Medicaid Eligibility in Pennsylvania: Income Limits & How to Apply
Medicaid Eligibility in Pennsylvania
Pennsylvania expanded its Medicaid program under the Affordable Care Act, opening PA Medical Assistance to adults aged 19-64 whose income falls at or below 138% of the federal poverty level. In 2026, that works out to roughly $21,597 for one person or $44,367 for a family of four.
Key threshold: If your income is below $21,597 (individual) or $44,367 (family of 4), you likely qualify for PA Medical Assistance with free or very low-cost coverage. No premiums, no deductibles.
The following residents are eligible for PA Medical Assistance:
- Adults aged 19-64 with income up to 138% FPL
- Children in families with income up to 200-300% FPL (varies by age)
- Pregnant women with income up to 185-200% FPL
- Seniors and people with disabilities who meet income and asset requirements
About PA Medical Assistance
If you're a Pennsylvania resident trying to understand your healthcare options, you'll want to explore PA Medical Assistance, which is the state's Medicaid program. It provides free or low-cost health coverage to eligible individuals and families. Adults under 65 with household incomes up to 138% of the Federal Poverty Level (FPL) can qualify. For example, in 2026, a single person could qualify with an income up to $22,025 annually, a household of two up to $29,864, and a household of three up to $37,702. Children and pregnant individuals have higher income thresholds. As of May 2025, nearly 3 million children and adults are enrolled in Pennsylvania Medicaid, demonstrating it's a significant and active program in the state.
If your income is slightly above the PA Medical Assistance limit, you might still qualify for financial help through Pennie, Pennsylvania's official health insurance marketplace. Here, you can receive subsidies, called Advanced Premium Tax Credits (APTCs), to lower your monthly premium, and potentially Cost-Sharing Reductions (CSRs) to reduce out-of-pocket costs like deductibles and copays. For instance, with a benchmark Silver plan costing around $512 per month, subsidies can significantly reduce what you actually pay. It is important to remember that your eligibility for either program can change with your income, so if your financial situation shifts, you should update your information to ensure you maintain coverage. If you were among the many Pennsylvanians who lost Medicaid coverage during the "unwinding" period after the public health emergency, you can reapply at any time.
PA Medical Assistance offers comprehensive benefits designed to cover a wide range of healthcare needs. This typically includes doctor visits, hospital stays, prescription drugs, mental health services, and long-term care. Generally, you will experience little to no cost-sharing for these services. Pennsylvania also has several unique waiver programs, such as the Consolidated Waiver and the Adult Autism Waiver, which provide home and community-based services to individuals with intellectual disabilities or autism, helping them live more independently. A notable program is the Children's PH-95 Waiver, which provides coverage for children under 18 with significant disabilities, and uniquely, does not consider parental income or assets for eligibility.
When applying for PA Medical Assistance, be prepared for potential processing delays and ensure you have all necessary documentation. Pennsylvania does have asset limits for certain Medicaid categories, particularly for those over 65, blind, disabled, or needing long-term care, though assets are generally not counted for most adults, children, and pregnant individuals. For a single individual, countable assets might be limited to $2,000, or $2,400 to $8,000 depending on income for specific programs. During the recent Medicaid unwinding, many people lost coverage due to procedural reasons, like not returning renewal forms. To avoid this, respond promptly to all requests for information from the state. Your immediate action step should be to visit COMPASS.state.pa.us to apply online or call 1-866-550-4355 for assistance.
Pennsylvania Medicaid Income Limits 2026
The following table shows the key income thresholds for Pennsylvania in 2026:
| Household Size | 100% FPL | 138% FPL (Medicaid Limit) | 400% FPL (Subsidy Limit) |
|---|---|---|---|
| 1 | $15,650 | $21,597 | $62,600 |
| 2 | $21,150 | $29,187 | $84,600 |
| 3 | $26,650 | $36,777 | $106,600 |
| 4 | $32,150 | $44,367 | $128,600 |
| 5 | $37,650 | $51,957 | $150,600 |
| 6 | $43,150 | $59,547 | $172,600 |
If your household income falls below the 138% FPL column, you qualify for PA Medical Assistance. If your income is between 138% and 400% FPL, you qualify for ACA marketplace subsidies to help pay for private insurance.
