The 2016 Pa Health Insurance Exchange provides affordable quality medical coverage to Pennsylvania residents. Our website is designed to provide you with free online quotes of available plans for single, family or small business policies. We'll help you compare different guaranteed options from the large and small carriers so you can easily apply and enroll for 2016 coverage and understand all of your benefits.
There are no costs and you can also purchase health care benefits through this website both "on" and "off" the Exchange. Our research and unbiased guidance will help you stay informed and receive the federal subsidies you are entitled to receive. You will not have to file a tax return to receive them since they will be automatically deducted from the cost of coverage. We also alert you of any changes that could impact the type of policy you should purchase.
Our Pa Marketplace
Each state has their own state or federally-run Exchange. Here in Pennsylvania, companies such as UPMC, Geisinger, Capital Blue Cross, Coventry, Highmark, Aetna, Keystone (and others) offer policies. Insurers can not deny coverage to applicants. And since approval is virtually guaranteed, applications are short. Of course, a licensed broker (and possibly a navigator) can assist in the process (which we can provide) so you are matched with the best plan.
NOTE: CHIP and Medicaid options are still available for low-income households. If you need our help calculating your eligibility, please contact us. It is possible for one family member to be covered by CHIP, while others enroll in Marketplace policies.
For the easiest enrollment and safest guidance, one of our own experienced brokers is your best resource. We offer decades of knowledge that ensures you can easily compare and understand the best available policies, and receive the highest available subsidy through accurate calculations. If you qualify for a reduced rate, we'll explain which plans will receive the biggest discount and how you can easily lower your deductible and copays.
You can quickly compare and apply for the best available options at our Pa Marketplace Enrollment link. It allows you to review subsidized and unsubsidized plans, and enroll in less than 15 minutes. Of course, we're also available to help you with any of the questions.
Compared to 2014 (The first year of Open Enrollment), the process is more friendlier, quicker, and the application time has reduced from 90 minutes (in some situations) to about 10-20 minutes. We provide a direct application link that allows you to quickly view the best policy options, and a streamlined enrollment.
The ACA (Obamacare)
The Patient Protection And Affordable Care Act is more than 1000 pages, so we always answer your questions and concerns, and help you apply for the most cost-effective plan for your particular circumstances.
All plans must meet specific qualifications and there may be benefits you don't want or need, but are forced to have. "Essential health benefits" must be offered in each Exchange plan. They will include many familiar items such as preventive, catastrophic, office visit and RX coverage.
However, many other items are standard benefits such as maternity, child oral and vision care, and many rehabilitative services and products. Self employed persons are able to easily apply for guaranteed coverage for themselves and family members. A separate "SHOP" Marketplace has been set up specifically for small-business owners.
Federal Operation Of Website
In our state, the federal government (not Pennsylvania) manages and operates the operation. This was determined in 2012 when Governor Tom Corbett (of course, since replaced by Tom Wolf) announced that the HHS (Department Of Health And Human Services) had not provided enough information regarding costs and organizational structure.
By having the federal government operate the Exchange, substantial tax dollars are saved. Although every year, the state legislature can make the decision to run the operation themselves. We believe, based on the millions of dollars that are saved each year, allowing the Department of Health And Human Services (HHS) to control and regulate is not a bad idea. Actually, only 14 states operate their own Exchange, and many have experienced major software and website issues.
Although there were many delays and enrollment issues in the early weeks of the 2014 operation, broker websites (like ours) use different software and there is now no wait-time to view prices. And the rates we provide are identical (it's the law) to the .gov website pricing. And as we have previously mentioned, we provide simple and easy enrollment options.
There are four levels of coverage. They are bronze, silver, gold and platinum. Each plan features a different level of benefits. The bronze plan, which is the least expensive of the four options, pays approximately 60% of the expected medical expenses that an average person would incur. The silver pays about 70%, the gold about 80% and platinum option about 90%. Naturally, the bronze plans are the cheapest available plans while the platinum options are the most expensive insurance policy offered.
The "Silver" and "Bronze" plans are the most popular, since they combine a combination of comprehensive office visit and drug benefits, while still keeping prices fairly low. Specialist and non-generic prescription benefits are included on many of these policies without having to meet a large deductible.
