Comparing CHC Medicaid Waiver Health Plans in Philadelphia: A Guide

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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 HealthChoices (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.

Pennsylvania's CHC Medicaid Waiver

The CHC waiver can provide an array of services, including home care services.

 

MCO Health Plans Compared under CHC

The plan comparisons below between Keystone First, UPMC, and PA Health and Wellness compare the following, among others:

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.

waiver programs in Pennsylvania for home care services and family caregivers

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.

Co-pays*

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

Adult dental
  • Beyond Medicaid coverage of dental services, qualified participants will get an oral hygiene kit
Adult vision
  • Beyond Medicaid covered vision services, no extra services
Phone services
  • Free Smartphone with 350 minutes of talk and unlimited texts for participants who qualify
Wellness programs
  • Home provider visits, lab draws and testing for qualified participants
  • Video visits with care manager
  • Bright Start® maternity program
Other benefits
  • 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

Phone number for PA Health and Wellness
1-844-626-6813

(TTY: 1-844-349-8916)

www.PAHealthWellness.com

For the list of services covered by all MCO health plans, check out our CHC waiver guide for services here.

Co-pays*

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

Adult dental
  • Beyond Medicaid coverage of dental services, extra dental cleanings, visits and oral hygiene kit for participants who are Nursing Facility Clinically Eligible (NFCE)
Adult vision
  • Beyond Medicaid covered vision services, $100 yearly allowance for glasses or contacts for participants who are NFCE
Phone services
  • Free Smartphone with 1000 free talk minutes, 1 GB of data and unlimited texts for participants who qualify
Wellness programs
  • After hospital stay: 14 days of home delivered meals
  • After hospital stay: 14 days of respite care
  • Caregiver access and supports
  • Health library
Other benefits
  • 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 HealthChoices

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.

Co-pays*

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

Adult dental
  • Beyond Medicaid covered services, $500 yearly allowance of certain dental services
Adult vision
  • Beyond Medicaid covered vision services, $100 yearly allowance for glasses or contacts and one fitting every 12 months
Phone services
  • Free Smartphone with up to 1000 minutes of talk and unlimited texts for participants who qualify
Wellness programs
  • Free health coaching services based on health needs and goals
  • Online program to ease stress
Other benefits
  • 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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