Pennsylvania Health Exchange Marketplace

The Pennsylvania Health Insurance Exchange Marketplace provides guaranteed health care coverage to Pa residents regardless of medical conditions. 2015 Open Enrollment begins on November 15th for all eligible persons. You can qualify for a federal subsidy while easily comparing multiple policies from the top-rated companies.

The Pa Exchange (2014 was the first year) was created under the “Affordable Care Act” (ACA), and provides the “Marketplace” that allows for the purchase of individual, family and small business coverage. Pre-existing conditions are longer be considered in the underwriting and approval of new plans. We simplify the enrollment process (it only takes about 10-20 minutes) and help you determine your subsidy-eligibility, compare and choose the best available plans, and act as a liaison between the carrier and yourself.

Pa Marketplace Companies

For 2015, 15 carriers will be represented (up from 14 in 2014). Only a handful of other states have more (16). Neighboring Ohio is one of those states. There are also additional specialty carriers that offer specific plans such as “short-term” and critical illness” benefits. Although they are legitimate policies, they  are not designed to cover the combination of major medical and essential health benefits.

The Exchange represents the bulk of the top carriers including Independence Blue Cross, Keystone, Highmark Blue Cross Blue Shield, Aetna, UnitedHealthCare, Capital Blue Cross, HealthAmerica, Geisinger, Coventry, Northeastern BC, and Assurant.

Currently, the federal government operates the mechanics of 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 2016 and 2017. Most states choose not to run their own Exchanges, since the cost is often hundreds of millions of dollars (that residents have to pay), and plan availability does not substantially change when the Department of Health And Human Resources “runs the show.”

Subsidy Calculations

State-regulated, but broker-friendly, the new method of purchasing healthcare benefits is much different than five years ago. Federal subsidies  help reduce premiums persons with moderate incomes that qualify and meet Federal Poverty Level guidelines. For example, if  a single 42-year old in Delaware County with income of $30,000 per year, would qualify for about $1,200 of annual subsidy assistance.

If married with two children and household income of $60,000, the estimated annual subsidy would jump to about $6,100 per year. Amounts will vary, depending on age, income, size of household and county residence. Allegheny County would generate much lower subsidy amounts.

Our Website And How It Helps You

We continue to assist 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 the specific details. We show you all available plans (that’s the law), even if we know that particular policies are quite expensive. However, we will fully explain and disclose differences in policy rates and benefits, and why we feel one option may be more beneficial than another.

It’s The Law!

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 $325 per person or 2% of income, whatever is higher.

HealthCare11 150x150 Pennsylvania Health Exchange Marketplace

Apply For Affordable Pa Healthcare

Thus, if you make $50,000 per year and don’t buy a qualified plan, the tax is $1,000. In 2016, the penalty increases to $695 and 2.5%. Thus, in this example, the penalty would become $1,250. 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 doubled 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.