
16 Nov Comparing CHC Medicaid Waiver Health Plans in Philadelphia: A Guide
Are you on the Pennsylvania Medicaid Waiver plan or considering selecting an insurance plan for Community HealthChoices? For Home and Community Based Services, read more for our comparison guide between Keystone First, PA Health and Wellness, and UPMC in greater Philadelphia.
For seniors and disabled adults, Community Health Choices (CHC) provides physical health benefits as well as long-term services and supports to eligible individuals to those who qualify. Let’s take a look at the benefits and services offered by Pennsylvania’s CHC Medicaid program under the different approved managed care organizations in the program. These include Keystone First, UPMC, and PA Health and Wellness in the Pennsylvania area.
MCO Health Plans Compared under CHC
The plan comparisons below between Keystone First, UPMC, and PA Health and Wellness compare the following, among others:
- Services offered. Be sure to check out our CHC waiver guide for services here for a comprehensive list.
- Co-pays for different services
- Additional benefits under the health plan
What if I have additional questions?
Be sure to check out our extensive resources to help you with the CHC Medicaid waiver. We not only walk you through the process to get signed up, but we help answer other common questions.
- Get Paid to Care For A Loved One in Pennsylvania: A Guide
- A Beginner’s Guide to Using Pennsylvania’s Medicaid Waiver for Home Care
- Community HealthChoices MCO Approved Providers List: Find Them Here
- Pennsylvania’s Medicaid Waiver: The Step by Step Enrollment Guide
Reach out to Chosen Family Home Care to answer any other questions you have. We are glad to assist you in choosing the best healthcare insurance plan under the Community HealthChoices Medicaid waiver.
Chosen Family Home Care is a greater Philadelphia area provider of home care and home health aide services across the five-county Philadelphia area to include Bucks, Chester, Delaware, and Montgomery counties. For families and their loved ones who need help at home and are approved for home care and personal care services, Chosen Family can help you get set up with a caregiver. This includes employing family caregivers to take care of loved ones who are eligible.
Keystone First
1-855-332-0729
(TTY: 1-855-235-4976)
www.keystonefirstchc.com
For the list of services covered by all MCO health plans, check out our CHC waiver guide for services here.
People with Medicare pay the co-pays below. The only exception is for prescription drug co-pays. People with both Medicare and Medicaid get most prescriptions through their Medicare Part D. They will pay Part D co-pays, and not the prescription co-pays listed here.
Ambulance – Per trip $0
Dental care – $0
Inpatient hospital
Per day – $0
Maximum with limits – $0
Medical centers
Ambulatory surgical center – $0
Federal Qualified Health Center or Regional Health Center – $0
Independent medical/surgical center – $0
Short procedure unit – $0
Medical equipment
Purchase – $0
Rental – $0
Medical visits
Certified nurse practitioner – $0
Chiropractor – $0
Doctor – $0
Optometrist – $0
Podiatrist – $0
Outpatient hospital
Per visit – Outpatient surgical, except maternity – $0
Per visit – Non-surgical or diagnostic – $0
Prescriptions
Generic – $0
Brand name – $2
X-rays – Per service $0
- Beyond Medicaid coverage of dental services, qualified participants will get an oral hygiene kit
- Beyond Medicaid covered vision services, no extra services
- Free Smartphone with 350 minutes of talk and unlimited texts for participants who qualify
- Home provider visits, lab draws and testing for qualified participants
- Video visits with care manager
- Bright Start® maternity program
- In-home supports and services to help participants not approved for LTSS avoid nursing home stay
- Welcome Home Benefit helps qualified participants with LTSS move from nursing facility to home, with up to $6000 for rental assistance ($2000 more than the $4000 state limit)
- For those not approved for LTSS, caregiver programs offer education, respite services and supports
* There are no co-pays for persons living in a nursing, personal care or domiciliary home. Pregnant women, new mothers and terminally ill participants getting hospice care have no co-pays. Some services, items and drugs have no co-pays.
