Health Care and Services forPersons with Disabilities
For information on Health Care and Services for Children with Disabilities, click to see our Health Care for Children page.
Health Care and Services for Adults with Disabilities
Adults with Disabilities may access healthcare through Medicaid, Medicare, or Private Insurance. Additionally, due to how programs and services are structured in Pennsylvania, available services may differ depending on the adult's disability and residential setting.
• Click here to see our page specifically on MR services in PA.
• Click here to see our page specifically on MH services in PA.
• Click here to see our page specifically on Drug and Alcohol services in PA.
• Click here to see our page specifically on HCBS Waiver programs in PA.
Below is information on healthcare program eligibility and access to services through Medical Assistance and Medicare for Adults with disabilities.
It is critical that people with disabilities have the healthcare coverage and supportive services they need to maintain the highest possible level of health and functioning . There are numerous state and federal healthcare programs available to Pennsylvanians with permanent disabilities.
Medicare:
Medicare is a federal health insurance program available to eligible individuals who have received Social Security Disability Insurance checks for 24 months. There are three benefit parts to Medicare:
• Part A (Hospital Insurance)
• Part B (Medical Insurance)
• Part D (Prescription Drug Insurance)
There are different ways to get the services covered by Medicare. In most cases, when you first become eligible for Medicare, you receive the Original (also known as traditional) Medicare Plan which includes Medicare Parts A and B. Since Part D became available in 2006, most people will also want to consider joining a Part D Medicare Prescription Drug Plan to add drug coverage. In the alternative, some people may want to consider a Medicare Advantage Plan (which is a health maintenance organization [HMO] or preferred provider organization [PPO]) that provides Part A, Part B, and often Part D coverage. When you become eligible for Medicare, you make a choice of whether to receive your Medicare benefits through the Original Medicare Plan or a Medical Advantage Plan. Each fall you can review your health and prescription needs and decide whether to switch to a different plan for the next year. Click here to go to our webpage on Medicare Part A, B, C, and D.
Medigap:
While Medicare is often a source of healthcare coverage for adults with permanent disabilities, Medicare provides incomplete healthcare coverage. Under Medicare, not all healthcare services are covered. Additionally, for those services that are covered, you will still have your share of out-of-pocket costs in the form of premiums, co-payments, and deductibles. The amounts of these premiums, co-payments, and deductibles increase each year. Because Medicare does not cover all healthcare services and because there is significant cost sharing for the services that are covered, you may want to supplement your Medicare with other insurance. You may fill these gaps in Medicare coverage with Medicaid (if you qualify), a Medicare Supplemental insurance policy or other insurance coverage.
There are 12 standard Medigap policies a person with Original Medicare can choose from. Click here for Understanding Medigap and Medicare Supplemental Policies.
Medicaid:
Medicaid is a public health insurance program. It is mostly free and is not welfare. In fact, most people on Medicaid receive health insurance coverage only and do not receive welfare in the form of cash benefits. Medicaid in Pennsylvania is also called “Medical Assistance” or “MA.”
To be eligible for Medicaid, you must be a resident of Pennsylvania, meet specific immigration status requirements, fit within a group or category that is covered by Medicaid, and meet the applicable income and resource requirements for your category of eligibility. Click here to see our page on Medicaid with more details on Medicaid Eligibility.
There are several categories of Medicaid that cover adults with permanent disabilities. Often, they have different eligibility requirements and different countable income and resource limits. Some main categories include:
• Persons with SSI (including some who had SSI and some who receive the SSI Personal Care Home or Domiciliary Care Home Supplement)
• Healthy Horizons
• Full Medicaid
• Payment of Medicare Part B only
• Medical Assistance for Workers with a Disability
• Home and Community Based Waiver Programs
• Spend-down
These are the most likely categories of coverage for an adult with a disability. Click here to go to our Medicaid page and get information on all Medicaid categories in Pennsylvania.
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