Medical Assistance for Older People and People with Disabilities

Pennsylvania's Medical Assistance program provides health care benefits for older people and people with disabilities. Information on this page describes general eligibility requirements and benefits.

Categorically Needy

  • SSI recipients
  • SSI-related (age 65 or older, disabled and blind) persons
Number of
People
NMP Categories
Net Monthly
Income Limit
1$757.10
2 $1136.30

Medically Needy Only

SSI-related (aged, disabled and blind)

Number of
People
MNO Categories
Net Monthly
Income Limits
MNO Categories
Net 6-Month
Income Limits
1$ 425$ 2,550
2$ 442$ 2,650
3$ 467$ 2,800
4$ 567$ 3,400
5$ 675$ 4,050
6$ 758$ 4,550
7$ 850$ 5,100
8$ 942$ 5,600
Each Additional Person$ 92$ 550

State Blind Pension

State-funded program for persons who meet visual and other eligibility requirements.

Healthy Horizons

Eligible persons may be eligible to receive help to pay their Medicare premiums. The Medical Assistance program (also referred to as Medicaid) includes a coverage plan designed to help elderly individuals or individuals with disabilities who are eligible for Medicare to pay some or all of their Medicare premiums. Individuals must meet the income and resource limits. Income limits are based on a percentage of the Federal Poverty Income Guidelines (FPIGs), which are revised annually.

Healthy Horizons includes the following:

Qualified Medicare Beneficiary (QMB) - Categorically Needy Program

Also referred to as Healthy Horizons in Pennsylvania, individuals who qualify for these benefits are eligible for Medical Assistance payment of their Medicare Part A and Part B premiums and payment of Medicare deductibles and coinsurance. They are also eligible for medical coverage through the Medical Assistance program. Income and resource limits are as follows:

Number of
People
2017 Federal
Poverty Level (FPIG)
Monthly Income Limit
(FPIG + $20 Deductible = Limit
Resource
Limit
1100% or less$1,005 + $20 = $1,025$2,000
2100% or less$1,354 + $20 = $1,374$3,000

Qualified Medicare Beneficiary (QMB)-Medicare Cost-Sharing Program

Also referred to as Healthy Horizons-Medicare Cost-Sharing in Pennsylvania, individuals who qualify for these benefits are eligible for payment of their Medicare Part A and Part B premiums and payment of Medicare deductibles and coinsurance. Income and resource limits are as follows:

Number of
Persons
2017 Federal
Poverty Level (FPIG)
Monthly Income Limit
(FPIG + $20 Deductible = Limit)
 
Resource
Limit
1100% or less$1,005 + $20 = $1,025$7,390
2100% or less$1,354 + $20 = $1,374$11,090

Specified Low-Income Medicare Beneficiary (SLMB) Program

Individuals who qualify for these benefits are eligible for payment of their Medicare Part B premium only. Income and resource limits are as follows:

Number of
Persons
2017 Federal
Poverty Level (FPIG)
Monthly Income Limit
(FPIG + $20 Deductible = Limit)
Resource
Limit
1At least 100% but less than 120%$1,005 + $20 = $1,025
Less than $1,206 + $20 = $1,226
$7,390
2At least 100% but less than 120%$1,354 + $20 = $1,374
Less than $1,624 + $20 = $1,644
$11,090

Qualifying Individuals Group 1 (QI-1)

Individuals who qualify for these benefits are eligible for payment of their Medicare Part B premium only. Income and resource limits are as follows:

Number of
People
2017 Federal
Poverty Level (FPIG)
Monthly Income
Limit (FPIG + $20 Deductible)
Resource
Limit
1At least 120% but
less than 135%
$ 1,206 + $20 = $1,226
Less than $ 1,357 + $20 = $1,377
$7,390
2At least 120% but
less than 135%
$1,602 + $20 = $1,622
Less than $1,827 + $20 = $1,847
$11,090