Medicaid
Frequently Asked Questions
About Medicaid and Health Partners Plans

You may be eligible for Medicaid depending on your financial situation or other Federal eligibility requirements. Medicaid covers individuals and families who qualify based on low-income status or non-financial factors, such as pregnancy, veteran status, age or disability. To join Health Partners Plans Medicaid, you must also be a resident of Pennsylvania.

To see if you are eligible, visit COMPASS.

You can apply for Medicaid through Pennsylvania’s online application portal, COMPASS to complete an online application.

If you qualify for Medicaid in Pennsylvania, enrolling in Health Partners Plans Medicaid is easy! Visit our How to Enroll page to get started.

If you have questions about Health Partners Plans Medicaid or the benefits we offer, our friendly Member Relations team is here to help. Call us at 1-800-553-0784 (TTY 1-877-454-8477).

If you are already a member, your member portal is also a great place to start. Here, you can order a new ID card, change your provider, access personalized benefits information and more. Click here to login.

Still can’t find what you’re looking for? Call our friendly Member Relations team at 1-800-553-0784 (TTY 1-877-454-8477). 

Benefits & Services

As a Health Partners Plans Medicaid member, you have no copays for covered Medicaid physical health services. To view a full list of covered services, please refer to your member handbook.

Your member handbook will have the latest information on covered and non-covered services, plus benefit information. The handbook and other important resources can be found here.

You can find a list of your benefits on our Medicaid plan page or in your member handbook. If you have any questions, our Member Relations team is here to help. Call us at 1-800-553-0784 (TTY 1-877-454-8477).

Outpatient laboratory services are provided through our preferred laboratory partner, Quest Diagnostics. We also contract certain hospitals for lab services. You can find participating locations via our online directory.

You can get care through telehealth for non-emergency medical conditions. As a Health Partners Plans Medicaid member, you can see a doctor without ever leaving your home. You have access to Jefferson providers 24/7 with JeffConnect. Download the JeffConnect app from the App Store or Google Play to get started.

You can also use Teladoc®. This is a phone and video service that connects you with doctors. Teladoc consults are free for Health Partners Plans Medicaid members. To register with Teladoc, visit Teladoc.com. Have your member ID number ready. 

If you have questions about telehealth, call Member Relations at 1-800-553-0784 (TTY 1-877-454-8477).

Health Partners Plans (HPP) offers benefits and programs that help you take an active role in your health.

Our programs include:

Are you dealing with more than one serious health problem? For example, do you have both diabetes and congestive heart failure?

Our care managers in the Disease Management Unit can help you with chronic health problems, including complex cases of multiple health conditions. Our experienced staff can help you arrange the care you need to help make living with these health problems easier.

For more information or to take part in our disease management programs, call 1-866-500-4571.

Help if you speak a language other than English

If you would like to request a Member Handbook or other Health Partners information in a language other than English, at no cost, just call Health Partners’ Member Relations department at 1-800-553-0784 (TTY 1-877-454-8477).

Help if you need an interpreter or TTY services

If you need an interpreter for any language, including sign language, or if you require TTY services for your healthcare needs, Health Partners’ Member Relations department can help you. Just call  1-800-553-0784 (TTY 1-877-454-8477).

If you need an interpreter and you call Member Relations, we have an online interpreter service that can help you. This service provides over 140 languages and is available 24 hours a day, seven days a week.

You will not have to make another telephone call to get this service. Member Relations will do this for you and will stay on the telephone with you. If you call the TTY line, you will be connected to a text telephone right away.

There is no cost to you for these services.

Our Wellness Partners team hosts virtual cooking, fitness and life skills classes and community education workshops. All Wellness Partners events are free and open to the public. Check out our schedule of events.

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Providers

Your primary care provider (PCP) provides most of your health care and will help you get other services you may need from hospitals or specialists. Think of your PCP as your family doctor. He or she will keep all your medical records and know your medical history.

When you sign up for Health Partners, you can choose a Primary Care Provider in our network by using our online Online Directory. 

Call Member Relations at 1-800-553-0784 (TTY 1-877-454-8477) anytime if you ever want to change your PCP, or need help selecting one.

You can search for a provider by their name or specialty. You can also search for providers in your area by entering your zip code. Click here to learn more.

We update the provider directory every month. It includes information provided by doctors, hospitals or pharmacies. Click here to view the online directory.

If you have any questions about in-network providers, please call Member Relations at 1-800-553-0784 (TTY 1-877-454-847).

To see a specialist, you need to go to your primary care provider (PCP) to get a referral. This does not include routine dental, vision or OB/GYN care. 

If you are looking for mental health providers or providers who treat substance abuse, please call your county’s HealthChoices behavioral health organization.

