Our official guide to understanding Obamacare and Pa health insurance will help you shop and compare the best policies, find the best prices, and purchase the plan that's the right fit for you. Although Pennsylvania healthcare reform and federal tax subsidy changes make the "Exchange" process a bit more confusing, we're confident you will save money.
What Is Changing?
A lot of things are changing, so we'll summarize them. Perhaps the most significant change is that applicants can no longer be turned down because of a single or combination of medical conditions. Whether it is heart disease, degenerative back issues or any type of cancer, you will be able to purchase health insurance in Pennsylvania.
Obesity and smoking will still be considered in the determination of rates. So if you smoke and you are extremely heavy, you will pay more than many other persons. But you will not be denied.
Your household income is now a factor in determining how much you pay. As you probably correctly assumed, the more money you make, the less help you're going to receive from Uncle Sam. The new federal subsidies are now based on the National Federal Poverty Level, also known as the FPL.
Current levels are $11,170 for a single household and $23,050 for a four-person household. Since up to 400% of NFPL receives a subsidy, a family of four with income under $92,200 will receive financial aid. Amounts above that will not receive any help. If you don't qualify for financial aid, buying non-Exchange plans should be considered. These policies often have bigger provider-participation networks, so you have more flexibility regarding which physicians, specialists and facilities to use.
Many "temporary" plans can be purchased away from the Marketplace, and are much less expensive than the typical policies that are available during Open Enrollment. But pre-existing conditions would not be covered on these short-term contracts and you will be subject to the Obamacare tax (1% of household income).
I Hate To Ask, But Are My Rates Going To Go Up?
I hate to say it, but for many consumers, they will. Some folks in lower income brackets will see smaller increases, or possibly substantial decreases with the help of the tax breaks. Moderate to high-income families and individuals may see prices spike up, although each situation is different. Of course, we'll be able to review your circumstances and offer advice that will keep your rates as low as possible.
In 2014, the first year of the change, there were increases. 2015 will also see increases, although not every policy (or company) will be charging more than in 2014. We will continue to inform customers which plans are the best bargains, and do the best job of paying the claims that are most likely to be filed.
The "Bronze" medal plans are the cheapest since the deductibles and coinsurance are be the highest. Many companies will offer an HSA option which will allow you to tax-deduct additional contributions and also receive negotiated lower pricing from the insurers.
We like this specific option, especially if you don't need unlimited office visit benefits. Preventive costs are always covered at 100%, and for many individuals and families, that represents most of your expenses for the year. And remember, you can change from one type of plan to another every year during Open Enrollment (see below).
When Is Open Enrollment?
Open Enrollment begins on the first day of October (2103) and continues through the last day of February (2014). During this time, you can apply for an Exchange policy (Don't forget to provide your zip code at the top of the page). Starting next year, the period of time will run from October 15th to December 7th. Extra time has been provided in the inaugural year of operation.
Special circumstances (divorce, termination from a plan etc...) will allow you to enroll at different times throughout the year, even if it is not during the official designated time period. The expectation is that you will have approximately 30 days to purchase a policy before having to wait until October. There will be about 56 policies available to compare.
What Happens If My Employer Drops Their Company Plan?
If your employer no longer offers healthcare benefits to you, you will be notified in advance and will have enough time to apply for coverage through the State Exchange. Duplicating the exact copays, coinsurance and deductibles probably will not be possible, but you will not be turned down. You will, however, retain most (or all) of your "Cadillac" benefits since essential benefits must be included on all plans.
A one-year moratorium was given to many businesses in 2014, allowing them to delay the mandatory requirement of providing ACA-compliant benefits. However, in 2015, it expires, which could lead to large numbers of layoffs or full-time workers dropping to part-time hours.
If I Am Not Eligible For A Federal Subsidy, Which Are The Best Pa Health Insurance Plans To Buy?
For a family, as previously mentioned, that would mean your income was under $93,000. Unless you are being treated for an injury or sickness that requires expensive medications and/or specialist visits, a "high-deductible" HSA policy would be a big cost-saver. Most of the companies participating in the "Exchange" will offer an HSA-type of option.
There will also be coverage that can be purchased away from the Exchange. These plans are quite economical and are a nice contract to consider if all of the applicants are in excellent health.Sharing of personal information with the government is avoided, which is a major concern for many consumers. And rightfully so.