At $512/month, Pennsylvania's benchmark Silver plan premium is comparable to the national average of ~$525. Subsidies make marketplace coverage accessible for most income levels between Medicaid and 400% FPL.
Marketplace Insurance in Pennsylvania
Pennsylvania residents who do not qualify for Medicaid can purchase private health insurance through Pennie. The average benchmark (second-lowest cost Silver) plan in Pennsylvania costs approximately $512/month for a 40-year-old in 2026.
Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in Pennsylvania might pay after subsidies:
| Income Level | Annual Income | Expected Contribution | Estimated Monthly Premium |
|---|---|---|---|
| 150% FPL | $23,475 | 4.01% of income | ~$78/mo |
| 200% FPL | $31,300 | 6.52% of income | ~$170/mo |
| 250% FPL | $39,125 | 8.33% of income | ~$272/mo |
| 300% FPL | $46,950 | 9.83% of income | ~$385/mo |
| 400% FPL | $62,600 | 9.83% of income | ~$513/mo |
These are estimates for an individual. Actual premiums depend on your age, household size, tobacco use, and the specific plan you choose. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays.
Pennsylvania uses its own state-run exchange, Pennie, for ACA marketplace enrollment. The state platform handles both Medicaid screening and marketplace plan selection in a single application.
Pennsylvania's Medicaid program goes beyond the ACA's minimum requirements. PA Medical Assistance includes comprehensive benefits, and the state's investment in its own marketplace reflects a broader commitment to accessible healthcare coverage.
How to Apply for PA Medical Assistance
- Online application — Start at Pennie. Your Medicaid eligibility is checked automatically when you enter your income details.
- State Medicaid office — Apply directly through Pennsylvania's Medicaid agency at any time during the year. Unlike marketplace insurance, Medicaid has no enrollment deadline.
- Phone assistance — Call Pennsylvania's Medicaid helpline for guided help completing your application.
- In-person help — Visit your county human services office or a local navigator for face-to-face support.
Have the following ready: recent pay stubs or tax returns, proof that you live in Pennsylvania, Social Security numbers for everyone in your household, and details on any existing health insurance.
Calculate Your Subsidy in Pennsylvania
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in Pennsylvania.
Check Your Eligibility →Frequently Asked Questions
How much can I earn and still qualify for PA Medical Assistance?
In 2026, the Medicaid income limit in Pennsylvania is 138% of the federal poverty level: $21,597 per year for an individual, $29,187 for a household of 2, $36,777 for 3, and $44,367 for a family of 4.
Has Pennsylvania expanded Medicaid under the ACA?
Yes, Pennsylvania has expanded Medicaid under the ACA. Adults aged 19-64 earning up to 138% of the federal poverty level qualify for PA Medical Assistance.
Can I get ACA subsidies in Pennsylvania?
Yes. Pennsylvania residents with household income between 100% and 400% FPL ($15,650 to $62,600 for an individual in 2026) qualify for premium tax credits that reduce the cost of marketplace health insurance. Apply through Pennie.
What is the Pennsylvania Medicaid program called?
Pennsylvania's Medicaid program is known as PA Medical Assistance. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and adults up to 138% FPL.
What should I do if my PA Medical Assistance coverage is ending?
If your PA Medical Assistance coverage ends due to income changes or redetermination, you qualify for a Special Enrollment Period on the marketplace. This gives you 60 days to sign up for a private plan through Pennie. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
Does working disqualify me from Medicaid in Pennsylvania?
Yes. Medicaid eligibility in Pennsylvania is based on your Modified Adjusted Gross Income (MAGI), not your employment status. If your household income is at or below 138% FPL ($21,597 for an individual), you qualify for PA Medical Assistance even if you work full-time. Many PA Medical Assistance enrollees are working adults.
Should I choose Medicaid or a marketplace plan in Pennsylvania?
Medicaid (PA Medical Assistance) is free or near-free with no premiums or deductibles. Marketplace plans in Pennsylvania average $512/month before subsidies. If you qualify for Medicaid, it's the more affordable option. If your income puts you just above the cutoff, subsidized Silver plans with cost-sharing reductions are the next best thing.
Medicaid Eligibility in Nearby States
- Delaware Medicaid Eligibility — Expansion state
- Maryland Medicaid Eligibility — Expansion state
- New Jersey Medicaid Eligibility — Expansion state
- New York Medicaid Eligibility — Expansion state