We’re here to help you understand your health care choices. Your questions are important. This is a good place to start if you want to learn about health plans, coverage, enrolling and PCPs.
What is a health plan?
A health plan is a group of doctors, hospitals, clinics and other health care providers. They work together to meet your health care needs. Health plans also keep track of your medical records.
When do I choose a health plan?
When you get an enrollment packet in the mail, it will ask you to choose. You will choose a health plan and a primary care provider (PCP) who works with your health plan.
You will choose a plan in your county that works with Medical Assistance (Medicaid). Counties have three to five plans to choose from. To see the health plans in your county, go to Compare plans.
Does everyone in my household have to choose the same health plan?
No. Each person can choose a different plan. Or you can all choose the same plan.
How do I enroll in the health plan I choose?
Once you choose a plan, there are three ways to enroll: online, by phone or by mail. To learn more, go to Enroll.
Can I change my health plan after I enroll?
If you choose a new health plan, make sure the PCP you want is in your plan’s network (group of providers). You can check your provider's network at Find a provider.
Who do I contact if I do not get a health plan ID card?
If you don't get a health plan ID card from the health plan you chose, call your plan’s toll-free number. To see health plan phone numbers, go to Contacting Your Plan.
What happens after I enroll?
After you enroll, your health plan will send you a health plan ID card and a member handbook. Your handbook tells you how to get health care services.
I enrolled in a plan but got a health plan ID card from a different plan. What do I do?
If you got an ID card from a health plan you did not choose, call our PA Enrollment Services at 1-800-440-3989 (TTY 1-800-618-4225). Choose Option 2 (“confirm your health plan start date”). Once you confirm that you are in the plan you chose, you can throw away the information and ID card from the plan you did not choose.
Who do I call to ask about my benefits or coverage?
Do I have health coverage before my health plan start date?
Yes. Use your ACCESS or EBT card to get health care services before your health plan start date. If you have questions, you can call your county assistance office at the phone number on Program Resources.
Should I keep my ACCESS or EBT card?
Yes. Keep your ACCESS or EBT card even if your health plan sends you a new card.
You need to show your ACCESS card and your new health plan card every time you visit the doctor or get other health care services.
What is a primary care provider (PCP)?
Your PCP is your doctor or other provider who gives you most of your regular health care. This includes checkups and other basic services. Your PCP works closely with you. Your PCP can send you to a specialist or hospital if you need those services.
When do I choose a primary care provider (PCP)?
Choose a PCP when you get your enrollment packet in the mail. You will choose a PCP who works with your health plan. Get tips to Choose a PCP.
Can I change my PCP later?
Yes. You can change your PCP at any time by calling your health plan. It may take a few days for the change to happen. To see health plan phone numbers, go to Contacting Your Plan.
Does everyone in my household have to choose the same PCP?
No. Each person can choose a different PCP. Or you can all choose the same PCP.
Can a doctor I see now become my PCP?
Yes, if your doctor works with one of the Medical Assistance (Medicaid) health plans in your county. To find out which health plans your doctor works with, go to Find a Provider.
What if I do not have a doctor now?
If you don't have a doctor and want help choosing one, we can help. To search from doctors near you, go to Find a provider.
Or call our PA Enrollment Services at 1-800-440-3989 (TTY 1-800-618-4225). We can talk with you about the kind of doctor you are looking for. We can help you find a PCP close to where you live.
What is a specialist?
A specialist is a doctor who only takes care of one kind of health care need. Specialists include doctors who treat things such as heart problems, broken bones or certain cancers. Your PCP will send you to a specialist for care when you need to see one. This is called a “referral.” If you already have a specialist that you see, ask your PCP for a referral for future visits.
Can I choose a specialist as my PCP?
In some cases you can choose a specialist, such as an Ob/Gyn, to be your PCP. Call your health plan to learn more. To see health plan phone numbers, go to Contacting Your Plan.
I got a health plan ID card with a PCP I did not choose. Who do I call to get the correct PCP listed on my card?
How do I correct my date of birth?
Please call your local county assistance office at the phone number on the Program resources page. Or call 1-877-395-8930. If you live in Philadelphia, please call 1-215-560-7226.
How do I correct or update my name?
Please call your local county assistance office at the phone number on Program resources . Or call 1-877-395-8930. If you live in Philadelphia, please call 1-215-560-7226.
What if I need behavioral health services?
You will get behavioral health (mental health and required substance use treatment) services through a behavioral health (BH) plan. The BH plan you will have is based on the county where you live. To see the behavioral health plans and phone numbers, go to Program Resources.