The White House originally estimated that prices would be less than the figures that the Congressional Budget Office (CBO) predicted. For example, a person in their mid-to-late 20s would pay about $185 per month. A married couple with two children would pay about $650-$700 although subsidies could reduce the cost. After many hours of research and evaluating prices, we have concluded that while in some areas these projections are accurate, in other parts of the state, the offers are different.
Are Navigators Helpful?
It depends. If you don't have access to a website like ours, or you prefer to have someone visit you at your house, they may be helpful. And despite their inexperience and lack of significant training, many communities utilize their outreach services. But they can not discuss why a specific policy may be best for your needs or the financial impact of different Metal plans on your income.
In the Allegheny County area, lack of training has kept many navigators from offering their help. Mental Health America and AIU are two organizations that have received federal funds. There are also "counselors" that can help, but they only receive five hours of training. In fact, many consumers will have more Exchange knowledge than the counselors! We feel that a few weeks of training is simply not enough time to be advising consumers on very complex scenarios.
What If I Move? Let's Say From Harrisburg to Pittsburgh?
If that occurs, you should get ready to buy some Steelers, Pirates and Penguins t-shirts because you don't want to miss out on all of the fun! And of course, a visit to Primanti Brothers for some french fries on your sandwich is a must!
Seriously, a move will not impact your eligibility or jeopardize existing benefits that you currently have. It is possible that the price of your policy could change, since prices often vary, depending on the county where you reside. For instance, prices in Dauphin County may be slightly less than Allegheny County rates, although the difference would not be substantial.
However, it is possible that a separate set of carriers may offer benefits in differing locations. For instance, Capital BlueCross and Geisinger are available in Harrisburg but not Pittsburgh. Conversely, UPMC prices are affordable and Highmark has a large number of providers in the western part of the state but not in Harrisburg. See what I mean?
What About Some Of The Obamacare Myths?
There are plenty of myths. For instance, it is not true that everyone can keep their existing coverage, although the President is attempting to be a little more flexible. It is also not accurate to say that healthcare costs will be lowered. So far we have not seen evidence of that happening. Also, in fairness to the new legislation, many consumers will be helped and millions of persons will become eligible for Medicaid, that were not previously eligible. That will be a big money-saver if you fall into that category.
Also, there will not be any "death panels," that mysteriously decide who shall live and who shall die! But it is true that ultimately, you will not have control over all of your healthcare expenditures (although you didn't before). It is safe to assume that you will have less influence on your overall treatment and the number of available trained doctors may be reducing.
However, although most small business owners are NOT reducing the size of their staff, many have ceased hiring new employees until they understand the impact of the new healthcare legislation. Possible results could be keeping their existing benefit packages or eliminating all group medical benefits.
We will keep you updated on any Obamacare changes that affect Pennsylvania.
November 2013 - Cancellation letters continue to be received by policyholders, informing them their existing plans will be terminated since they don't meet the strict guidelines and basic requirements of the ACA. Although many persons want to keep their basic contracts, even with the White House offering some flexibility, they may not be able to. Bare-bones plans are very popular because of their low cost, and most policyholders are reluctant to give them up.
June 2014 - Navigators in Pennsylvania (VERY different from brokers) provide basic information to consumers. They have limited training and no criminal background checks are required as a condition of their employment. Thankfully, that may change if Senate Bill 1268 becomes legislation. Consumer protection will get a badly-needed boost upon passage.
"Navigators" have access to personal confidential financial information, and therefore it is critical that they receive comprehensive training that is much more extensive than they receive now. Most consumers prefer to work with experienced brokers and/or websites, since they provide much more detailed and expert advice.
May 2015 - With the expansion of Medicaid in 2015, about one in five Keystone residents is receiving Medicaid benefits, and 250,000 of those persons are first-time recipients. Many more individuals are expected to become eligible before 2016 since the threshold is now income less than 138% of the Federal Poverty Level (instead of 100%).
Managed plans cover most Medicaid plans in Pa. The main insurers that offer coverage are Aetna, UPMC, and Gateway. Recently, the federal government proposed some changes that may increase network-availability for patients, which is always a concern.
June 2015 - Obamacare is here to stay. Right? Probably, but if the Supreme Court rules that federal subsidies can only be paid in states that operate their own Exchanges, Pennsylvania would lose about $80 million each month in financial aid. Rates for some households could easily double or triple.
If this occurs, a contingency plan is being discussed by Governor Wolf that would create a state-based Exchange, although implementation could take more than a year. Within the next 45 days, we should have a ruling.