The Pennsylvania Health Insurance Marketplace (Exchange) provides Pa residents the opportunity to purchase affordable high-quality medical plans. No medical questions. No hassle. No denials or cancellations. We know you have questions, so here are some of the answers:
What Is The “Marketplace?”
It’s actually just another name for the Pa Health Insurance Exchange. The two terms are interchangeable. Typically, in a “marketplace,” you shop for the best deals from a variety of different companies. After learning and comparing, you have a much better understanding of the product choices.
Included in the operation are websites, online resources, and customer service call centers. More than 1 million residents in the state are without coverage, and we’re here to help, by providing free comparisons and an easy method to apply for a policy.
How Do I Find Available Plans?
There are a few ways. Of course, going directly to the .gov website is one option, although delays and logjams have made the enrollment process almost impossible for thousands of visitors. Perhaps the easiest way to view policies is to utilize our free quote feature, and you’ll be able to view and compare plans in your area.
Remember that different parts of the state will feature different carriers and plans. For example, while Capital Blue Cross may be available in Lebanon, you won’t find any of their plans offered in Pittsburgh.
How Much Does It Cost To Use These Services?
There are never any costs or fees for utilizing the newly-hired navigators, the 1-800 phone numbers that the government provides or any broker or assistance provided by our website. Any person that attempts to charge a fee is likely not authorized to assist you.
We Help You With Pa Marketplace Plan Selections
For example, we have helped consumers find, compare and understand their best options for more than 32 years and have never collected any fees. However, instead of the three-day training that is required to become a navigator, we have more than 30 years of experience assisting consumers obtain quality insurance coverage. That’s why most consumers prefer the free help we provide.
Who Are The Companies That Have Been Approved To Sell Policies Through The Pa Marketplace?
The following carriers are offering policies:
Capital Blue Cross
Independence Blue Cross (Keystone and QCC)
Blue Cross (Northeastern Pennsylvania)
Which Companies Have The Cheapest Pa Health Insurance Rates?
That depends where you live. For example, if you live in the Pittsburgh area (Allegheny or Westmoreland County), Highmark and UPMC (and perhaps Coventry) will offer the least expensive Exchange options. However, if you live in Lancaster County, Geisinger, Capital Blue Cross and Highmark may be the best choices. And in Montgomery County, Aetna and Independence Blue Cross have the most competitive prices.
So, as evidenced by the wide variation in pricing, it’s important to selectively shop (which is what we do best) so you are matched with the policies that best fit within your personal budget. If you move from one county to another, your options will change.
I Have A Pa COBRA plan. Can I Cancel The Coverage and Buy An Exchange Plan ?
You can not own both a COBRA plan and another policy at the same time. So, as long as you cancel COBRA benefits at the same time your Exchange contract goes into effect, during Open Enrollment, you can change. It is important to know in advance what your exact premium, federal subsidy, benefits and out-of-pocket costs will be. Also, if you are losing dental or vision benefits, you can choose if you want to replace them.
Will My Policy Go Into Effect Right Away?
If the application is completed by December 15th, you can get an effective date of January 1st. Starting in 2014, to have coverage effective the first day of the month, you must complete your enrollment by the 15th of the preceding month. But if you wait until the 16th of the month to apply, your coverage will not go into effect the following month.
I’m Staying With The Same Company. Will I Still Be Able To Use My Physician?
Probably, but it’s important you find out before enrolling. Many doctors and specialists are not participating in all policy plans. We can provide that information, or you can contact your physician or the government healthcare website.
Most Pa Plans Cover Generic And Non-Generic Drugs
I Currently Take Two Generic Medications And Two Non-Generic Medications. Are They Covered?
Each policy must provide a list or link of the formulary drugs that are covered. There is other additional information regarding usage, availability, mail-order and of course, cost. You can view a link to this list at the time you are viewing specific details about each plan.
