assistance or food stamps. (PA 600 M (AS) 8/19)
Benefits Eligibility Screening Tool (B.E.S.T.)
The Social Security Adminisitration's Benefit Eligibility Screening Tool (BEST) is an online tool that you can use to find out if you could be eligible for benefits from any of the programs Social Security administers. This tool will give you eligibility information based on answers you give on the online form.
Benefits.gov
Benefits.gov is the official benefits website of the U.S. government whose mission is to increase citizen access to benefit information, while reducing the expense and difficulty of interacting with the government. It is a free, online confidential tool that helps you find government benefits you may be eligible to receive.
Pennie - Pennsylvania's Health Care Marketplace
Pennie provides information on health care coverage available and how to sign up. All Pennsylvanians can search and choose coverage from November to January 15. After January 15th, folks who experience a Qualifying Life Event are still eligible to apply for financial assistance and shop for health insurance. Visit their website to learn more on qualifying life events.
Social Security Benefit Application - Medicare
Online Medicare application from the Social Security Administration.
Medicare Drug Plan Finder
The Medicare Drug Plan Finder from the Centers for Medicare & Medicaid Services can help you find and compare Medicare prescription drug plans in your area.
Medicare Eligibility & Premium Calculator
Use this calculator from the Centers for Medicare & Medicaid Services to get an estimate of when you’re eligible for Medicare and your premium amount. This calculator provides information for many but not all situations. If your situation isn’t in this calculator, contact Social Security to see if you’re eligible to enroll.
Medigap Policy Search
This interactive tool from the Centers for Medicare & Medicaid Services helps you Find a Medigap Policy in Your Area.
Hospital Compare - A quality tool provided by Medicare
This tool from the U.S. Department of Health and Human Services provides you with information on how well the hospitals in your area care for all their adult patients with certain medical conditions. This information will help you compare the quality of care hospitals provide.
PA Health Law Project Toll-Free Helpline - Call: 1-800-274-3258
The PA Health Law Project provides free legal services and advocacy to Pennsylvanians having trouble accessing publicly funded health care coverage or services. For assistance, call the PHLP Helpline at 1-800-274-3258 or 1-866-236-6310 TTY or e-mail the PHLP at staff@phlp.org. Information from the PHLP is also available online at www.phlp.org.
Medicare
Basic information from Community Legal Services of Philadelphia on the Medicare program and how to get help in Philadelphia.
Community HealthChoices Toolkit
Community HealthChoices (CHC) is a new waiver program for individuals over 21 years old with a disability who previously received services through the Independence, CommCare, or Aging Waivers. This toolkit was developed by the Pennsylvania Assistive Technology Foundation, in collaboration with the Pennsylvania Health Law Project to provide information on CHC.
Dual Eligibility in Pennsylvania: What Happens When I Am Newly Eligible for Medicare and Medicaid?
This manual from the Pennsylvania Health Law Project is for advocates and consumers who have Medicare and are also eligible for or enrolled in a Medicaid program. Medicaid in Pennsylvania is called "Medical Assistance" or "MA." Persons with Medicare and Medicaid are frequently referred to a "dual eligibles" due to their being simultaneously eligible for both Medicare and Medicaid. (PDF) (February 2013)
Choosing a Medicare Prescription Drug Plan
Information from the Pennsylvania Health Law Project to consider when selecting your Medicare prescription drug plan. (October 2011) [PDF]
Medicare Part D - A Guide For Advocates and Providers Who Work With Older Adults in Pennsylvania
Comprehensive manual written by M. Francesca Chervenak, Esq. and Erin E. Guay, MA of the Pennsylvania Health Law Project on Medicare Part D, the Medicare Prescription Drug Program that offers Medicare consumers prescription drug insurance through private insurance companies. [PDF]
Medicare Part D Extra Help (Video)
In this video, the Pennsylvania Health Law Project explains a program called Extra Help which helps with Medicare prescription drug costs. The Extra Help program is also known as the Low Income Subsidy (LIS).
2022 Medicare Part D Standard Zero Premium Prescription Drug Plans
In Pennsylvania, all dual eligible and those approved for full Extra Help with their Part D costs will have no premium if they enroll in any of the plans listed in the PDF below. This list was composed by The Pennsylvania Health Law Project.
Medicare Savings Program Guide (2022)
Information from the Pennsylvania Health Law Project on the Medicare Savings Programs that help lower-income seniors and persons with disabilities pay for their Medicare Part B premium. [PDF] (February 2022)
2023 Income and Resource Limits for Medicaid and Other Health Programs
Information on income and resource limits for Medical Assistance for 2023 provided by the PA Health Law Project.
