Medical Assistance and CHIP in Berks County: Who Qualifies
Who qualifies for Medical Assistance, Pennsylvania's Medicaid, and for CHIP in Berks County: the 2026 income limits by household size and age, what CHIP costs by tier, how to apply through COMPASS or the county office, the HealthChoices plans that serve Berks, and the 2027 renewal and work rules.
If your household's income has dropped, someone in your house may now fit Medical Assistance, Pennsylvania's name for Medicaid. That includes a pregnant woman, a grandparent or other caretaker raising a child, and adults with no kids. The kids may fit CHIP, the state's insurance for children whose family earns too much for Medical Assistance. The only way to know for sure is to apply: one application, online through COMPASS, the state's benefits application, or at the Berks County Assistance Office in Reading, checks everyone in the house at once and places each person in the program they fit. Once the coverage starts you'll pick a primary care doctor, and our list of doctors in Berks County shows who's nearby.
Who qualifies for Medical Assistance in Pennsylvania, and what are the income limits?
The state covers children 18 and under, pregnant women, parents and caretakers of children under 21, and adults 19 to 64 under the income line. A parent or caretaker between 19 and 64 is in the adults group too, and a pregnant woman uses the higher pregnant-women line and counts the baby in her household size. People 65 and older and people with disabilities can qualify too, with an asset test; at 65, start with Medicare plans in Berks County. Pensions and Social Security count as income. How a layoff or unemployment pay is counted, and who counts as your household (an unmarried partner, a grandchild you're raising), is a caseworker's call at the county office; the application and your pay stubs settle it.
The lines come from the federal poverty guideline. For 2026, the adults line is $22,025 for one person and $45,540 for a family of four, and the lines for younger children and pregnant women sit higher.
| Household size | Adults 19 to 64 | Children 6 to 18 | Children 1 to 5 | Pregnant women and babies under 1 | Free CHIP, up to | Low-cost CHIP, up to |
|---|---|---|---|---|---|---|
| 1 | $22,025 | $21,227 | $25,058 | $34,314 | $33,197 | $50,115 |
| 2 | $29,864 | $28,782 | $33,975 | $46,526 | $45,012 | $67,950 |
| 3 | $37,702 | $36,336 | $42,893 | $58,738 | $56,826 | $85,785 |
| 4 | $45,540 | $43,890 | $51,810 | $70,950 | $68,640 | $103,620 |
| 5 | $53,379 | $51,445 | $60,728 | $83,162 | $80,455 | $121,456 |
| Each additional person | add $7,839 | add $7,555 | add $8,918 | add $12,212 | add $11,815 | add $17,836 |
Annual gross household income limits as the state printed them on October 28, 2026 (Medical Assistance columns effective January 13, 2026; CHIP columns effective March 1, 2026). The adults column is the state's 138 percent table, and those figures already include the 5 percent income disregard federal law allows on top of the 133 percent line the state's eligibility pages name; don't add it again. A child 1 or older who is over the Medical Assistance line for their age gets free CHIP, then low-cost (a baby under 1 goes straight to low-cost); above the last column, full-cost CHIP.
Take a family of four earning $48,000: a child under 6 fits Medical Assistance, a child 6 or older fits free CHIP, and the parents are over the adult line and go on to Pennie. This is general information, not a promise, so a question about your own household goes to the Berks County Assistance Office or the state's Customer Service Center at 1-877-395-8930.
What does CHIP cost for kids in Berks County?
CHIP, the Children's Health Insurance Program, covers uninsured kids under 19. The benefits are the same at every income. Free CHIP runs up to about $68,000 a year for a family of four, and above that you pay a monthly premium per child.
| Tier | Household income, family of four | Average premium per child, per month | Doctor visit | Specialist visit | Emergency room visit | Prescriptions |
|---|---|---|---|---|---|---|
| Free | Above the Medical Assistance line, up to $68,640 | $0 | $0 | $0 | $0 | $0 |
| Low cost | $68,640 to $103,620 | $65 to $104, by income band | $5 | $10 | $25 unless the child is admitted | $6 generic, $9 brand name |
| Full cost | Above $103,620 | $281 | $15 | $25 | $50 unless the child is admitted | $10 generic, $18 brand name |
From the state's 2026 CHIP Income Guidelines Chart: income bands effective March 1, 2026, premiums and copays effective January 1, 2026.
