Get an Application

Am I eligible for the HealthyCare Card?
• If you are eligible for health insurance, you will need to pursue these options before submitting this application.  Health insurance from your employer, or spouse’s employer, Medicare, the Federal Health Insurance Marketplace, Healthy PA.  See How to Get Insurance tab.
• Even with commercial health insurance you may still be eligible for financial assistance.
• Eligibility is based on household income and assets.

If you have questions, please contact us and we will help to guide you.

Not sure when your card expires?
The expiration date is located on the bottom right corner of your card.
  
Download the HealthyCare Card application – English Version  -  PDF 
  
Click here for one person applying (6 pages will print) 
  
Click here for each additional person applying (additional 2 pages print)
 
Download the HealthyCare Card application – Spanish Version - PDF 
 
Click here for one person applying (6 pages will print) 
 
Click here for each additional person applying (additional 2 pages print)

After completing an application please send it to:
 

In Adams County:

Healthy Community Network
39 N. Fifth Street
Gettysburg PA 17325

  

In York County:

Healthy Community Network
116 South George Street, Suite 101
York, PA  17401

 

Should you be approved, you will be sent a plastic card that looks like the picture below:

Contact or call any of the following locations to receive an application:

In Adams County:

Family First Health
Gettysburg Center
Peebles Plaza
1275 York Road Suite 17
Gettysburg
Telephone: (717) 337-9400

SCCAP  (South Central  Community Action Program, Inc.)
153 North Stratton Street
Gettysburg
Telephone: (717) 334-7634

United Way of Adams County
123 Buford Avenue
Gettysburg
Telephone: (717) 334-5809

Gettysburg Hospital
147 Gettys Street
Gettysburg
Telephone: (717) 334-2121

Hanover Hospital
300 Highland Avenue
Hanover 17331
Telephone: (717) 637-3711

WellSpan Medical Group
Telephone: 851-6816 or
800-839-1404
 
WellSpan HealthSource
1001 South George Street
York
Telephone: (717) 851-3500

Adams County Assistance Office
225 South Franklin Street
PO Box 4446
Gettysburg
Telephone: 800-638-6816

 

  

In York County:

Community Progress Council
226 East College Avenue,
York
717-846-4600
 
219 York Street
Hanover 17331
717-632-9191
 
Family First Health
South George Street Center
116 South George St., York
845-8617
 
Hannah Penn Center
415 E. Boundary Ave., York
843-5174
 
Hanover Center                                                                                        1230 High Street
Hanover 17331
(717) 632-9052
 
Hanover Hospital
300 Highland Avenue
Hanover 17331
(717) 637-3711
 
Memorial Hospital
325 South Belmont St.,
York
843-8623
 
United Way of York County
800 East King Street, York
843-0957
 
WellSpan HealthSource
1001 South George St.,
York
851-3500
 
WellSpan Physician Billing 
851-6816 or
1-800-839-1404

York City Bureau of Health
235 West Market St., York
849-2299
 
York County Assistance Office
130 N. Duke Street, York
771-1100
  
ForSight Vision
1380 Spahn Avenue, York
848-1630
www.forsight.org