Pennsylvania Private Vs. Group Health Insurance Options

Pennsylvania private vs. group health insurance. Rates are different. Coverage is different. Underwriting guidelines are slightly different. Which option is best for you? Actually, that depends on many factors. We utilize more than 34 years of  knowledge and experience to help you make the proper and most informed decision. It could save you thousands of dollars and dozens of headaches each year.

Group Health Insurance In Pa

Employer-sponsored medical coverage is very popular. Big companies, such as PPG, Comcast, Heinz, Cigna and US Steel offer comprehensive  benefits and very affordable prices. Of course, once you leave, it might be different, depending on your situation. Typically, you can’t take your group benefits with you unless you retire before age 65. And even then, the benefits may not be the same.

You may have a conversion option, depending on the underwriting policy of the provider. This would allow you to keep the policy until you become eligible for Medicare. And depending on the generosity of your former place of work, your premiums could possibly reduce, especially if you select a “high-deductible option.

However, thanks to the passage of the Affordable Care Act legislation (also known as Obamacare), you also have the opportunity to choose a private plan if you lose group coverage,  regardless of the time of the year. Although Open Enrollment (2015) occurs between November 15th and February 15th, an SEP (Special Enrollment Period) is available at any time for workers that no longer have employee-provided benefits.

Large company plans typically feature very comprehensive coverage with rich benefits and low out of pocket expenses on large hospital claims. Often, deductibles are as low as $250 or $500. If the policy is an HMO, there may be no deductibles to meet. Primary care physician and specialist visits may also be covered with very low copays…perhaps $10 or $15. And sometimes there are no copays, which is very costly to the employer. In recent years, large businesses (and especially smaller ones) are tightening their belts and forcing their workers to share some of the costs.

The Point Pittsburgh Pennsylvania 300x225 Pennsylvania Private Vs. Group Health Insurance Options

Group Health Care In Pa

And a few specific benefits such as maternity and mental illness, may be either completely covered or have very small out of pocket costs to the group policyholder. Other unusual coverage such as chiropractor visits may have no limitations and there may be very small copays on ER visits. The smaller the business, however, as previously mentioned, the more likely the employee has to pay more out of pocket money.

Of course, Pa group  insurance plans are more expensive than private coverage because of the excess benefits. If the employer is paying all or most of the premiums, it’s a great situation for the employee. However, if very little (or none) of the expense is paid by the employer, it can be quite expensive. Often, premiums can be as much as $500-$900 per month. And occasionally, the price exceeds $1,000.

Private Health Insurance In Pa

Personal medical plans are easily purchased from many of the biggest and most reputable companies. Large insurers, such as Aetna, UnitedHealthcare, Coventry, and Highmark, along with smaller carriers, such as Geisinger and Northeastern Blue Cross, offer multitudes of policies for Pa residents with or without coverage. Plans are not underwritten, which means rates will be the same for persons with very few, multiple, or no health issues.

A group or individual plan will accept just  all applicants, which is part of the reason rates can be so high. This “guarantee issue” clause was part of the Obamacare legislation process. Prior to its passage, Keystone was one of the few companies that offered a private policy with virtually no underwriting. This “Personal Choice” plan was available in Southeastern Pennsylvania. It was a great option if you have trouble qualifying for other coverage.

Family Medical Coverage

When you purchase your own family coverage, the selection process is a bit harder than choosing a plan through an employer. The main reason is that there are hundreds of different plan variations with different coverage, deductibles, copays and out of pocket limits. In addition to understanding the different Metal tiers (Bronze, Silver, Gold, and Platinum), calculation of subsidies and verifying new network provider choices can be quite a daunting task if you are handling it yourself.

So obviously, utilizing a website like ours is a must, so we can easily help you compare the best plans and ensure you are applying for the most appropriate and affordable policy. Not all policies are available in every county, and of course, the best choice for you must be based on your projected medical costs, your budget, and amount of federal aid you are eligible for.

Private medical policies allow you to customize your benefits to meet your individual or family requirements. You can pick a plan with a high deductible or purchase an HSA to keep premiums low.  If you need specialized coverage, such as extra accidental benefits, dental coverage or vision insurance, with many carriers, it can be added to your package.

And very importantly, when you own your own policy, it becomes portable. Whether you remain employed with a company or leave them, your own benefits are not impacted. This can be a big factor if you develop a serious condition, since you would not have to utilize COBRA, which would likely be extremely expensive.

And you can keep your policy until you become eligible for Medicare.  At that time, you won’t need any additional private medical coverage. If you have a gap between your retirement and Medicare-eligibility, a special enrollment period will allow you to choose  Marketplace coverage from several available carriers.

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Posted on: 3 Comments

3 Responses

  1. Jeff/Philly says:

    My group plan through my job was way to expensive. I’m in good health so maybe that helped. I bought a Keystone plan (through your website) and it was much cheaper.But my employer makes us pay all of the cost so it was expensive.

  2. Lehigh says:

    just trying to figure out my best options when i leave school which is very soon. i like copays and low deductibles but there are about 5 good options. maybe geisinger? Your help is appreciated. thanks.

  3. Mary Fleig says:

    Seems like private health insurance in Pa has a lot more choices than the employer plans. Just my opinion but I like buying my own. Cheaper by a lot. Great website by the way! MF