Pennsylvania Health & Wellness
(TTY: 1-844-349-8916)
For the list of services covered by all MCO health plans, check out our CHC waiver guide for services here.
People with Medicare pay the co-pays below. The only exception is for prescription drug co-pays. People with both Medicare and Medicaid get most prescriptions through their Medicare Part D. They will pay Part D co-pays, and not the prescription co-pays listed here.
Ambulance – Per trip $0
Dental care – $0
Hospital inpatient stays
Per day – $0
Maximum with limits – $0
Medical and health centers
Ambulatory surgical center – $0
Federal Qualified Health Center or Regional Health Center – $0
Independent medical/surgical center – $0
Short procedure unit – $0
Medical equipment
Purchases – $0
Rental – $0
Medical visits
Certified nurse practitioner – $0
Chiropractor – $0
Doctor – $0
Optometrist – $0
Podiatrist – $0
Outpatient hospital
Per visit – Outpatient surgical, except maternity – $0
Per visit – Non-surgical or diagnostic – $0
Prescriptions
Generic – $0
Brand name – $3
X-rays – Per service $0
- Beyond Medicaid coverage of dental services, extra dental cleanings, visits and oral hygiene kit for participants who are Nursing Facility Clinically Eligible (NFCE)
- Beyond Medicaid covered vision services, $100 yearly allowance for glasses or contacts for participants who are NFCE
- Free Smartphone with 1000 free talk minutes, 1 GB of data and unlimited texts for participants who qualify
- After hospital stay: 14 days of home delivered meals
- After hospital stay: 14 days of respite care
- Caregiver access and supports
- Health library
- Healthy Rewards Program purchasing card to get health items at authorized retailers. Learn more on the My Health Pays™ web page
- Support services for members waiting for LTSS eligibility determination
- 90-day prescription refill for those not on Medicare
- 1 week of home delivered meals for each member leaving nursing facility, regardless of waiver benefit coverage
* There are no co-pays for persons living in a nursing, personal care or domiciliary home. Pregnant women, new mothers and terminally ill participants getting hospice care have no co-pays. Some services, items and drugs have no co-pays.
UPMC Community Health Choices
Phone number for UPMC
1-844-833-0523
(TTY: 1-866-407-8762)
www.upmchealthplan.com/chc
For the list of services covered by all MCO health plans, check out our CHC waiver guide for services here.
People with Medicare pay the co-pays below. The only exception is forprescription drug co-pays. People with both Medicare and Medicaid get most prescriptions through their Medicare Part D. They will pay Part D co-pays, and not the prescription co-pays listed here.
Ambulance – Per trip $0
Dental care – $0
Inpatient hospital
Per day – $0
Maximum with limits – $0
Medical centers
Ambulatory surgical center – $0
Federal Qualified Health Center or Regional Health Center – $0
Independent medical/surgical center – $0
Short procedure unit – $0
Medical equipment
Purchase – $0
Rental – $0
Medical visits
Certified nurse practitioner – $0
Chiropractor – $0
Doctor – $0
Optometrist – $0
Podiatrist – $0
Outpatient hospital
Per visit – Outpatient surgical, except maternity – $0
Per visit – Non-surgical or diagnostic – $0
Prescriptions
Generic – $0
Brand name – $3
X-rays – Per service $0
- Beyond Medicaid covered services, $500 yearly allowance of certain dental services
- Beyond Medicaid covered vision services, $100 yearly allowance for glasses or contacts and one fitting every 12 months
- Free Smartphone with up to 1000 minutes of talk and unlimited texts for participants who qualify
- Free health coaching services based on health needs and goals
- Online program to ease stress
- 24/7 UPMC provider live video access for minor health issues
- Personal support services for participants waiting for LTSS eligibility decision
- Caregiver support with daily advice, coaching and a stipend instead of personal assistance services
- Help with Medical Assistance renewal process
- Up to $5000 allowance to move from a nursing facility to the community
*There are no co-pays for persons living in a nursing, personal care or domiciliary home. Pregnant women, new mothers and terminally ill participants getting hospice care have no co-pays. Some services, items and drugs have no co-pays.
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