Individual and small group health insurance rates in Pennsylvania typically increase each year. The amount of the increase is determined by how much the insurer is requesting, and the amount that is ultimately approved after careful review by the Department. Any rate change must be fair and appropriate for both the carrier and consumer.
Prior to 2016, the general public could not view requests or findings unless the proposed increase was more than 10%. However, now you can view all results, regardless of the amount of change. And yes, sometimes, Pa health insurance prices reduce. Before a decision is made, several of the most important criteria include underwriting profits and losses, deducible and copay data, coverage changes, administrative fees, and historical and future predicted claim information.
We have listed below (courtesy of the DOI) the actual requested and approved changes submitted to the State Department of Insurance. These increases and decreases are reflected in 2016 Pa Marketplace plan coverage in the Keystone State.
Company Requested Increase Granted Increase
First Priority Life 29.5% 21.5%
Geisinger Health Plan 40.6% 20.0%
Geisinger Quality Options 58.4% 20.0%
Highmark Individual 25.5% 20.1%
Highmark Small Group 15.5% 9.9%
Highmark Benefits Group 13.5% 9.9%
HM Health 35.9% 26.2%
Keystone Health Plan West 36.6% 26.7%
Aetna Individual 5.6% 5.6%
Aetna Small Group 6.1% 5.2%
AmeriHealth 6.77% 6.88%
Capital Advantage Group -2.4% -2.4%
Capital Advantage Ind. 2.3% 1.6%
First Priority Life 9.5% 9.5%
Freedom Life 9.9% 0.0%
Geisinger Small Group 7.2% 7.2%
Geisinger Quality Options 9.88% 9.88%
Health Assurance 3.7% 1.9%
Highmark Advantage Group 9.7% 9.7%
HM Health 9.1% 9.1%
Inter-County Hospitalization 1.75% 1.75%
Keystone Health Plan Central -2.00% -2.00%
Keystone Health Plan East 2.8% 1.9%
Keystone Health Plan West 9.4% 9.4%
UnitedHealthcare Life 9.1% 3.5%
UPMC 0.0% 0.0%
Medicare Supplement coverage in Pennsylvania is an affordable option to pay for healthcare expenses that are typically not covered by original Medicare. The Keystone State features many low-cost Senior plans that reduce your out-of-pocket costs and include guaranteed enrollment. The best Pa Medigap policies are also very easy to apply for. Maximum benefits or exclusions may apply to specific plans.
If you are age 65 or older, our website allows you to easily view and compare the best available plans at the lowest available rates. All quotes are free (see top of page) and are provided without any cost or obligation. Supplement policies are designed to pay your coinsurance, copayments, deductibles, and other expenses that are not typically paid for.
Parts A (hospitalization) and B (medical services) coverage are provided by the federal government. Part C are the privately-run Medicare Advantage plans which provide benefits for parts A and B, along with other coverage. Part D is your prescription drug coverage.
Available Pa Senior Plans
Available plans are standardized in the following forms: A, B, C, D, f, G, K, L, M, and N. A “high-deductible” option is also offered for Plan F. K and L contracts put a maximum cap on your annual out-of-pocket expenses each year. Once you have satisfied Part B deductible an annual limit, 100% of covered benefits are paid. Premiums are based on either community-rated, issue-age rated, or attained-age rated underwriting. Generally, Plan G is the most comprehensive, while Plan A provides the fewest benefits.
Illustrated below are the specific plans offered by companies licensed and approved to offer coverage in Pa.
2016 Pennsylvania Medicare Supplement Plans
Aetna – A, B, F, F (High Deductible), G, N.
American Continental – A,B,F, F (High Deductible), G, N.
American Progressive Life – A,B,C,D, F (High Deductible, G.
American Republic – A,B,F, F (High Deductible), K, L.
American Retirement Life – A,B,F,G,N.
Avalon – A,B,C,F,N.
Bankers Fidelity Life – A,B,F, F (High Deductible), G,K.
Blue Cross of Northeastern Pa – A,B,C,F, F (High Deductible), N.
Capital Blue Cross – A,B,C,F,N.
Central States – A,B,C,D,F,G,N.
Colonial Penn Life – A,B,F,F (High Deductible),G,K,L,M,N.
Companion Life – A,B,F,G.
Equitable – A,B,F,N.
Forethought – A,B,C,G,F,N.
Geisinger – A,B,C,F,F (High Deductible),M,N.
Gerber – A,B,C,D,F,G.
Globe Life & Accident – A,B,C,F (High Deductible).
Government Personnel Mutual – A,B,C,D,F,G,N.
Highmark Blue Cross Blue Shield – A,B,C,F, F (High Deductible), N.
Highmark Blue Shield – A,B,C,F,F (High Deductible), N.
Humana Dental – A,B,F,F (High Deductible),K,N.
Humana – A,B,C,F,F (High Deductible), K,L,N.
Independence Blue Cross – A,B,C,F,F (High Deductible), N.
KSJK Life – A,B,C,D,F,G,M,N.
Liberty National – A,B,C,D,F,G,N.
Loyal American – A,B,C,D,F,G,N.
Manhattan Life – A,B,C,F,G,N.
Medico – A,B,F,F (High Deductible),G,N.
Mutual Of Omaha – A,B,C,D,F,G.
Oxford Life – A,B,C,N.
Philadelphia American Life – A,B,C,F,F (High Deductible),G,N.
Physicians Mutual – A,B,F,F (High Deductible),G.
Sentinel Security – A,B,C,D,F,G,N.