The premiums in the table are averages, and the insurer you pick sets the actual amount. Across the eight insurers in Berks County, the cheapest low-cost band runs from $45.41 to $87.80 a month per child and the full-cost band from $199.25 to $380.64. The eight are Aetna Better Health Kids, Capital Blue Cross, Geisinger Health Plan, Highmark Healthy Kids, Jefferson Health Plans, UnitedHealthcare, UPMC for Kids, and WellKids by PA Health and Wellness; they all give the same benefits, what differs is price and network, and you can switch by calling the CHIP line at 1-800-986-5437. Our Get Help entry on CHIP in Pennsylvania covers the program.
How do you apply for Medical Assistance or CHIP in Berks County?
One application covers the whole house, filed four ways: online at COMPASS, by phone at 1-866-550-4355, by mail, or in person at the Berks County Assistance Office at 625 Cherry Street in Reading. how to apply for Medicaid in Berks County walks through each route. Berks Community Health Center's insurance assisters file it with you at its three Reading health centers, at 610-988-4838, extension 1211.
Have your pay stubs or tax forms, Social Security numbers and birth dates for everyone applying, and a birth certificate plus a driver's license or state ID. If you don't have every document, sign and submit anyway; the state follows up within 30 days.
A CHIP decision takes about four to six weeks, and coverage usually starts the first of the next month. Medical Assistance can currently cover bills from up to three months before the month you apply. From January 1, 2027 that window shrinks to one month for adults 19 to 64 who qualify on the adults line, and two months for everyone else, so apply now even if bills are piling up. While you wait, our post on how to see a doctor without insurance in Berks County covers where to be seen.
What happens after you're approved?
If anyone in the house got Medical Assistance, a mailed packet asks you to choose a HealthChoices plan, the managed care plan that runs your Medical Assistance coverage. Five serve Berks County: AmeriHealth Caritas Pennsylvania, Geisinger Health Plan, Highmark Wholecare, Jefferson Health Plans EverWell and UPMC for You, and you can compare or switch any time through PA Enrollment Services (enrollnow.net, 1-800-440-3989). You'll also pick a primary care provider in the network, so look at doctors in Berks County and how to find a doctor taking new patients in Berks County.
Until the plan starts you can get care with your ACCESS card, the state's Medicaid card. Mental health and substance use care run through a separate county plan, Community Care Behavioral Health in Berks; our Get Help entry on Behavioral HealthChoices in Berks County explains it. For a dentist, see dentists that take Medical Assistance in Berks County.
How do you keep your coverage at renewal, and what changes in 2027?
Medical Assistance renews every 12 months: a packet comes in a pink envelope about 90 days ahead, and you can renew by mail, on COMPASS, by phone or in person. Miss the date and coverage ends, but turn it in within 90 days and, if you still qualify, it reopens with no gap.
Starting January 1, 2027, adults 19 to 64 without a dependent child under 14 have to show, when they apply and at each renewal, at least 80 hours a month of work, volunteering, job training or school, or household income of at least $580 a month, or an exemption.
The exemptions include being a parent or caretaker of a child under 14, pregnant or postpartum, disabled or medically frail, in treatment for substance use, a veteran with a total disability, a former foster youth under 26, or recently incarcerated. If you apply before January 1, 2027, the work questions aren't on the application yet and start with your first renewal in 2027. It's checked at application and renewal, so losing a job before your renewal doesn't end your coverage. Some of those adults will then renew every six months; your next renewal date is on COMPASS or the myCOMPASS PA app.
What if your household is over the income line?
The application doesn't stop; the state sends it on to Pennie, Pennsylvania's insurance marketplace, where income-based savings are available. If you had Medical Assistance and lost it, you have 60 days to pick a Pennie plan; if what ended was a job plan, our post on Pennie open enrollment for Berks County residents covers your window.
Two limits apply. Someone denied Medical Assistance for not meeting the 2027 work requirement gets no Pennie savings, only full-price plans. And since October 1, 2026, some lawfully present non-citizens who are over 21 and not pregnant or postpartum, refugees and asylees among them, may no longer qualify for Medical Assistance; the county office can tell you whether that change reaches your household.
Apply today, on COMPASS tonight or at Cherry Street tomorrow, and let the state do the sorting. Once the coverage starts, our guide to healthcare providers in Berks County picks up from there.
Questions people ask about Medical Assistance and CHIP in Berks County.
Do I have to choose between Medical Assistance and CHIP for my kids?
No, and you don't get to: the state places each child by the family's income and the child's age, so a baby on Medical Assistance beside older siblings on CHIP is a common result.
Do I have to sell my car or spend down savings to qualify?
