Keystone Mercy Health Insurance Company originated as Mercy Health Plan in 1982 in West Philadelphia, at Misericordia Hospital. In 1996, Mercy Health Plan joined Keystone Health Plan East, an Independence Blue Cross company, and became a health insurance company known as Keystone Mercy. With a special concern for the poor, Keystone Mercy Health Insurance Company is Pennsylvania’s largest Medical Assistance (further referred to as Medicaid) plan.
Headquartered in Philadelphia, Keystone Mercy serves more than 300,000 recipients in Southern Pennsylvania. Bucks County, Chester County, Delaware County, Montgomery County, and Philadelphia County are part of Keystone Mercy’s ministry, which is run by the Sisters of Mercy.
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Top Ranked Philly Health Plan
Being ranked number 18 among all Medicaid health plans makes Keystone Mercy the top ranked plan in Philadelphia and one of the highest ranked plans in the nation. In 2006, they were named as one of America’s Best Health Plans by U.S. News and World Report. The NCQA (National Committee for Quality Assurance) has awarded them an excellent status, which is the highest accreditation you can receive.
Keystone Mercy Health Hoops® Program
The NCQA has also recognized Keystone Mercy for Innovative Practices in Multicultural Health Care for their Health Hoops® program. Initially started as a basketball program in 2003 for pediatric asthmatics, it has now been expanded to include other childhood diseases such as obesity and heart disease. The program’s goal is to educate on disease management, such as proper medication usage, nutrition, exercise, and recreation. It includes comprehensive screening, personalized health plans, and personalized health education. With more than 2,500 participants in Southeastern Pennsylvania, including children ages three to six, the successful program is in the process of going national. It is already established in South Carolina and is currently being developed in Florida and Kentucky. Additionally, Keystone Mercy and its employees volunteer time and resources for a variety of charitable organizations. They also have an Annual Mission Partnership Program that supports their Member Scholarship Program, Member Art Program, and Gifts of Mercy program.
Defining Pennsylvania Medicaid
Pennsylvania Medical Assistance (MA), also known as Medicaid, is offered through the Department of Public Welfare and is a joint state and federal program that covers 1.9 million Pennsylvania residents. This program pays for health care services for eligible members, who are typically low income individuals with high medical expenses. For people that do not qualify, their children may still be eligible for assistance through CHIP (Children’s Health Insurance Program).
Pennsylvania Medicaid is available to qualifying individuals based on certain eligibility requirements. In addition to being a United States citizen or lawful alien and being a Pennsylvania resident, you must also fit into a specified coverage group, meet income requirements for that group, which are calculated as a percentage of the Federal Poverty Level, and meet resource and asset requirements for that group.
Depending on your county, eligible participants will be covered either by HealthChoices or Fee-for-Service. HealthChoices offers various options for treatment once you join a MCO (Managed Care Organization). The MCO will help you find a provider, who will be your PCP (Primary Care Provider), and even assist you with making appointments if necessary. The Fee-for-Service option allows all doctors to participate, although many choose not to. With this plan you are responsible for locating a doctor who will accept the ACCESS card and you will need to make all of your own appointments.
Pennsylvania residents that are eligible for Keystone Mercy’s health plan have access to a network of 2,105 PCPs (Primary Care Practitioners), 6,798 specialists, 225 dentists, and 60 hospitals. Depending on your category of assistance, medically necessary benefits include: non-emergency ambulance services, behavioral health treatment that includes mental health, drug and alcohol services, CAT or CT scans, chiropractors, durable medical equipment, emergency room service, EPSDT (Early and Periodic Screening, Diagnosis, and Treatment), which includes well-child visits and immunizations, Family Planning, hearing aids for children under twenty-one years of age, MRI and MRA, orthodontia for teeth and jaws for children under the age of twenty-one, orthopedist for bones, PCP visits, podiatrist, prescriptions, routine dental exams for children under twenty-one, routine OB/GYN visits, tobacco cessation counseling, vision services, and a twenty-four hour nurse line.
Co-payments vary in range from $0 to $6 depending on the service(s) received. In addition to the benefits of the Medicaid plan, members are offered health education and wellness programs in order to better manage their health in an effort to avoid serious illness.
Keystone Mercy Coverage Network
In order to use the Keystone Mercy network, you must choose a PCP. Your PCP will oversee your health and refer you to specialists and other providers as necessary. Qualified PCPs are family practice doctors and general practitioners who treat adults and children, internal medicine doctors or internists who treat adults over the age of eighteen, pediatricians who treat newborns through to the age of twenty-one, and some CRNPs (Certified Registered Nurse Practitioner). In certain extreme cases, such as a disabling disease or someone with special needs, a specialist may be chosen as a PCP. Medicare members have the exceptional right to choose Medicare-covered services from a Medicare provider.
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Medicaid is one insurance option for many low income households who cannot afford private insurance or do not have access to a group plan. To compare different health insurance options for your needs, free of charge, please enter your zip code above.