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Changes to PA Medicaid: What You Need to Know

July 21, 2022

Medicaid plans in Pennsylvania are changing! Some plans will no longer be offered at all in certain areas of the state, which means you might have to choose a new plan by August 16th.

Here’s what you need to know:

  • These changes do not affect people who have Community HealthChoices.
  • These changes do not mean you will lose your Medicaid benefits. You will keep your benefits, but you might have to choose a new plan.
  • Depending on where you live and what plan you have, you might have to choose a new plan to make sure you don’t have any coverage interruptions.
  • If your plan will no longer be available, you have until August 16th to choose a new plan that begins on September 1st. Otherwise, you will be automatically assigned a new plan that might not fit your needs.

Which plans are changing?

Aetna will no longer be available anywhere in PA. Anyone with an Aetna Medicaid plan will need to choose a new plan by August 16th.

Anyone with the following plans who also live in the counties listed will need to choose a new plan by August 16th:

United is leaving the Southwest and Lehigh/Capital regions.
The Southwest region includes: Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Somerset, Washington, and Westmoreland counties.

The Lehigh/Capital region includes: Adams, Berks, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Lancaster, Lebanon, Lehigh, Northampton, Perry, and York counties.

Gateway is changing its name to Highmark and is leaving the Northwest region. 
The Northwest region includes: Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, Mercer, McKean, Potter, Venango, and Warren counties.

Next Steps

Here’s what you need to do if these changes impact you:

  1. Check here to see if the plan you have is still available in your county and which plans will be added.
  2. 
If your plan is leaving, go to enrollnow.net to see which plans your doctors are in network with.
  3. Call PA Enrollment Services at 1-800-440-3989 (TTY: 1-800-618-4225) or go to enrollnow.net to select a new plan by August 16th.

Need Help? Call PHAN!

PHAN can help you choose a new plan or answer any questions you might have. Call, email, or text us at:

[email protected]
877-570-3642