Pennsylvania's Medicaid program, officially called Medical Assistance (MA), provides free or low-cost healthcare coverage to millions of residents across the state. As a Medicaid expansion state since January 2015, Pennsylvania covers all adults under 65 with household incomes at or below 138% of the Federal Poverty Level (FPL), regardless of whether they have dependent children. If you are wondering whether you or your family qualifies for Pennsylvania Medicaid in 2026, this guide breaks down the income limits, application process, and covered benefits so you can take the next step with confidence.
Not sure if you qualify? Check your eligibility for Medicaid and other benefits in minutes with our free screener.
Who Qualifies for Pennsylvania Medicaid in 2026?
Pennsylvania Medical Assistance covers several groups of residents. Your eligibility depends on your age, income, household size, and certain life circumstances. Here is a quick overview of who may qualify:
- Adults ages 19 to 64 with income at or below 138% FPL
- Children ages 0 to 18 with income limits ranging from 138% to 220% FPL depending on age
- Pregnant women with income at or below 220% FPL
- Seniors age 65 and older and individuals with disabilities who meet income and asset requirements
- SSI recipients who automatically qualify for PA Medicaid
- Children who do not qualify for Medicaid may still be eligible for PA CHIP, which covers kids in families earning up to 319% FPL
Because Pennsylvania expanded Medicaid, there is no "coverage gap" in the state. Adults who earn too little to qualify for marketplace subsidies are still covered by Medical Assistance.
Pennsylvania Medicaid Income Limits for 2026
Income limits for Pennsylvania Medicaid are based on the Federal Poverty Level, which is updated each year. The table below shows the current monthly income limits for the most common eligibility categories.
Adults Ages 19 to 64 (138% FPL)
| Household Size | Monthly Income Limit | Annual Income Limit |
|---|---|---|
| 1 | $1,800 | $21,597 |
| 2 | $2,433 | $29,194 |
| 3 | $3,065 | $36,791 |
| 4 | $3,698 | $44,367 |
| 5 | $4,330 | $51,964 |
| 6 | $4,963 | $59,561 |
| Each additional | +$633 | +$7,597 |
Note: There is no asset test for adults qualifying under the MAGI (Modified Adjusted Gross Income) category. Your savings, home, and vehicle do not count against you.
Children
| Age Group | Income Limit (% FPL) |
|---|---|
| Newborns to age 1 | 220% FPL |
| Children ages 1 to 5 | 162% FPL |
| Children ages 6 to 18 | 138% FPL |
Children who exceed Medicaid income limits may qualify for PA CHIP, which covers children in households earning up to 319% FPL. Visit chipcoverspakids.com for more details.
Pregnant Women (220% FPL)
Pregnant women in Pennsylvania qualify for Medical Assistance with household income up to 220% FPL. Coverage includes prenatal care, labor and delivery, and postpartum care. There is no asset test for pregnant women.
Seniors and Individuals with Disabilities
| Category | Monthly Income Limit | Asset Limit |
|---|---|---|
| Seniors/Disabled (Healthy Horizons) | $1,304 (approx. 100% FPL) | $2,000 |
| Nursing Home Medicaid | $2,901 | $8,000* |
*Nursing home asset limit includes a $6,000 disregard on top of the $2,000 base.
For seniors and individuals with disabilities, both income and assets are considered. The rules differ from the MAGI-based categories above, so it is worth reviewing your situation carefully.
How to Apply for Pennsylvania Medicaid
Applying for Medical Assistance in Pennsylvania is straightforward. You have several options depending on what works best for you.
Step 1: Gather Your Information
Before you begin, have the following ready:
- Social Security numbers for everyone in your household
- Proof of income (pay stubs, tax returns, or a letter from your employer)
- Proof of Pennsylvania residency (utility bill, lease, or ID)
- Date of birth and citizenship or immigration status documentation
- Information about any current health insurance
Step 2: Choose Your Application Method
Online (Recommended) Apply through the COMPASS portal at compass.dhs.pa.gov. COMPASS is the state's online system for applying to Medicaid, SNAP, TANF, LIHEAP, and other programs all in one place. You can apply 24/7 from any device.
By Phone Call the PA DHS helpline at 1-866-550-4355. Representatives can help you start an application or answer questions about your eligibility.
In Person Visit your local County Assistance Office (CAO). Find your nearest office at pa.gov/agencies/dhs.
By Mail Download and print an application from the DHS website, fill it out, and mail it to your local CAO.
Step 3: Submit and Wait for a Decision
Once you submit your application, the state will review your information. In most cases, you will receive a decision within 30 days (or 45 days for disability-related applications). If approved, your coverage may be retroactive up to 3 months before your application date if you had qualifying medical expenses during that time.
Step 4: Choose a Managed Care Plan
Most Pennsylvania Medicaid recipients receive coverage through managed care under the HealthChoices program. Once approved, you will be asked to select a managed care organization (MCO). If you do not choose one, you will be assigned to a plan. You can change your MCO during the first 90 days of enrollment.
