The Pennsylvania Health Insurance Exchange Marketplace provides guaranteed health care coverage to Pa residents regardless of medical conditions. 2015 Open Enrollment began on November 15th for all eligible applicants and ended on February 15th. You can qualify for an Obamacare federal subsidy while easily comparing multiple policies from the top-rated companies. Plans are offered to small business owners through a separate SHOP Exchange.
Policies are available with or without federal financial assistance. If your household income falls below 400% of the Federal Poverty Level, you are likely eligible for an instant tax credit. However, you are not obligated to accept the funds, and can enroll in an “off-Exchange” plan. These plans still provide the required 10 “essential benefits” including preventive, maternity, mental illness, prescription and other required coverage. However, the enrollment process is often much quicker, since the government website is not involved, and income verification is not required.
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 no longer considered in the underwriting and approval of new plans. Generally, lower-income households pay less than prior to Obamacare, while households that don’t qualify for a subsidy, pay more. Customization of policies has been severely curtailed.
Several Supreme Court decisions have been needed to allow the ACA (Affordable Care Act) to continue. Although many tweaks, exceptions, and variations have changed parts of Obamacare, the core legislation has remained (most of it) in tact. It’s not anticipated that a repeal will occur before 2016, even with one specific political party controlling both the Congress and the Presidency. However, a replacement of the ACA is very possible after that date.
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. Because of the instability and difficult navigation of the government website, we continue to offer simple sign-up through our website, with no cost or fees.
Pa Marketplace Companies
For 2015, 15 carriers are 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.”
NOTE: The future of the ACA may be determined by the Supreme Court. King Vs. Burwell questions the legality of financial subsidies that are provided to states that do not operate their own Exchange. Pennsylvania is one of those states. One of the main issues is whether the IRS in 2011 illegally issued a rule authorizing all states to offer subsidies.
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, a single 42-year old in Delaware County with income of $30,000 per year, would qualify for about $840 of annual subsidy assistance. A single Mother with the same income (assuming child is CHIP-eligible) would qualify for about $1,560 of subsidies.
If married with two children and household income of $60,000, the estimated annual subsidy would increase to about $1,800 per year, although both children would be covered at little or no cost through CHIP. 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.
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.
Is Obamacare A Good Piece Of Legislation?
It has yet to be determined if healthcare 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.
By 2017, there should be enough quantitative data to determine how effective the legislation has been in driving down expenses. However, it’s not just personal and corporate health insurance premiums that are being studied. But also, the cost of providing treatment, and the expense of developing new products for consumers as well.
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, during Open Enrollment, coverage is purchased. Although it may benefit the consumer short-term, it causes long-term rates to dramatically rise for everyone else.
Would raising the non-compliance tax to 5% of household income reduce the number of uninsured, and bring in added revenue that will keep the legislation from costing hundreds of millions of dollars in potential tax increases? 5% might be too high of a burden, but undoubtedly, changes to the ACA legislation will have to be made. The Supreme Court may actually hold the “trump” card.
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. Compare multiple plans now.