Pennsylvania Health Exchange Marketplace

The Pennsylvania Health Insurance Exchange Marketplace provides guaranteed health care coverage to Pa residents regardless of medical conditions. Beginning in 2014 (Open Enrollment begins in October 2013) and created under the “Affordable Care Act” (ACA), the Marketplace will play an important role in the approval of Pennsylvania medical plans. Pre-existing conditions will no longer be considered in the underwriting and approval of new plans.

The Exchange will  represent the bulk of the top carriers including Independence Blue Cross, Keystone, Highmark Blue Cross Blue Shield, Aetna, UnitedHealthCare, Capital Blue Cross, HealthAmerica, Geisinger, Celtic and Assurant. It will be state-regulated, but broker-friendly. Federal subsidies will help reduce premiums for Pa residents with moderate incomes that qualify. Currently, the federal government will run the program, although the  legislature will still be able to play an active role if they choose. We expect this role to expand in years 2015 and 2016.

We will play an active role in assisting Pennsylvania consumers find low cost medical coverage that provides the benefits needed for each individual or family situation. Our website will provide free online quotes that allow you to easily compare the best  policies. We will provide personal and expert guidance  so that you are paying the lowest possible premium for the maximum amount of available benefits. There are many popular plans that will contain the required essential health benefits, and we’re always happy to explain those to you.

Two of the most critical aspects of the legislation are the requirement that all individuals must purchase healthcare coverage and making available federal subsidies that will substantially reduce premiums for many single persons, families and owners of small businesses. The tax (penalty) for not buying a policy in Pennsylvania is $95 per person or 1% of income, whatever is higher.

HealthCare11 150x150 Pennsylvania Health Exchange Marketplace

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Thus, if you make $50,000 per year and don’t buy a qualified plan, the tax is $500. In 2015, the penalty doubles to $325 and 2%. Thus, in this example, the penalty would be $1,000. And whether you live in Pittsburgh, Dillsburg or any part pf the state, the tax still applies. These amounts are “per person so the numbers are doubles for two adults. Children are only charged 50% of the tax.

The more positive change is the addition of tax credits (subsidies) that can potentially save thousands of dollars per year on the coverage you are forced to buy. The concept is simple. The less money you make, the bigger the amount of the subsidy. If you make too much, you are penalized by not qualifying for a subsidy. Yes, the concept could use a little tweaking! However, purchasing coverage away from the Marketplace may result in lower rates for some consumers.

It has yet to be determined if health care costs will reduce from the establishment of this program. Although many government officials feel consumers may initially pay less for their medical benefits (see CBO reports), there have been exhaustive and reputable studies that show costs will indeed continue to rise. As more information and data is studied, perhaps we’ll have answers to these questions.

One of the major concerns among economists is that the new tax on consumers that don’t buy medical insurance, is too low. It essentially invites consumers to easily go out without coverage and pay a small tax until a major condition appears. Then, at that time, coverage is purchased. Although it may benefit the consumer short-term, it causes long-term rates to dramatically rise for everyone else.

Our free online tools and expertise (and live help) will make comparing and applying for Pennsylvania Health Exchange plans much smoother. Our goal is for you to quickly find the best option, understand your benefits and pay as little as possible.

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Posted on: 5 Comments

5 Responses

  1. Pete Golder says:

    The market-place should be interesting if it ever comes about. I think it might be a mass of confusion and bureaucracy. That’s why we need you guys (brokers)! Keep up the good work.

  2. Harv Sheehan says:

    So I guess we will wait to see if the Market places ever get off the ground. I’m for reform but I want to make my own decisions and I want a broker that I choose helping out. Not a navigator that just got the job. As far as the state-run websites, I can do without them. It sounds like less choices and policies forced down my throat. I much rather prefer to work with a broker’s website. Yours tells me what I need to know and I know I’m getting a straight answer.

  3. Anna Rice says:

    It looks like the Exchanges may not become a reality. According to you and other people, I guess we will find out in a few years. Any updates are helpful since I check your blog each week.

    Anna R

  4. Fergio says:

    I have to say, your blog is one of the best written blogs there is on Pa medical plans! Keep up the great work.

  5. MT says:

    I am following the Supreme Court proceedings right now. I guess the Exchanges might or might not happen. I like things now where I can work with brokers that I trust and know what they are doing. I would not want that to change. If I can keep my broker with these changes then I guess it will be all right. But I am still concerned about rates.