Generic prescriptions should not have a high out of pocket cost. But if you take multiple non-generic prescriptions, it is important to discuss the specific policies that offer the lowest copays and/or deductibles. Appeals are possible if you are prescribed a drug that is not listed under your benefits.
I Am On Medicare. Am I Affected By These Changes?
No. If you are covered by Medicare, you can not apply for these new plans. And the new law that requires coverage to be purchased by 2014 is not applicable. However, you can purchase supplemental and Advantage plans that will cover many of the gaps in coverage.
Do I Have To Buy A Policy That Is Through The Exchange?
No. You can purchase coverage inside or outside. Plans issued outside of the Marketplace will not receive any subsidy reimbursement so they should only be considered in upper-income households. However, these “outside” plans do have some appealing features.
Applications will be much more streamlined and approvals will be quicker. It’s also likely that the number of available physicians and hospitals will be higher. And for persons that don’t want an “Obamacare” plan, the “off” options are issued directly by the insurance companies with no government involvement or privacy issues.
More than one million Pennsylvania residents don’t have health insurance. That’s about to change in the upcoming months with Open Enrollment in October that will allow individuals, families and small businesses to purchase affordable medical coverage. Our website, along with other brokers and navigators, will help Pa consumers choose the best plans and assist in determining eligibility for the federal subsidy. We will provide the most affordable Pa Health Exchange prices from each of the participating companies.
Recently, the Administration distributed approximately $3 million to five volunteer groups in Pa to assist in getting the word out. Nationwide, almost $70 million was spent on promoting community outreach programs, often with the help of “Navigators,” who will have limitations placed on the assistance they can provide. Although they are expected to help explain basic plan descriptions and show how consumers can apply for coverage, they can not make specific recommendations regarding which plans to apply for, or calculate tax subsidy amounts.
They will be most helpful in residential areas where residents are not comfortable using computers are using the internet. Also, for many disabled persons or others that lack transportation, once again, these are prime examples were navigators may help. However, they still are not able to provide the in-depth comparison and research that a broker-website like ours can offer.
Health and Human Services Secretary Kathleen Sebelius is hoping that a combination of elected lawmakers, industry leaders and community church and civil groups can help brokers (and websites like ours) contact persons that prefer face-to-face communication instead of internet or email. The amount of allocated money is less than anticipated since many states have chosen to let the federal government operate their Exchanges. About 34 states have declined to run their own Exchanges although most will re-consider next year.
Get Help With Applying For Pa Health Insurance Exchange
Here in Pennsylvania, like most states possible security breaches are major concerns. The flow of personal information, including social security numbers, medical records, tax information and other personal items will be a challenge to keep secure. Already, Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner is facing criticism regarding the Data Services Hub, which is the source of all information and data for the new Health Exchanges.
With Open Enrollment only a month ago, testing still has not been completed and numerous vulnerabilities still remain. CMS has indicated that all bugs and security issues would be fixed by October, when consumers can start applying for coverage. But there are many complex tasks that have yet to be completed, including independent analysis of system procedures, and explaining how secure subcontractors (that were recently hired) will be with the flow of information they provide.
“Resources For Human Development” received almost $1 million of free government money. This was the biggest donation given to any entity in Pa for this type of work. They will mainly focus on 10 counties, with special attention given to the Pittsburgh area. About five persons will be hired, which leaves little time to train, do thorough background checks and monitor past activities.
A 20-30 hour training module is required along with taking an passing a test. While this type of requirement is, of course, badly needed, it simply does not go far enough. The problem may be that the six-week allotted time limit is not enough. Six months of supervised classes, training and testing would have improved both the knowledge and confidence of the new workers. And having an active license from the Department of Insurance would have been the ideal requirement, if time was not a consideration.
So get ready! The Pennsylvania Healthcare navigators may be coming to a community near you. They are there to help, although licensed experienced brokers, and websites such as ours, will provide a much broader base of updated information and policy recommendations that will help you with the Pa Exchange Marketplace.