What Does Pennsylvania Medicaid Cover?
Pennsylvania Medical Assistance provides comprehensive health coverage, including:
- Doctor visits and preventive care
- Hospital stays (inpatient and outpatient)
- Prescription medications
- Mental health and substance use disorder treatment
- Dental care for adults and children
- Vision care including eye exams and glasses
- Lab tests and diagnostic imaging
- Maternity and newborn care
- Emergency services
- Transportation to medical appointments (through Medical Assistance Transportation Program)
- Home and community-based services for those who need long-term support
There are no premiums for most Medicaid recipients in Pennsylvania, and copayments are minimal or nonexistent for many services.
Medicaid Renewals: What You Need to Know
Pennsylvania Medicaid coverage must be renewed each year. The state will send you a renewal notice before your coverage is set to expire. Here is what to keep in mind:
- Respond promptly to all renewal notices from DHS
- Keep your contact information updated in COMPASS so renewal notices reach you
- Report changes in income, household size, or address as they happen
- If you miss your renewal deadline, your coverage may be terminated
- If you are disenrolled and believe you still qualify, you can reapply at any time
Since the end of the COVID-era continuous enrollment protections in 2023, Pennsylvania has returned to regular annual renewals. Over 848,000 people were disenrolled during the unwinding period, with more than half losing coverage because they did not return renewal paperwork rather than being found ineligible. Do not let that happen to you.
Other Benefits You May Qualify For
If you qualify for Pennsylvania Medicaid, you may also be eligible for additional assistance programs. Many of these use similar income thresholds or offer automatic eligibility to Medicaid recipients:
- SNAP (Food Stamps): PA uses a 200% FPL gross income limit with no asset test for most households. Apply through COMPASS.
- LIHEAP (Heating Assistance): Helps pay energy bills for households at or below 150% FPL. Apply through COMPASS.
- WIC: Nutrition assistance for pregnant women and children under 5. Medicaid recipients are automatically income-eligible.
- Lifeline: $9.25/month discount on phone or internet service. Medicaid recipients automatically qualify.
- Free School Meals: Children in Medicaid/SNAP households may qualify for free breakfast and lunch.
- Child Care Works: Subsidized child care for working families earning up to 200% FPL.
Check your eligibility for all of these programs at once with our free benefits screener.
For a complete overview of assistance programs in the state, visit our Pennsylvania Benefits Overview.
Frequently Asked Questions
What is the income limit for Pennsylvania Medicaid in 2026?
For most adults ages 19 to 64, the income limit is 138% of the Federal Poverty Level. For a single person, that is approximately $1,800 per month or $21,597 per year. For a family of four, the limit is approximately $3,698 per month or $44,367 per year.
Does Pennsylvania have a Medicaid asset test?
For adults, children, and pregnant women qualifying under MAGI rules, there is no asset test. Your bank accounts, home, and car are not counted. However, seniors and individuals with disabilities applying for non-MAGI Medicaid do face asset limits (typically $2,000 for an individual).
How long does it take to get approved for Medicaid in PA?
Most applications are processed within 30 days. Disability-related applications may take up to 45 days. You can check your application status online through COMPASS.
Can I apply for Medicaid and other benefits at the same time?
Yes. The COMPASS online portal lets you apply for Medicaid, SNAP, TANF, LIHEAP, and Child Care Works all in a single application. The system will check your eligibility for each program based on the information you provide.
What happens if I earn too much for Medicaid?
If your income exceeds Medicaid limits, you may qualify for subsidized health insurance through Pennie, Pennsylvania's state-based marketplace. Visit pennie.com to see your options. Children who exceed Medicaid limits may qualify for PA CHIP.
Is Pennsylvania Medicaid the same as Medical Assistance?
Yes. "Medical Assistance" (MA) is the official name for Medicaid in Pennsylvania. The terms are used interchangeably.
Do undocumented immigrants qualify for Pennsylvania Medicaid?
Generally, undocumented immigrants do not qualify for full Medicaid benefits. However, emergency Medicaid is available regardless of immigration status for qualifying emergency medical conditions. Pregnant women may also have additional options.
How do I find a doctor that accepts Pennsylvania Medicaid?
Once you are enrolled in a managed care plan through HealthChoices, your MCO will provide a directory of in-network providers. You can also call your MCO's member services line for help finding a doctor near you.
Take the Next Step
Applying for Pennsylvania Medicaid could save you thousands of dollars in healthcare costs each year. The process is free, and you can apply online in about 20 minutes through COMPASS.
If you are not sure whether you qualify for Medicaid or other assistance programs, use our free benefits screener to find out in just a few minutes. It checks your eligibility for over 11 programs at once, including Medicaid, SNAP, LIHEAP, and more.
