This resource from Children’s Hospital of Philadelphia provides information on how to switch Medicaid providers in Pennsylvania.
Why would I want to switch my Medicaid insurance plan?
Every county in Pennsylvania offers different Medicaid plan options (Managed Care Organizations). It’s important to know what plans the adult healthcare provider you want to see accepts. In order to see a particular provider you might choose to switch insurance plans.
Before switching your insurance, remember that all insurance plans are different. To compare Medicaid plans to see which one best meets your needs, go to https://enrollnow.net. Find the "Choose" option and navigate to "Compare plans." Select your county and the Medicaid options for that area will appear. You can select which plans you want to compare.
How do I switch insurance providers?
Call Pennsylvania Enrollment Services at 1-800-440-3989. You can also visit PA Enrollment Services.
You will need: patient’s name, address, date of birth and social security number, and which Medicaid plan you want to select.
You will also need to know the name of the adult healthcare provider you plan to see. If needed, you may keep the name of your pediatrician as your primary care provider on your insurance card until you decide on an adult provider. Youth with special health care needs have the right to request to see more than one adult provider if the first provider is not the right fit. Talk to the Special Needs Unit of your Medicaid plan for more information.
When does the new insurance plan start?
Usually, changes made early in the month are effective the first of the following month. However, it is important to ask the representative on the phone when the new insurance plan starts because the dates can change.
Is there anything else I should know?
Changing your insurance plan can sometimes affect your other care. Before making changes, explore the possible impact by talking to all those involved in your care.
- Call all the home care or medical supply companies you use to find out what plans they accept and if you would have to change companies with a new insurance plan.
- The new insurance plan may need special permission or authorization to cover prescriptions and other benefits like home nursing and medical supplies. All insurance plans are different, and it is possible that some benefits that you get now may be different or may not be covered by a new plan.
- If you already see other adult providers, call to make sure they accept any new plan.
All Medicaid members with special needs are eligible for support from the Special Needs Unit (SNU) under their individual plans. Learn more about what help they can provide and how to contact your plan.