Pa Health Care Exchange Enrollment Information

Pa Health Care Exchange enrollment allows you to purchase low-cost medical coverage without answering any medical-related questions. You don’t have to take a physical and regardless of what pre-existing conditions you have (or had),  your Pennsylvania health insurance plan will cover it.

But what about applying and enrolling for a plan? What about the glitches, the delays, the frustration and hair-pulling? Some of those issues have not disappeared, but with our professional assistance, obtaining quality Marketplace coverage at the most affordable price is guaranteed.

The Beginning Of The Process

We ask a few questions so we have the necessary information to determine the best plan options. The only information needed is the age of all persons to be covered, the household income (to determine the subsidy level), your county of residence, and your smoking status. No questions will be asked about your medical history, what prescriptions you take or any surgeries that need to be scheduled.

If you are over the age of 65, then you need to look at Pa Senior Healthcare options, which we discuss in the article linked in this sentence. The Exchanges do not offer coverage to persons that are eligible for Medicare or Medicaid.

Calculating Your Subsidy

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Don’t Gamble With Your Subsidy Calculation. We’ll Do It For You.

Determining how much money the government will give you to pay your health insurance premium is a very quick calculation. The subsidy is based on the modified adjusted gross income ( MAGI) of your household. Also taken into account is income from anyone listed on your tax return.

Members of your household that are not to be covered will actually increase the amount of the subsidy. For example, if your spouse is covered through an employer, although you do not need benefits for them, it will increase your eligible amount. And don’t worry. We’ll perform all of the calculations for you.

Picking A Plan

Platinum. Gold. Silver. Bronze. Catastrophic. Not only are there four Metal options and a catastrophic policy to choose from, but the total number of available policies is usually 40 or more. This is where our three decades of experience helps. Although securing affordable rates is important, the benefits you are most likely to be used must be covering with the lowest available copays and deductibles.

We are able to effectively research all available plans and determine (based on your budget, income and health) the best policies for you and every other family member. We explain, in detail, the coverages these policies will provide, and what your likely cost will be for the calendar year (both premium and out of pocket costs).

Doctors, Specialists And Hospitals

A healthcare plan is only as good as the network providers you can use. Selecting larger carriers usually means you won’t have trouble finding a doctor within 10-20 minutes of your residence. The companies with the largest networks include Highmark, UPMC, UnitedHealthcare, Aetna, Independence Blue Cross (Keystone), Capital Blue Cross and Coventry. However, smaller companies, such as Geisinger, should not be ignored if you reside in their territory.

The Application And Enrollment

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Need Help With Pa Healthcare Enrollment? Call Or Email Us!

Firstly, you don’t have to answer any medical questions. Your height and weight doesn’t matter and your medication information remains private. You will be asked if you use nicotine, but that’s the only information that is somewhat medically related. Since pre-existing conditions are covered, and your cost is not dependent on your health, the actual application is significantly shorter than the typical eight-page form from before 2014.

You may be asked to “verify your identity.” This involves one (or a few) questions requesting you to perhaps identify a street you used to live on, a mortgage company you did business with, or an old phone number that you once used. Although a bit unusual, this step does help with protecting your privacy. This step is ONLY needed when a subsidy is used and the .gov website is involved.

Once the plan is chosen, and the application is completed and submitted, it may take approximately 3-15 days to receive written confirmation from the insurer. Certain companies tend to be a bit quicker than others. For example, Highmark and Aetna  seem to be among the fastest Pa carriers to send out billing statements and ID cards. You can also manually pay a bill online with our assistance.

You can terminate coverage at any time and also modify and/or apply for a different plan at the end of every year during a new Open Enrollment. It is possible that additional carriers will be available during the next  period. While you have coverage, you will never be subjected to the hour-long waits at the government website or customer-service number.

Simply call or email us. As your broker-of-record, we’ll be able to quickly help you with your Pa Health Care Exchange issues or questions.


July 25 2014 – More than $5 million of refunds will be sent to customers in Pennsylvania that purchased individual or group policies in 2013. Why? The “80%  MLR” (Medical Loss Ratio) rule requires companies to spend at least 80% of their revenue on patient-care expenses. Any excess spending on administrative expenses, salaries and other unapproved costs must be refunded.

UniteedHealthcare’s Golden Rule will send checks for about $1.7 million while Aetna will refund about half of that amount. Many other large companies, such as UPMC and Highmark, met the 80% MLR rule. The average refund will vary, but is typically between $50 and $100.

Pennsylvania Health Marketplace FAQ

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.

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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)

HealthAmerica (Coventry)

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.

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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.

Healthcare Navigators In Pennsylvania May Help With Obamacare

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.

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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.