Standard Security Life – A,B,F,G,K,N.
State Farm – A,B,C,F.
Thrivent Financial – A,B,C,D,F, F (High Deductible),G,L,M.
Transamerica – A,B,C,D,F,G,K,L,M,N.
United American – A,B,C,D,F,F (High Deductible),N.
UnitedHealthcare (for AARP) – A,B,F,F (High Deductible),G,K,L,N.
United World Life – A,B,C,D,F,G,M.
UPMC – A,B,F.
Plans E,H,I, and J can no longer be purchased as new coverage. However, if you bought one of these plans (assuming it was issued before June 1, 2010), you were permitted to retain coverage. When the Medicare Modernization Act was passed, these three options were discontinued. The principal reason was that many of the benefits were duplicated on other plans, including comprehensive preventative coverage.
Although you are not required to change from an existing E,H.I. or J plan, it is often beneficial to consider alternative policies since your rate may reduce, while additional benefits are added. However, it is very important to properly compare all differences (including the premium), to determine if an upgraded contract is cost-efficient.
Pennsylvania Medicare Supplement and Medicare Advantage plans are offered through top-rated companies. Shop for customized coverage that meets your benefit and budget needs. If you are a legal citizen and have been in the United States for at least five years, you are likely eligible for benefits. Plans are issued individually, so, for example, if both you and your spouse enroll, two separate policies will be issued. This does not result in higher premiums.
Senior options can be fully-customized to help reduce out-of-pocket expenses. Free quotes are available at the top of this page. If you have not reached age 65 yet, it’s possible you may be eligible for Medicaid, or a subsidized Marketplace healthcare plan.
October 2015 – Open Enrollment began on October 15th and ends on December 7th. 2016 prices and plan details have been published. If you are satisfied with your current plan, unless otherwise notified, you can renew it or shop for alternative coverage.
Although same-sex couples can now legally marry in all US states, here in Pennsylvania, gay and lesbian partners were already able to marry for the last year. But now, it is the “law of the land,” as the Supreme Court ruled 5-4 that 14 states will no longer be able to enforce their ban. It took about 20 years of litigation, but the fight appears to be over.
In the majority opinion, Justice Anthony Kennedy proclaimed “no union is more profound than marriage. In forming a marital union, two people become greater than once they were.” The number of same-sex married couples (currently around 400,000) is expected to substantially increase.
Self-insured and self-funded group health plans subject to ERISA requirements may now be forced to offer medical coverage to same-sex spouses. Although this segment of the legislation is a bit vague, employers may choose to avoid risky and expensive litigation and simply offer the benefits. Also, “domestic-partner” coverage may simply continue, since the cost and coverage would be identical.
Discrimination Not Allowed
Since the Keystone State allows these types of marriages already, an insurer can not discriminate against either partner when applying for a policy, or when a claim is paid. Premium tax-credits and potential out-of-pocket expenses must also be treated without discrimination. However, in order to take advantage of subsidies, the couple must file a joint tax return or state that they intend to file together.
NOTE: In 2014, in the US District Court (Middle District of Pennsylvania) overturned the Pa “Marriage Laws” which required marriages to only be between members of the opposite sex. The Judge was John E. Jones III, and an appeal was not filed. Details of the ruling can be found here. The ruling took effect immediately since there was no stay.
Effect On Pennsylvania Health Insurance Coverage
Pa Healthcare Benefits For Same-Sex Couples Is Available
One of the biggest changes will save time, but not necessarily money. Prior to the ruling, many insurers insisted that each person (husband and husband or wife and wife) must be covered separately under two different policies. Although the overall cost may not have been impacted, often the maximum out-of-pocket expense was higher, and billing was more inconvenient.
By consolidating both persons on one Pa health insurance policy, a single deductible will be available from many carriers, including Highmark, Aetna, Keystone, UnitedHealthcare, and many more. Thus, if one partner has a major illness or sickness, and meets the annual deductible and applicable coinsurance, the other partner will have no out-of-pocket expense on covered expenses. UPMC health plans (Western Pa) will also incorporate these changes into their policy designs.
For example, many existing Silver-tier plans have an individual deducible of $3,000 and a family deductible of $6,000. Thus, if one person is hospitalized and meets the $3,000 single deductible, an additional $3,000 deductible must be met. However, beginning in 2016, depending on the policy and carrier, in the previous scenario, the entire deductible will have been met.
Less than 50% of small and large businesses offer medical benefits to unmarried same-sex couples. However, more than 90% offer coverage to spouses. And although the Supreme Court ruling on same-sex marriages does not specifically state that this practice must end, there will undoubtedly be an increase in the number of spouses that can now purchase a group policy.
“Domestic Partner Benefits,” however, may reduce, especially if you wok for a large company. If two partners decide they don’t want to get married, it’s possible the coverage they currently receive, would be less comprehensive than if they married. It’s expected that a simple comparison tool will be offered so employees in this situation cam make an educated and informed analysis.
Social Security benefits will now also be affected. Typically, there are more advantages than disadvantages to being married. Spouses, children, and the estate of the deceased could end up with more funds. Of course, sudden illnesses, divorce, prenuptial agreements, and divorce will now also play a role.
With Open Enrollment beginning again in November (effective date of policies will be January, February, or March of 2016), newer plans and coverage descriptions may be tweaked to include any mandated benefits or required changes. Existing plans can also be adjusted to conform to updated requirements. However, “grandfathered” plans that are not required to adhere to Affordable Care Act legislation guidelines, may remain the same.