Special "cost-sharing" Silver-plan provisions are offered if your household income falls within specific guidelines. For example, a family of four (ages 43, 42, 15 and 12) with 45,000 of household income and living in Allegheny County, will be eligible for a subsidy of about $3,600 per year.
But just as importantly, a typical deductible of $3,000, will be reduced to about $500-$800, resulting in a substantial savings. Highmark, Coventry and UPMC are three carriers in the Western part of the state that offer excellent Silver-tier plans.
There is an additional level of benefits available for young adults and older persons that may not be able to afford premiums. It is a "catastrophic" level that excludes some of the comprehensive coverages contained in the four Metal plans. Although an annual routine physical is fully covered, many other expenses fall under the deductible.
However, prices are inexpensive and often, the savings easily offsets the benefits that are missing. This option may be ideal for healthy students that don't want to spend a significant amount of money. If you are under age 30, or are over age 30 and meet one of the 12 hardship exemptions, you can purchase this plan.
The Obamacare Subsidy
Depending on your household income, a tax-credit could lower your premiums. A family of two adults and two children with income of more than $95,000 will not receive any tax relief. However, an increasing amount of financial will be provided for lower incomes. The assistance is based on the Federal Poverty Level is be adjusted each year. The estimated credit per family is often as much as $10,000-$15,000.
The more family members you have, the higher the subsidy. For example, a married couple (age 42) with no children living in Allegheny County with a $40,000 household income will receive approximately $960 in annual federal subsidies. However, if two children are included, the subsidy increases to more than $4,500, a whopping 400% increase!
It Is The Law!
Perhaps the most controversial aspect of the all of the ACA changes is that it is now against the law NOT to purchase medical insurance. For the first year, the tax was $95 per adult (half of that amount per child) and up to $285 per family. However, if 1% of your income was higher than the tax, you were required to pay the higher of the two. For example, if you made $75,000 per year, you were taxed $750 if you did not buy coverage.
However, by 2016, the tax substantially increases and becomes $695 for adults and $2,085 per family. If 2.5% of your income is higher, then you pay that amount. So expect to pay $2,500 if you make $100,000 and don't want to purchase a policy. This "mandate" has been strongly debated by US politicians for years. In 2018 a separate tax will be charged to insurers that offer policies that are too rich in coverage.
More Choices IN 2015 Than 2014
One big difference starting in 2014 was the reduction in the number of plan choices you had. Previously, through our website and with the help of experienced brokers, you selected affordable policies from hundreds of options. Whether you wanted no deductible and a $10,000 deductible, or no office visits covered or unlimited office visit coverage, the choice was yours.
You still have many options, and more plans and carriers are now available. In 2015, more companies began offering Marketplace plans, such as UnitedHealthcare, one of the largest carriers in the US. In most areas, UHC offers very competitive rates, especially on Bronze and Silver plans.
UPMC, as mentioned earlier, offers many low-cost policies in several counties, including Allegheny, Westmoreland, and Washington. However, since many physicians and facilities in their Network do not accept Highmark providers, when switching companies, it's very important to verify your doctors and specialists are "in-Network."
9-27-2013 Aetna will be participating in the Exchange for 2014. Previously, they were noncommittal regarding whether they would join UnitedHealthcare in sitting out 2014. Also, CHIP (children's coverage for low-income households) may be removing the 6-month waiting period. The Senate has approved the bill and the House will now consider the legislation.
11-4-2013 Although Open Enrollment has been available for than a month, there are still about 150,000 children without coverage. CHIP and Medicaid are available for many kids, but the number of applications received is still fairly low. Recent legislation has eliminated the waiting period of six months that was previously required for CHIP.
11-17-2013 So far, about 2,000 persons have signed up for the Exchange through our website, other brokers or the .gov website. Also, President Obama announced that policyholders may be able to keep their canceled policies, if allowed by the Pa Department of Insurance. However, because of the sudden proposal, it is not feasible.
12-23-2013 Today is the last day to enroll with a January 1 effective date. All enrollment requests received after today will receive an effective date of February 1. However, the eligibility and/or amount of the government subsidy will not be affected.
11-18-2014 Now in its third day, 2015 Open Enrollment is progressing smoothly. The application process is quicker without as many of the glitches that were prevalent in 2014. Required income verification, however, is often requested. Generally, you have 30-60 days to show proof of income, or to provide the requested information regarding your subsidy.