Update November 1 2013 – Delays and confusion continue to plague the .gov healthcare website. Of course, navigators are finding it difficult to help, since the enrollment process has been considerably slowed down. and their tasks have become more difficult. However, broker websites (such as this one) continue to provide perhaps the best method to view online quotes.
Expansion of Medicaid in Pennsylvania will have to wait. The State Senate has adjourned for the summer after narrowly missing passing a bill that would have provided virtually free health insurance coverage to hundreds of thousands of needy persons. Typically, the federal government pays the entire cost (at first), and then each state must pay for most or all of the coverage in the future.
A bill that was mostly related to the state budget did pass this week, but any mention of Medicaid expansion was removed. Earlier in the week, the Senate voted and approved a bill that would have provided the needed benefits. However, the next day, the House removed the Medicaid-related legislation.
One of the issues delaying the passage of the bill is the insistence by Pennsylvania Governor Tom Corbett that the federal government give permission to Pa to adjust and make changes to parts of the state Medicaid program. Although requested many months ago, there has been no definitive response from the federal government. Corbett wants assurances that specific reforms and guarantees will be provided.
Corbett has repeatedly contacted Kathleen Sebelius (US Department of Health and Human Services) requesting her not to transfer CHIP participants into Medicaid. The Pa CHIP program is different than many other states since it features a large network provider list that is bigger than local government-sponsored programs. Sebelius’ unresponsiveness is rather mysterious.
Will Pa Medicaid Expansion Get Approval?
Currently, about 16% of Pa residents are on Medicaid. However, under the expansion, that figure is expected to rise to about 25%. The financial burden on the state in future years could be substantial, and the money simply is not available. The only way to meet the cost of all of the extra coverage is to eliminate some current programs or increase taxes. Neither option would be very popular.
It has been verifies that the state will save almost $200 million by not going through with the expansion. The savings takes into account administrative costs, setup fees and additional salaries. The Rand Corporation also points out that by delaying expansion, between 30,000 and 40,000 employment opportunities might be gone along with more than a half billion dollars of ER expenses that hospitals could have covered by Medicaid.
Senate Minority Leader Jay Costa, however, believes that the expansion will ultimately be approved. One reason may be because it will improve Governor Corbett’s ratings, which have recently been dropping. Also, more than 50,000 less children were covered through Medicaid and related services last month, compared to early 2011.
The Senate reconvenes in September, and the subject will be discussed again. Senate Majority leader Dominic Pileggi, a Republican from the 9th District (Delaware and Chester Counties), indicated that perhaps an agreement could be reached after the summer break.
UPDATE: 10-16-2013 CHIP has been extended to 2015, thanks to the passage of legislation by the Pa House of Representatives. Governor Corbett is expected to sign the bill. The six-month waiting period (specific persons were subject to this) has been terminated. No additional funding is expected to be needed for this extension.
UPDATE 11-4-2013 Governor Corbett has submitted a proposal to the Obama administration regarding limiting plans, and requiring persons on Medicaid to show proof they are looking for employment, actively working or involved in a qualified job-training program. The use of Medicaid funds to buy healthcare from companies on the Exchanges has been tested in a few other states with no major drawbacks.
Blue Cross Blue Shield (BCBS) has many policyholders (soon to be ex-policyholders) that might benefit by this proposal. Since their guaranteed-issue policies are not being renewed, they would welcome the opportunity to purchase affordable benefits.
UPDATE 12-7-2013 Governor Corbett released details of his proposal to the Federal Government designed to provide billions of dollars of financial aid to Medicaid recipients. The proposal emphasizes healthy behavior and personal responsibility. For example, healthier persons that are working at least 20 hours per week, would be required to meet specific job-searching requirements to retain benefits.
UPDATE: 1-12-2013 Discussion continues on helping about 500,000 Pa residents with their healthcare benefits. A waiver is still being requested, and will hopefully be received so that the program can be implemented on July 1st of this year. One of the sticking points is the work-search provision. This type of clause has never been approved before, which may be why HHS has still not approved it.