Pennsylvania health care reform information is updated regularly on this website. Pahealthinsurancecoverage.com is the state’s premier resource for current Pennsylvania health care reform information. There have been many changes, with dozens more being discussed. We’ll research and review these changes and discuss how they will affect your Pennsylvania health insurance coverage. Also, while you’re visiting the site, fell free to instantly view, compare or apply for affordable health care coverage. Simply click on the “Get Instant Quote button at the top of the page.
In March 2010, the US House of Representatives passed H.R. 3590 – The Patient Protection And Affordable Care Act and H.R. 4872 – The HealthCare and Education Reconciliation Act of 2010. Legislation starts going into effect in 2010, although much of the legislation will not be enacted until 2014 and later.
Pennsylvania Care Reform Changes For 2010
No Exclusion For Children
Pennsylvania health insurance companies will be prohibited from adding pre-existing exclusion riders to children’s coverage. This will apply to children AND adults in 2014.
Young Adults Can Stay On Parent’s Policy
Young adults may remain on their parent’s health insurance policy until age 26. Currently, many carriers require children that are not full-time students at age 19, to obtain their own coverage. This change will probably raise premiums to cover the extra risk.
No Lifetime Maximum
Lifetime caps will be removed from Pennsylvania health insurance plans. This portion of the reform bill will likely never affect you since individuals and families rarely exceed their maximum limit.
No Health Rescission
Health insurance companies will not be able to rescind policies when a person submits a claim. This practice, however, is rarely used.
Temporary High Risk Pool For Pennsylvania Residents
Pennsylvania health insurance reform will utilize a temporary national high-risk $5 billion pool to provide health insurance to Pennsylvania residents with pre-existing medical conditions.
Indoor Tanning Tax
Starting July 1, there will be a 10% tax on indoor tanning services. No kidding!
Preventive And Wellness Benefit Change
New Pennsylvania plans must offer wellness and preventive benefits without copays or deductibles. Currently, most comprehensive plans feature nominal copays but no deductibles on wellness coverage.
Pennsylvania Health Care Reform Changes For 2011
HSA Withdraw Change
HSA withdraws made before age 65 for nonqualified medical expenses will be subject to a tax of 20% (up from 10%). Archer Medical Savings Account withdraws will also increase to 20% (up from 15%).
Pennsylvania Health Care Reform Changes for 2013
Less Paperwork
Health insurance plans must contain uniform standards for electronic exchange of medical information to reduce administrative costs and paperwork.
Flexible Savings Account Limit
Contributions to flexible savings accounts (NOT HSAs) will be limited to $2,500 per year (gradually increasing after 2013). Obviously, existing Pennsylvania HSAs will not be affected.
Hospital Insurance Tax
For Pennsylvania households earning more than $200,000 ($250,000 if married filing a joint return), the hospital insurance tax will increase 0.9%.
Pennsylvania Health Care Reform Changes for 2014
Pennsylvania Health Insurance Exchange
The Pennsylvania health insurance exchange must be created by 2014 and administered by a non-profit entity or government agency. The exchange will offer plans that meet stated required guidelines. We do not charge any fees for helping you find a plan in the exchange and the rate you receive will be the guaranteed lowest rate allowed by the state. Small employers will also be able to shop for plans. However, if you have no medical conditions, purchasing coverage outside of the exchange may be a better option. We will review all possible scenarios with you.
Change In How Your Rate Is Determined
Pennsylvania health insurance companies will be prohibited from denying coverage or charging higher rates based on medical condition, health status or prior claims experience. Premiums will vary by age, smoking status and other factors. Existing individual plans will not be subject to the new guidelines.
Tax Credits Will Help Pay Premiums For Exchange Plans
Tax credits will be given to individuals to help pay their Pennsylvania health insurance premiums. To qualify, household income must be between 100% and 400% of the federal poverty line. A family of four earning less than $88,000 per year would qualify for a partial credit. To receive the credit, you must purchase the policy. We’ll be happy to guide you through the process.
Get Health Insurance Or Pay A Fine
Pennsylvania citizens will be required to have “acceptable” coverage or pay a fine of $95 in 2014, $325 in 2015 and $695 in 2016. Children’s fines are half of those amounts with a cap of $2,250 per family. The government will decide what constitutes “acceptable coverage.” Failure to maintain coverage, however, will not result in criminal actions or fines. Penalties are absurdly too low and enforcement will have to be modified.
Pennsylvania Health Insurance Exchange Requirements
Any health insurance plan issued through the Pennsylvania health insurance exchange must provide medical benefits that include cost sharing limits. Coverage will be available in four benefit categories: Bronze (60% Coinsurance), Silver (70% Coinsurance), Gold (80% Coinsurance) and Platinum (90% Coinsurance). A lower-cost major medical catastrophic policy must be offered to individuals under 30 or any other individual that is exempt from the insurance requirement.
50 Or More Employee Requirement
Companies with 50 or more employees, must offer medical coverage to their employees or pay a $2,000 penalty. The fine is levied per employee (after 30) if at least one employee is receiving a tax credit. Waiting period for coverage to be effective is limited to 90 days.
Company Employee Exemption
Employees of a company who are exempt from individual responsibility for medical coverage, but don’t qualify for tax credits, can receive their employee contribution and buy coverage through the exchange. We offer free assistance when buying coverage through the health insurance exchange.
If you have any questions regarding Pennsylvania health insurance exchanges, health reform, or Pennsylvania health insurance plans, please call us at (888) 513 6446. You may also email us at eharris@pahealthinsurancecoverage.com
4-12-10 Update- No word yet on the exact date that high risk pools will be available. It should be in the Summer or Fall.
9-23-10 Update- Most of the large health insurers have eliminated "child only" plans as a result of health care reform changes. Due to potential huge claims and massive losses, children under age 19 will have to be included on a parent's plan to be covered.
10-14-10 Update- A federal judge in Florida has ruled that 20 US sates can proceed with their lawsuit seeking to overturn Obamacare. US District Judge Roger Vinson disagreed with the Justice Deaprtment argument that the individual mandate requiring Americans to purchasehealth insurance in 2014, was a tax.
11-1-10 Update- The decision on whether to include birth control as part of the 100% mandatory preventive benefit is still being debated. Within a few weeks, a decision should be made.
6-25-11 Update- Many parts of the health care reform law are unfunded and not ready for implementation according to the American Public Health Foundation. Most of the 18 programs do not have the proper funding.
6-30-11 Update- A Federal Appeals Court in Cincinnati ruled that the propsed law requiring citizens to purchase health insurance was NOT unconstitutional. Similar court decisions have ruled differently in other states, so a Supreme Court showdown is likely.
7-12-11 Update- Health Insurance Exchange rules were released by the Obama administration. The Exchanges are to be ready in 2014 and will allegedly offer consumers a simple way to buy health care...just like an airline ticket. But those of us in the business realize that this system will probably confuse consumers and won't offer the expertise needed to make the correct decision. Most states agree and are dragging their feet on the implementation of the Exchanges. This type of marketplace is part of the billions of dollars of spending required to implement Obamacare.
8-1-11 Update- Today, US Dept. Of Health & Human Resources ruled that starting in 2013, women's birth control must be covered by health insurers with no deducible, no coinsurance and no out-of-pocket expenses. Other related preventive benefits must also be covered. We expect rates for femailes to rise, especially ages 18-50.
12-19-11 Update- March 26, 27 & 28 (2012) will be "debate week" as the Supreme Court hears arguments about Obamcare. The final ruling shouldtake place around June. Stay tuned.
Additional Links:
Health Care Section-By-Section Analysis