Medicare Part D Extra Help Guide - 2022
Information from the Pennsylvania Health Law Project about the Medicare Part D Extra Help Program (also called the Low-Income Subsidy or “LIS”) that helps Medicare consumers dramatically lower their prescription drug costs and can help individuals save thousands of dollars per year.
Medicare Savings Program (MSP) [Video]
In this new video updated for 2022, PHLP attorney Katy McKee talks about a program called the Medicare Savings Program (MSP), which can help with Medicare costs. The Medicare Savings Program is also known as the Buy-In.
Person Centered Service Planning in Community HealthChoices (CHC)
Information on what Pennsylvanians with disabilities need to know about getting long term services and supports in Community HealthChoices.
Medicare
Information from the Erie County Bar Association on the Medicare health insurance program for senior citizens from the Erie County Bar Association. (August 2018)
A Guide to Legal Issues for Pennsylvania Senior Citizens [PDF]
The handbook from the Pennsylvania Bar Association provides valuable information on legal issues and questions that concern Pennsylvania's senior citizens and the persons and organizations that care for them. (2016-2017) [PDF Format, 83 pages]
Need Help with Medicare? Call PA MEDI!
Information on Pennsylvania Medicare Education and Decision Insight (PA MEDI, formerly called APPRISE), an agency that helps people of any age to make informed health insurance decisions regarding Medicare.
What's Medicare?
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities. This provides more information about what coverage is available through Medicare.
Community HealthChoices
Community HealthChoices (CHC) is Pennsylvania’s mandatory managed care program for individuals who are dually eligible for both Medical Assistance and Medicare, older adults, and individuals with physical disabilities — serving more people in communities while giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life.
Community HealthChoices (Video)
This video from the Pennsylvania department of Human Services explains the new Community HealthChoices program. Community HealthChoices will coordinate your health care coverage to improve the quality of your health care experience — serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life.
Medicare Drug Plan Finder
The Medicare Drug Plan Finder from the Centers for Medicare & Medicaid Services can help you find and compare Medicare prescription drug plans in your area.
Medicare.gov: Prescription Drug Coverage (Part D)
Information on the Medicare Prescription Drug Benefit from Medicare.gov.
Medicare - Preventive & Screening Services
Information about preventive services that may be covered by Medicare.
Medigap Policy Search
This interactive tool from the Centers for Medicare & Medicaid Services helps you Find a Medigap Policy in Your Area.
Hospital Compare - A quality tool provided by Medicare
This tool from the U.S. Department of Health and Human Services provides you with information on how well the hospitals in your area care for all their adult patients with certain medical conditions. This information will help you compare the quality of care hospitals provide.
Medicare Benefits
Information from the Social Security Administration providing an overview of the Medicare program.
PA MEDI (formely APPRISE)
Effective July 1, 2021, APPRISE is now Pennsylvania Medicare Education and Decision Insight or PA MEDI – Same Program, Same Services for Pennsylvania’s Medicare Beneficiaries, now with a New Name. Pennsylvania Medicare Education and Decision Insight (PA MEDI) offers free Medicare counseling to older Pennsylvanians. PA MEDI Counselors are specially trained to answer your questions and provide you with objective, easy-to-understand information about Medicare, Medicare Supplemental Insurance, Medicaid, and Long-Term Care Insurance. PA MEDI Counselors do not sell Medicare products but rather offer current, unbiased Medicare education to help you make the most informed choice about the Medicare options available to you.
Are you a kinship caregiver or a grandparent raising grandchildren?
Informational brochure from Pennsylvania Medicare Education and Decision Insight (PA MEDI) about how you could save money with Medicare Savings Programs and Extra Help!
Benefit Publications from the Social Security Administration
Large collection of publications providing information on the various programs such as: disability benefits, appeal process, benefits for people with HIV, how workmans' compensation can affect your disability benefits, children with disabilities, info on receiving your payments, benefits for those who are blind or have low vision, details on ticket to work incentives, info on working while disabled, retirement benefits, government pension offset, medicare, windfall provision, survivors benefits, SSI, SSI for non-citizens, food stamps and other nutrition progams, protecting your on social security numbers, and more. Many publications available in Spanish.
Frequently Asked Questions: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency
Answers to some frequently asked questions about medical coverage from the Centers for Medicare and Medicaid Services related to the End of the COVID-19 Public Health Emergency. While some FAQs are relevant for all programs, including Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and private insurance, other questions are program specific as indicated.
Insulin Coverage
This information from Medicare.gov outlines changes to Medicare Part D insulin costs starting January 1, 2023. The major change is that the cost of a one-month supply of Medicare Part D-covered insulin is capped at $35, and you don’t have to pay a deductible for insulin. This applies to everyone who takes insulin, even if you get Extra Help. For more information on the changes visit this resource from Medicare.gov.
