There are many types of Pennsylvania health insurance plans. “Catastrophic” and “HSA” plans will tend to be the least expensive options, but feature high out-of-pocket costs to the insured. “Comprehensive” plans offer lower out-of-pocket costs on the most common claims, but are the most costly type of coverage.
For families, typically, this is a very popular type of policy and similar to employer-sponsored plans. Large unexpected medical bills can be easily covered, along with smaller day-to-day items such as physician visits for common colds, the flu, stomach viruses etc... HMO, PPO and POS contracts are available for enrollment.
Pa comprehensive health insurance covers the standard inpatient major medical items such as room/board, intensive care, recovery and operating room, prescriptions, ambulance, and professional fees of doctors, surgeons and nurses. Outpatient expense benefits include facility/hospital fees for outpatient surgery, surgeon fees, emergency room fees, some mental and nervous disorders and X-ray and lab fees performed at network facilities. Service provided at non-network facilities is usually covered, but at a lower level.
Traditionally, office visits (primary care and specialist) and prescriptions (generic and non-generic) are included expenses although a copay is certain to apply. In Bronze-tier plans, a higher copay ($25-$50) is fairly customary, while Silver, Gold, and Platinum plans often feature copays in the $5-$25 range. Naturally, specialist visit copay are much higher, and can reach $50-$100, depending on the policy and Metal-tier.
Mandated Preventative Expenses Have No Deductible Or Copay To Meet
Qualified wellness and preventive costs are covered at 100%, so you have no out of pocket expenses for those items. There are no waiting periods or co-payments either and these benefits extend to children and teenagers. These enhancements were part of "The Affordable Care Act" legislation and are expected to remain, regardless of any potential adverse Supreme Court ruling.Some specific Pennsylvania wellness/preventative coverages include mammograms, pap smears, PSA screenings, child immunizations and annual physicals. As you get older, additional treatments will be covered and the Department of Health and Human Services will periodically update and add new benefits. In recent years, many diagnostic tests and screenings have been added and the list has become quite extensive.
Many women's expenses have been added in recent years. Some of the most utilized examples are anemia and cervical cancer screening, contraception, domestic violence counseling, breastfeeding information and counseling, sexually-transmitted disease counseling, and smoking-cessation interventions.
The Pa Insurance Exchange/ Marketplace may also make changes. One of the more controversial issues is the inclusion (or lack of inclusion) of federal/state funds paying for expenses related to abortion. Currently, the Exchange does not approve of those types of expenses. It is also not expected that any future legislation will attempt to challenge the status quo.
Companies That Offer Comprehensive Benefits
Most major Pennsylvania medical insurance companies offer policies that are benefit-rich and the list is quite extensive. Aetna (and Coventry), UnitedHealthOne (UHC), Independence Blue Cross, Keystone, Capital Blue Cross, Highmark, UPMC, Geisinger and HealthAmerica offer extremely competitive rates. This type of coverage is typically available in either a PPO (Preferred Provider Organization) or an HMO (Health Maintenance Organization). With a PPO, you can see any doctor or visit any hospital within the preferred network of providers. “Out of Network” providers will pay smaller benefits.
Older Grandfathered Plans
An HMO may provide a broader coverage, but with smaller Network availability. HMOs also offer maternity protection on grandfathered plans, while older PPO plans often excluded that coverage. If you have an existing policy and are not happy with the network or provided benefits, you can sign up for a different plan during Open Enrollment (November to February).
Some of the most popular policies that are no longer available include HealthAmerica’s Copay 100% plan, Aetna’s HMO 20 and HMO 30 plans, UnitedHealthOne’s Copay Select plan, Capital Blue Cross' Personal Blue plan and Blue Cross’ Keystone Health Plan East HMO. Of course, there are other comprehensive plans that may be your best option, depending on your specific situation. Pittsburgh health insurance is well represented by Highmark and UPMC while Geisinger has some popular options in the middle of the state.
Aetna, Celtic and UHC also offered discounted comprehensive coverage from 2009-2013 that covered a specific number of office visits. Premiums were reduced about 25% and these policies were always considered if they were available in your area. UHC and Aetna have developed updated compliant plans while Celtic does not offer a viable option in the state.
We'll often compared the specifics of these types of plans to other types of coverage. The UHC "Copay Value" and Aetna "Value" plans were very popular options, but are also no longer offered. For persons that were uninsured, these types of policies were budget-oriented regardless of your age. You sacrificed some office visits, but your premium also reduced.
What About Low-Cost Policies Now?
Bronze and Silver-tier options will cost the least, but still provide all-inclusive benefits that you need, such as inpatient and outpatient hospital treatment. Maternity and mental illness are also covered, since they are a required mandated benefit.
If you don't have any dependents (or you have older dependents), and there are no existing medical issues, an HSA or a high-deductible policy may be worth your consideration. We'll take the time to review the advantages and disadvantages of that type of coverage and what specific impact it has on your situation. We can also teach you what benefits are important when you are shopping for a new policy.
To quickly request a free quote, please enter your zip code in the quote portion at the top of the page. Within minutes, you can review the best medical benefits available to residents of the Keystone State. Comprehensive healthcare plans in Pennsylvania are much easier to find compared to five years ago. And for many persons, they're now also cheaper!