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. We help you find the most cost-efficient plans, and we also greatly simplify the enrollment process.
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 are here to help, by providing free comparisons, determining if your medical providers are “in-network,” and also calculating your federal subsidy.
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 can 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, Lancaster, and Harrisburg, you won’t find any of their plans offered in Pittsburgh. The same applies to Geisinger products. However, Aetna and UnitedHealthcare are typically available in most areas.
When Does 2017 Open Enrollment Begin?
On November 1, 2016, enrollment begins for plans with 2017 effective dates. It ends on January 31st, although if you qualify for a Special Enrollment Period exception, you can purchase coverage at any time throughout the year.
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.
For example, we have helped consumers find, compare and understand their best options for more than 35 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 three decades of experience assisting consumers obtain quality insurance coverage. That’s why most consumers prefer the free help we provide, instead of using a “navigator” or attempting to contact the government website.
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)
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 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, Independence Blue Cross has the most competitive prices.
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. Also, since rates change each year, choosing a new plan during Open Enrollment is quite common.
Listed below are several of the least expensive 2017 Pa Marketplace plans. Policies are not offered in all Counties.
UPMC Advantage Bronze $6,950/$35
Highmark my Connect Blue 6500B
Highmark my Community Blue Flex PPO 6800B
Highmark Major Events PPO Blue 7150
Geisinger Marketplace HMO 30/60/3500
Independence Blue Cross Personal Choice Bronze Basic
Independence Blue Cross Personal Choice PPO Bronze Reserve
First Priority Health my Priority Blue Flex HMO 6800B
Capital Advantage Silver PPO 4500/0/10
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. Individual dental policies are offered by many companies outside of the Marketplace.
Will My Policy Go Into Effect Right Away?
If the application is completed by December 15th, you can receive an effective date of January 1st. The deadline for a February 1 effective date is January 15th. And the deadline for a March 1 effective date is January 31st. If you wait until after January 31st to attempt to enroll, you will need an SEP exception to secure a plan. Otherwise, many non-compliant options are available, although coverage may be limited.
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 provider. Online directories are helpful, but often are not fully updated until March or April. Also, many carriers (UPMC for example), have several different networks that are applicable to specific plans.
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 generally do 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. NOTE: Bronze-tier contracts usually place a deductible on non-generic prescriptions.
I Am On Medicare. Am I Affected By These Changes?
No. If you are covered by Medicare, you can not apply for Exchange plans. And the legislation that requires that qualified coverage to be purchased is not applicable. However, you can review and compare Supplemental and Advantage plans (Medigap) that will cover many of the gaps in coverage. Senior plans can be customized to match your specific needs, and Part D plans (prescription drug benefits) can also be personalized to best limit your out-of-pocket costs.
Fall Open Enrollment for Medigap plans begins October 15th and ends on December 7th. You can change your existing coverage or purchase an Advantage contract. January 1 will be the effective date of the new policy.
Do I Have To Buy A Policy That Is Through The Exchange?
No. You can purchase coverage inside or outside the Exchange. 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 are much more streamlined and approvals are generally quicker. It’s also possible that the number of available physicians and hospitals may be higher, if an alternative provider-network is used. 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. Although specific mandated benefits are still required, we can avoid utilizing the .gov healthcare website.
UPDATES FROM THE PAST:
August 2015 – Anthem and Cigna have agreed to merge, which will create the largest health insurer in the US. Neither carrier issues a significant amount of group or individual plans in Pennsylvania. So why does the American Hospital Association believe that prices in our state (and many others) could potentially increase because of reduced competition?
The fear is that several other mergers may now occur, which would impact premiums of other Pa carriers. Also, state regulators could recommend that specific services be eliminated because of monopoly concerns. This merger follows that Aetna-Humana agreement, which has a larger effect on local households, since Aetna has a fairly large local market share.
July 2016 – With the Presidential election in three months, changes may be coming. The current system is floundering, with several carriers (including UnitedHealthcare) planning on staying away from many State and Federal Exchanges. Other companies suffered massive underwriting losses and have requested large rate increases for 2017 plans. Also, C0-Ops have continued to perform poorly, and we expect several more to fail within the next 12 months.