Medicare Savings Program Pennsylvania: Healthy Horizons Income Limits, Two Different Asset Limits, and Who Qualifies
Both are Pennsylvania's asset limits, and both are current. Healthy Horizons is not one programme — it is a family of them. The Categorically Needy tier carries full Medical Assistance on top of the Medicare help, and it uses the tighter $2,000 and $3,000 limits. The Cost-Sharing tiers pay Medicare costs only, and they use the higher federal resource figures. A page quoting one number without saying which tier it belongs to is describing half the programme.
Pennsylvania sits at the federal income floor and counts resources — but it counts them at two different levels depending on which tier you land in, and the higher one is generous enough that most people are not caught by it.
The tiers, and what each one pays
The state's regulations set these out in Chapter 140 of the Public Assistance Manual. In everyday terms:
| Tier | Income, as a share of the poverty guideline | What it pays |
|---|---|---|
| Categorically Needy sometimes written QMB Plus |
Up to 100% | Full Medical Assistance plus Medicare Part A and B premiums, deductibles and coinsurance |
| QMB Cost-Sharing | Up to 100% | Medicare Part A and B premiums, deductibles and coinsurance |
| SLMB Cost-Sharing | Over 100%, up to 120% | Part B premium |
| QI-1 | At least 120%, under 135% | Part B premium |
→ swipe the table sideways
Source: 55 Pa. Code Chapter 140, Subchapter B — eligibility provisions for the Healthy Horizons Program for the elderly and disabled. Percentages are of the federal poverty income guidelines, which Pennsylvania abbreviates FPIG.
You do not choose a tier. One application is measured against all of them, and the state places you. The practical consequence is that being over the QMB line is not a denial — there are two bands above it.
The 2026 numbers
Pennsylvania applies the federal standards for the cost-sharing tiers. What that program buys is the Part B premium — $202.90 a month in 2026, a little over $2,400 a year that stops coming out of your Social Security payment.
| Programme | Single | Couple | Assets |
|---|---|---|---|
| QMB | $1,350 | $1,824 | $9,950 / $14,910 |
| SLMB | $1,616 | $2,184 | $9,950 / $14,910 |
| QI | $1,816 | $2,455 | $9,950 / $14,910 |
| Categorically Needy carries full Medical Assistance |
Up to 100% FPIG | Up to 100% FPIG | $2,000 / $3,000 |
→ swipe the table sideways · Monthly gross income, including the $20 general disregard
Cost-sharing figures follow the federal Medicare Savings Program standards Pennsylvania applies; see our 50-state comparison. Tier structure and the Categorically Needy resource standard from 55 Pa. Code Chapter 140 and DHS eligibility guidance. Figures are revised annually — confirm with your County Assistance Office.
Why there are two asset limits, and what neither one counts
The tighter limit exists because the Categorically Needy tier is not only Medicare help — it opens full Medical Assistance, with doctor visits, prescriptions and long-term services attached. Pennsylvania applies its standard Medical Assistance resource rule there.
The cost-sharing tiers pay Medicare costs and nothing else, so they use the federal resource figures, which are roughly five times higher. Most people applying for premium help land in that group.
There is also a rule worth knowing that runs the other way. Pennsylvania is explicit that Medicare Buy-In always counts resources — even for household types that are exempt from resource tests in other Medical Assistance categories, such as households with a child under 21. There is no route around the resource test here.
What is never counted, at either level: the home you live in, one vehicle, household goods, family heirlooms, and certain prepaid burial arrangements. The paid-off house that stops people from applying was never in the calculation.
Three ways to file, what to gather, and the name to use at the counter — because asking for a "Medicare Savings Program" in this state can get you the wrong answer.
How to apply in Pennsylvania →How Pennsylvania compares
On these programmes alone, Pennsylvania is middling: federal income limits, a resource test retained. About eleven states set higher income ceilings and thirteen plus DC have dropped the asset test entirely.
| Single applicant | Pennsylvania | New York | Highest |
|---|---|---|---|
| QMB income | $1,350 | $1,856 | DC, $4,010 |
| Asset test | Yes | None | 13 states and DC count nothing |
| State prescription programme | Yes — PACE and PACENET | EPIC | — |
Comparison figures from our own 50-state table.
The last row is where Pennsylvania pulls ahead. Most states offer Medicare premium help and then nothing further. Pennsylvania adds a lottery-funded prescription programme with income ceilings many times higher than these, and no asset test at all. Someone who is turned down here may still walk straight into that one.
Six things that surprise people
$2,000 belongs to the tier that carries full Medical Assistance. The Medicare-only tiers use the far higher federal figures.
SLMB sits above it and QI above that. One application is read against every tier.
Your home, a vehicle, household goods and certain burial arrangements are excluded at every level.
Pennsylvania states that Buy-In counts resources even for households exempt in other categories.
Federal law bars providers from sending them. Invoices that keep arriving are a billing error, not a debt.
Any of these tiers makes you eligible for federal Extra Help automatically, with no second application.
| Programme name here | Healthy Horizons · Medicare Buy-In |
| Agency | Department of Human Services (DHS) |
| Rules | 55 Pa. Code Chapter 140, Subchapter B |
| Apply online | compass.state.pa.us |
| Consumer Service Center | 1-866-550-4355 |
| Programme page | pa.gov — Medicaid for older people |
Related programs
The procedureHow to apply in Pennsylvania→ If you are over these limitsPACE and PACENET: no asset test, far higher income→ CompareMedicare Savings Programs: all 50 states→ Comes with approvalExtra Help for prescription costs→Tools you'll need
pa.gov — Medicaid for older people
shiphelp.org — free Medicare counseling
medicare.gov/plan-compare — which drug plan costs least
findahealthcenter.hrsa.gov — clinics that charge by income
211.org — local help finder
Sources. 55 Pa. Code Chapter 140, Subchapter B — eligibility provisions for the Healthy Horizons Program for the elderly and disabled, including the income bands for each tier. Pennsylvania Department of Human Services, Medicaid for older people and people with disabilities, and Medicaid general eligibility — the resource rule for Medicare Buy-In. Federal Medicare Savings Program standards as applied by Pennsylvania; see our 50-state comparison for the underlying tables.
Verified: August 1, 2026. These figures are revised annually. Confirm with your County Assistance Office before relying on any number here.
This page explains a public program. It is not legal or financial advice and it is not an eligibility decision. Only the Department of Human Services can determine whether you qualify.
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