The 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 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.
Each state will have their own Exchange. Here in Pennsylvania, companies such as UPMC, Geisinger, Capital Blue Cross, Highmark, Aetna, Keystone (and others) will offer policies. Insurers can not deny coverage to applicants. And since approval is virtually guaranteed, applications will be 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.
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 will select the most appropriate policy and receive the highest available subsidy through accurate calculations.
The Patient Protection And Affordable Care Act is more than 1000 pages, so we will 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 will become standard benefits such as maternity, child oral and vision care, and many rehabilitative services and products. Self employed persons will also be able to easily apply for guaranteed coverage.
Guess Who Runs It?
Here in Pa, the federal government will run the operations, and not the state. This was announced in December of 2012 when Governor Tom Corbett 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 will be saved. And every year, the state legislature can make the decision to take control.
Although there have been many delays and enrollment issues in the early weeks of operation, broker websites (like ours) use different software and there is virtually 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, is expected to pay approximately 60% of the expected medical expenses that an average person would incur. The silver will pay 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 may of these policies without having to meet a large deductible. Also, special "cost-sharing" provisions are offered if your household income falls within specific guidelines.
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. Althoughan 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.
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 tax aid will be provided for lower incomes. The assistance is based on the Federal Poverty Level which can 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 in their 40s (no children) living in Allegheny County with a $40,000 household income will receive approximately $800 in federal subsidies. However, if two children are included, the subsidy increases to more than $4,000. This is a significant difference.
It Is The Law!
Perhaps the most controversial aspect of the all of these 2014 changes is that it is now against the law NOT to purchase medical insurance. For the first year, the tax will be $95 per adult (half of that amount per child) and up to $285 per family. However, if 1% of your income is higher than the tax, you pay the higher of the two. For example, if you make $75,000 per year, you are taxed $750 if you don't buy coverage.
However, in 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.
One big difference starting in 2014 is the reduction in the number of plan choices you have. Previously, through our website and with the help of experienced brokers, you selected affordable policies from hundreds of options. Whether you wanted no deductible or a $10,000 deductible, or no office visits covered or unlimited office visit coverage, the choice was yours.
You still have choices, although not quite as many. And comparing your options is a bit more difficult since not all companies are participating in Open Enrollments, and special "cost sharing" perks are only available on "Silver" policies. Also, the calculation and application of your subsidy can greatly determine which contracts are the most appropriate for you.
UPDATE 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.
UPDATE 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.
UPDATE 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.
UPDATE 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.