Pennsylvania Medicaid Eligibility Calculator
Check if you qualify for Medicaid in Pennsylvania (PA). Enter your household size and income to see eligibility for adults, children, and pregnant women. ✓ Expanded
Pennsylvania Medicaid at a Glance
138%
Adult FPL Limit
326%
Child FPL Limit
3,600,000
Enrolled
5.2%
Uninsured Rate
Check Your Eligibility
Pennsylvania Medicaid Income Limits (2026)
| Household Size | Adult Limit | Child Limit | Pregnant Limit |
|---|---|---|---|
| 1 person | $21,597/yr | $51,019/yr | $34,430/yr |
| 2 people | $29,187/yr | $68,949/yr | $46,530/yr |
| 3 people | $36,777/yr | $86,879/yr | $58,630/yr |
| 4 people | $44,367/yr | $104,809/yr | $70,730/yr |
| 5 people | $51,957/yr | $122,739/yr | $82,830/yr |
| 6 people | $59,547/yr | $140,669/yr | $94,930/yr |
| 7 people | $67,137/yr | $158,599/yr | $107,030/yr |
| 8 people | $74,727/yr | $176,529/yr | $119,130/yr |
What Pennsylvania Medicaid Covers
Pennsylvania Medicaid provides comprehensive health coverage including:
✓ Doctor & specialist visits
✓ Hospital inpatient & outpatient
✓ Prescription medications
✓ Lab tests & X-rays
✓ Mental health services
✓ Preventive care & screenings
✓ Emergency room visits
✓ Maternity & newborn care
✓ Dental (varies by state)
✓ Vision care (varies by state)
How to Apply for Medicaid in Pennsylvania
1. Online: Visit your state Medicaid website or HealthCare.gov to submit an application.
2. Phone: Call 1-800-318-2596 (TTY: 1-855-889-4325) to apply by phone.
3. In Person: Visit your local Pennsylvania Department of Social Services or Medicaid office.
4. Mail: Download and mail a paper application from your state Medicaid website.
Tip: You can apply for Medicaid at any time — there is no open enrollment period. Processing typically takes 45 days (90 days for disability-based applications).
Frequently Asked Questions
What are the Pennsylvania Medicaid income limits for 2026?
In Pennsylvania, Medicaid income limits are 138% FPL for adults (expansion state), 326% FPL for children, and 220% FPL for pregnant women. For a single adult, this means approximately $21,597/year.
Has Pennsylvania expanded Medicaid?
Yes, Pennsylvania has expanded Medicaid under the Affordable Care Act, covering adults up to 138% of the Federal Poverty Level (FPL). This means more low-income adults qualify for free or low-cost health coverage.
How do I apply for Medicaid in Pennsylvania?
You can apply for Pennsylvania Medicaid online at HealthCare.gov, by calling 1-800-318-2596, visiting your local Medicaid office, or mailing a paper application. Applications are accepted year-round.
What is MAGI and how does it affect Medicaid eligibility?
Modified Adjusted Gross Income (MAGI) is the income methodology used for most Medicaid eligibility determinations. It includes taxable income, tax-exempt interest, and Social Security benefits. Deductions like student loan interest and IRA contributions are subtracted. A 5% income disregard is applied to the FPL threshold.
Can I have assets and still qualify for Pennsylvania Medicaid?
For most MAGI-based Medicaid categories (adults, children, pregnant women), there is no asset test — only income matters. However, elderly and disabled applicants may face asset limits, typically $2,000 for individuals or $3,000 for couples, though some states have eliminated asset tests.
What is the Medicaid coverage gap in non-expansion states?
Since Pennsylvania has expanded Medicaid, there is no coverage gap. All adults up to 138% FPL are covered.