No, not for the children, pregnant, parent and adult groups: there's no asset test. Questions about bank accounts and vehicles are asked only of people 65 or older, or with a disability, who don't have a child under 21 at home.
What if I'm denied?
The denial notice gives you 30 days to ask for a hearing, and the Pennsylvania Health Law Project's free helpline, 1-800-274-3258, opens for intake at 8 a.m. on scheduled Mondays and Wednesdays. If the denial is about income, the application goes on to Pennie.
Sources
- Pennsylvania Department of Human Services, "Medicaid / Medical Assistance General Eligibility Requirements" and "Apply for Medicaid Benefits" (read October 28, 2026): the eligibility groups, counted and uncounted income, the asset-test exceptions, residency, citizenship, Social Security numbers, the four ways to apply, what to have ready, and the HealthChoices plan choice.
- Pennsylvania Department of Human Services, "Federal Poverty Income Guidelines" (tables effective January 13, 2026; read October 28, 2026): the 138 percent Medicaid income table, the children's and pregnant women's table, the 133 percent column and the 100 percent poverty guideline.
- Pennsylvania Department of Human Services, "Medicaid/Medical Assistance for Children and Pregnant Women" and "Medicaid for Children with Special Needs (PH95)" (read October 28, 2026): the 215, 157 and 133 percent lines by age, the unborn-child household rule, and PH95.
- Pennsylvania Department of Human Services, "CHIP Income Guidelines Chart" (income effective March 1, 2026; premiums effective January 1, 2026) and "Appendix 8-A, 2026 Federal Income Guidelines for Determining CHIP Eligibility": the free, low-cost and full-cost bands, the average premiums and copays, and the 5 percent disregard note.
- Pennsylvania Department of Human Services, "CHIP Contractor Rate Information" (effective January 1, 2026, revised September 15, 2026): the insurers that list Berks County and each one's monthly premium by tier.
- Pennsylvania Department of Human Services, "CHIP Eligibility & Benefits", "Apply for the Children's Health Insurance Program" and "What is CHIP?" (read October 28, 2026): who qualifies, the benefits, no waiting list, 12 months of coverage, renewals and the CHIP line.
- Pennsylvania Department of Human Services, CHIP FAQs on eligibility and benefits, application status and your coverage (read October 28, 2026): one family in two programs, re-evaluation after an income change, the four-to-six-week decision, coverage from the first of the next month, applying before job coverage ends, and switching insurers.
- Pennsylvania Department of Human Services, "CHIP Insurance Companies" (read October 28, 2026): the statewide insurer list.
- Pennsylvania Department of Human Services, "County Assistance Offices" and "Helpful Phone Numbers" (read October 28, 2026): the Berks County Assistance Office address, hours and phones, the drop box, and the state's helplines.
- Pennsylvania Department of Human Services, "Application for Health Care Coverage" (form PA 600 HC, 7/22): the paper application, what you may need, the 30-day follow-up and the 30-day hearing window.
- Pennsylvania Department of Human Services, "Statewide Managed Care Map" (read October 28, 2026): the five HealthChoices physical health plans for the Lehigh/Capital zone, which includes Berks.
- PA Enrollment Services, "FAQ" (read October 28, 2026): the enrollment packet, choosing and changing a plan, the ID card and handbook, the ACCESS card, and what HealthChoices costs.
- Pennsylvania Department of Human Services, "Behavioral Health Managed Care Organizations" and County of Berks, "HealthChoices Program" (read October 28, 2026): Community Care Behavioral Health as Berks County's behavioral health plan and the county office's contact.
- Pennsylvania Department of Human Services, "Medicaid & CHIP Renewals" (read October 28, 2026): the pink envelope, the 90-day notice, the four ways to renew, the 90-day reopening window and the Pennie referral.
- Pennsylvania Department of Human Services, "Changes Coming to Medicaid in Pennsylvania in January 2027" and "FAQ: Medicaid Changes" (read October 28, 2026): the work and community engagement requirement, the exemptions, six-month renewals, retroactive coverage, self-attestation in 2027, the October 1, 2026 non-citizen change and the questions line.
- Pennie, "Loss of Medical Assistance Coverage" (read October 28, 2026): the transfer to Pennie, the 60-day window, the work-requirement exception and the non-citizen savings note.
- Berks Community Health Center, "Insurance Assisters" and Pennsylvania Health Law Project, "Get Legal Help" (read October 28, 2026): free application help in Berks and the statewide helpline for denials.