Medicare Prescription Drug Donut Hole
Explanation of Medicare Prescription Drug Donut Hole from HealthCare.gov.
Medicare Publications
Listing of publications from Medicare.gov on a vairiety of issues. Publications are in PDF format with links to copies converted to web pages.
Pennie - Pennsylvania's Health Care Marketplace
Pennie provides information on health care coverage available and how to sign up. All Pennsylvanians can search and choose coverage from November to January 15. After January 15th, folks who experience a Qualifying Life Event are still eligible to apply for financial assistance and shop for health insurance. Visit their website to learn more on qualifying life events.
Pennsylvania Health Insurance Premium Payment (HIPP) Program
Information from the Pennsylvania Department of Human Services on the PA Health Insurance Premium Payment Program. The Health Insurance Premium Payment (HIPP) Program is a program developed to help families, who have at least one person enrolled in Medical Assistance (MA), pay for private health insurance through an employer.
Self Employed: Social Security and Medicare
Fact Sheet from the Social Security Administration for people who are self-employed regarding paying Social Security and Medicare taxes, earning credits, calculating net earnings, and more. (2022) [PDF]
Social Security Benefit Application - Medicare
Online Medicare application from the Social Security Administration.
Your Ticket To Work
Information from the Social Security Administration regarding the Ticket To Work Program and how more Americans with disabilities have the opportunity to participate in the workforce and lessen their dependence on public benefits. Some of the work incentives allow you to keep some Social Security Disability Insurance (SSDI) or SSI benefits, and your Medicaid or Medicare, while you transition to the workplace. (July 2020) [PDF]
An Overview of Medicare
This fact sheet from the Kaiser Family Foundation provides a basic overview of the Medicare program, including how it is financed, who is eligible and what benefits are covered under the program. In addition, it describes supplemental health insurance, benefits provided by the new drug law and data on Medicare expenditures and financing. (Feb. 13, 2019)
An Overview of the Medicare Part D Prescription Drug Benefit
This fact sheet provides an overview of the Medicare Part D program, plan availability, enrollment, and spending and financing, based on data from the Centers for Medicare & Medicaid Services (CMS), CBO, and other sources. (Oct. 13, 2021)
Choosing a Medicare Prescription Drug Plan
Information from the Pennsylvania Health Law Project to consider when selecting your Medicare prescription drug plan. (October 2011) [PDF]
Medicare Part D - A Guide For Advocates and Providers Who Work With Older Adults in Pennsylvania
Comprehensive manual written by M. Francesca Chervenak, Esq. and Erin E. Guay, MA of the Pennsylvania Health Law Project on Medicare Part D, the Medicare Prescription Drug Program that offers Medicare consumers prescription drug insurance through private insurance companies. [PDF]
Medicare Part D Extra Help (Video)
In this video, the Pennsylvania Health Law Project explains a program called Extra Help which helps with Medicare prescription drug costs. The Extra Help program is also known as the Low Income Subsidy (LIS).
2022 Medicare Part D Standard Zero Premium Prescription Drug Plans
In Pennsylvania, all dual eligible and those approved for full Extra Help with their Part D costs will have no premium if they enroll in any of the plans listed in the PDF below. This list was composed by The Pennsylvania Health Law Project.
Medicare Drug Plan Finder
The Medicare Drug Plan Finder from the Centers for Medicare & Medicaid Services can help you find and compare Medicare prescription drug plans in your area.
Medicare.gov: Prescription Drug Coverage (Part D)
Information on the Medicare Prescription Drug Benefit from Medicare.gov.
An Overview of the Medicare Part D Prescription Drug Benefit
This fact sheet provides an overview of the Medicare Part D program, plan availability, enrollment, and spending and financing, based on data from the Centers for Medicare & Medicaid Services (CMS), CBO, and other sources. (Oct. 13, 2021)
Insulin Coverage
This information from Medicare.gov outlines changes to Medicare Part D insulin costs starting January 1, 2023. The major change is that the cost of a one-month supply of Medicare Part D-covered insulin is capped at $35, and you don’t have to pay a deductible for insulin. This applies to everyone who takes insulin, even if you get Extra Help. For more information on the changes visit this resource from Medicare.gov.
Medicare Part D Extra Help Guide - 2022
Information from the Pennsylvania Health Law Project about the Medicare Part D Extra Help Program (also called the Low-Income Subsidy or “LIS”) that helps Medicare consumers dramatically lower their prescription drug costs and can help individuals save thousands of dollars per year.
Medicare Prescription Drug Donut Hole
Explanation of Medicare Prescription Drug Donut Hole from HealthCare.gov.