Medicaid plans › Pennsylvania
Pennsylvania Medicaid Managed-Care Plans for Providers
Enrollments are billed 50% at the start and 50% at submission; everything else 100% at the start.
Pennsylvania Medical Assistance is run by the Pennsylvania Department of Human Services. 2,738,844 people were enrolled in its 7 managed-care plans in 2024. To see their patients, a provider enrolls with Pennsylvania Medical Assistance through PROMISe, then applies to each plan separately.
| Plan | Members (2024) | Share | Parent |
|---|---|---|---|
| Vista Health Plan (AmeriHealth Caritas Pennsylvania and Keystone First) | 990,564 | 36.2% | Independence Health Group |
| UPMC Health Plan | 713,760 | 26.1% | In-state |
| Geisinger Health Plan | 428,376 | 15.6% | In-state |
| Health Partners Plan | 310,182 | 11.3% | In-state |
| Highmark Wholecare | 121,751 | 4.4% | Highmark |
| UnitedHealthcare Community Plan | 95,611 | 3.5% | UnitedHealth Group |
| Pennsylvania Health & Wellness | 78,600 | 2.9% | Centene |
How Joining Works in Pennsylvania
First the state: Pennsylvania Medical Assistance enrollment through PROMISe, which gives you the Medicaid ID every plan asks for. Then the plans: each takes its own participation request and credentials you from your CAQH ProView (DataSpring) profile. 4 parent companies run plans here, and plans owned by the same company still contract state by state.
How to Join Each Pennsylvania Plan
Vista Health Plan (AmeriHealth Caritas Pennsylvania and Keystone First) (Independence Health Group): Plans in the AmeriHealth Caritas family take participation requests on each plan's own provider website and credential from your CAQH ProView (DataSpring) profile.
Highmark Wholecare (Highmark): This is Highmark's Medicaid line, contracted separately from Highmark's commercial network.
UnitedHealthcare Community Plan (UnitedHealth Group): UnitedHealthcare Community Plans use UnitedHealthcare's provider onboarding: a participation request on the UnitedHealthcare provider site, credentialing from your CAQH ProView (DataSpring) profile, then a state-specific Community Plan agreement.
Pennsylvania Health & Wellness (Centene): Centene runs this plan alongside its Ambetter and Wellcare products. Each Centene plan takes its own contract request on the plan's provider website, credentials from your CAQH ProView (DataSpring) profile, and will not load a provider without the state Medicaid ID.
UPMC Health Plan, Geisinger Health Plan, Health Partners Plan: This plan is run in-state rather than by a national carrier, so participation requests go to the plan's own provider relations or contracting team, listed on its provider website.
Also in Pennsylvania: Medicare, Pennsylvania Medical Assistance and commercial credentialing.
Questions
Which Pennsylvania Medicaid plan is the largest?
Vista Health Plan (AmeriHealth Caritas Pennsylvania and Keystone First), with 990,564 members in 2024, 36.2% of the 2,738,844 people enrolled in Pennsylvania's Medicaid managed-care plans.
Do I have to join every Pennsylvania Medicaid plan?
No. Each plan is a separate contract. Practices usually start with the two or three largest plans in their county, then add others as patients ask for them. All of them require Pennsylvania Medical Assistance enrollment first.
Membership from KFF, Medicaid MCO Enrollment by Plan and Parent Firm, 2024. Plans change when the state rebids its contracts; we confirm the current list on every file.