Prescriptions

The Health Partners Plans Medicaid formulary contains two kinds of drugs: brand name and generic. This could affect which medications you get when using your benefit. When you search for a brand name drug on the formulary, you will see a generic equivalent (if available). View our formulary for more information. 

Health Partners Plans Medicaid works with local doctors and pharmacists to select the drugs in the formulary. We choose drugs that are safe, effective and high quality. New drugs and treatments are reviewed regularly. We make changes to the formulary as needed.

Your PCP must ask us to approve it for you. This is known as prior authorization. When we receive a complete request for prior authorization, we will contact you by phone within two business days from the date we received the request to tell you if we approved the service or item requested. To learn more, click here.

Health Partners Plans Medicaid typically limits medications to a 30-day supply. However, we offer an option for inexpensive chronic medications to be dispensed for a 90-day supply. This list is subject to change without notice.

A 90-day supply is also available through our mail order pharmacy, Caremark. Getting your prescriptions by mail is convenient. You will never miss a refill. You must have a valid prescription to use this service. Please note, not all covered drugs are available for mail order. To view the complete list of 90 days’ supply medications, click here. To learn more, call 1-800-756-7186 or visit Caremark.com/mailservice. 

To view a drug recall list, click here. If you are impacted by a drug recall, you will receive a drug recall notice from Health Partners Plans Medicaid.

To pay the lowest out-of-pocket costs for your prescriptions, you should fill them at an in-network pharmacy. We work with in-network pharmacies to provide lower prices on medications.

To view a list of covered prescription drugs, click here. 

In addition to in-network pharmacies, our online directory also includes in-network doctors, hospitals, labs and specialty services.

If you need medicine, your PCP or specialist will write a prescription. If you are eligible for prescription coverage, simply take the prescription slip to one of the more than 1,000 area pharmacies (drug stores) that fill Health Partners prescriptions. Your prescription will be filled if the prescription is covered under your pharmacy benefit. Depending on your category, you may be charged a copayment for your prescription. All members under age 18 are eligible for prescription coverage at no charge.

If you are asked to pay a copayment for your prescription and think you should not have to, please contact the Member Relations department from the pharmacy for assistance. If the pharmacist wants to charge you for a prescription, please ask him/her to contact Health Partners.

The Provider Directory also contains a list of participating pharmacies. If you need assistance, please contact Member Relations.

If you have questions about your eligibility for prescriptions, need help finding a pharmacy, or would like a complete list of participating pharmacies, call our Member Relations department toll-free at 1-800-553-0784 (TTY 1-877-454-8477). We are here to help you 24 hours a day, seven days a week.

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Rights & Responsibilities

At Health Partners Plans, we understand the importance of keeping your personal information private, and we take our obligation to do so seriously. This Notice of Privacy Practices (NPP) describes how medical information about you, as a Health Partners Plans Member, may be used and disclosed, and how you can get access to your information. 

A new federal rule that allows our members to easily access important health data is in effect. More information about member privacy and security resources will be posted soon.

Contact Information

If you have any questions about the Privacy Practices or if you think your privacy rights have been violated, you may contact the Health Partners Plans Privacy Office directly by U.S. mail at the address or by sending an email below:

Health Partners Plans
HIPAA Privacy Services
901 Market Street, Suite 500
Philadelphia, PA 19107
Email: PrivacyOfficial@hppplans.com

At Health Partners Plans, we want to keep you healthy. That’s why we pledge to give you the care you need, when you need it.

Health Partners Plans does not directly or indirectly give financial rewards or incentives (a gift or something else that will make someone want to do something) to doctors or staff to limit or deny approvals for care. In this way, Health Partners Plans makes sure that you get the care that is best for your medical needs.

If you have an emergency and you are outside the Health Partners service area, you should seek medical care from the nearest hospital or healthcare provider.

The hospital or provider may not be one of Health Partners’ participating providers. This means that you might need to transfer to a participating hospital or provider. This transfer cannot take place until your condition is stable. Your PCP will discuss your condition with the doctor who is treating you. They will decide when you can be moved.

Call your PCP within 48 hours or as soon as possible to arrange follow-up care. 

If you’ve moved or changed your phone number recently, it’s important to let the Department of Human Services (DHS) know. Health Partners depends on DHS to keep your address and phone number current, and DHS depends on you. You can make changes at your County Assistance Office or simply call 215-560-7226 (1-877-395-8930 outside Philadelphia)

Member Newsletter

If you would like a printed copy, please call Member Relations at 1-800-553-0784 (TTY 1-877-454-8477).

We share our newsletter three times a year, in the spring, summer and fall.