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Pennsylvania Health & Wellness

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1-844-626-6813 
(TTY: 1-844-349-8916)
www.PAHealthWellness.com

To see a list of services covered by all plans, go to Physical and behavioral health benefits and Long-term services and supports.

Co-pays*

People with Medicare pay the co-pays below except prescription drug co-pays. People with both Medicare and Medicaid get most prescriptions through Medicare Part D. They pay Part D co-pays, not the prescription co-pays listed here.

Ambulance - Per trip $0

Dental care - $0

Inpatient hospital
Per day - $0
Maximum with limits - $0

Medical centers
Ambulatory surgical center - $0
Federal Qualified Health Center or Regional Health Center - $0
Independent medical/surgical center - $0
Short procedure unit - $0

Medical equipment
Purchase - $0
Rental - $0

Medical visits
Certified nurse practitioner - $0
Chiropractor - $0
Doctor - $0
Optometrist - $0
Podiatrist - $0

Outpatient hospital
Per visit – Outpatient surgical, except maternity - $0
Per visit – Non-surgical or diagnostic - $0

Prescriptions
Generic - $0
Brand name - $3

X-rays - Per service $0

Adult dental
  • Beyond Medicaid coverage of dental services, extra dental cleanings, visits and oral hygiene kit for participants who are Nursing Facility Clinically Eligible (NFCE)
Adult vision
  • Beyond Medicaid covered vision services, $100 yearly allowance for glasses or contacts for participants who are NFCE
Phone services
  • Free Smartphone with 1000 free talk minutes, 1 GB of data and unlimited texts for participants who qualify
Wellness programs
  • After hospital stay: 14 days of home delivered meals
  • After hospital stay: 14 days of respite care
  • Caregiver access and supports
  • Health library 
Other benefits
  • Healthy Rewards Program purchasing card to get health items at authorized retailers. Learn more on the My Health Pays™ web page
  • Support services for members waiting for LTSS eligibility determination
  • 90-day prescription refill for those not on Medicare 
  • 1 week of home delivered meals for each member leaving nursing facility, regardless of waiver benefit coverage

There are no co-pays for persons living in a nursing, personal care or domiciliary home. Pregnant women, new mothers and terminally ill participants getting hospice care have no co-pays. Some services, items and drugs have no co-pays. For co-pay updates, go to ow.ly/WGQM30hern9.