Pennsylvania health care reform information is updated regularly on this website. We provide current and unbiased tips and information designed to keep you current and save you money. There have been many changes, with dozens of additional ideas being discussed. We research and review these changes and discuss how they will affect your health insurance coverage.
Also, while you are visiting the site, feel free to view, compare or apply for affordable health care coverage. Simply add your zip code to the “Get Free Quotes" box at the top of the page. More than one million persons in the state are uninsured and we're here to help. Both on and off-Exchange policies are offered. The Obamacare subsidy could lower your premiums by up to 50%-100%.
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 started to become effective in 2010, although much of the legislation was not enacted until 2014 and later.
Changes For 2010
No Exclusion For Children
Pennsylvania 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 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.
Changes For 2011
HSA Withdraw Change
HSA withdraws made before age 65 for non-qualified 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%). We felt this increase was unfair to HSA customers.
Over-the-counter drugs not prescribed by a physician are no longer tax-deductible. This impacts the majority of HSA account owners. For example, several allergy medicines have become available without a doctor's prescription. Although more readily available, the cost no longer is tax-deductible.
Changes For 2012
State Or Federal
The Pa legislature must inform the Department of Health and Human Services whether Pennsylvania will operate a state-run Marketplace or allow the federal government to be solely involved. A partnership is also a possibility.
Drug Companies Pay More
New fees on pharmaceutical companies are imposed. A branded prescription drug charge impacts most manufacturers.
Easy To Read Benefits
A uniform summary of benefits coverage (SBC) must be provided for individual and group coverage. This applies to new applicants that are purchasing a policy. By comparing before enrolling, it is hoped that consumers will be able to make more-informed decisions.
Changes for 2013
Plans must contain uniform standards for electronic exchange of medical information to reduce administrative costs and paperwork. If effectively implemented, this change will help lower rates in the future.
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%.
The itemized deduction threshold (unreimbursed medical expenses) changes from 7.5% of adjusted gross income (AGI) to 10%. This results in higher taxes for many consumers with large medical bills.
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. Of course, The Exchange may never get off the ground. We'll wait and see.
Change In How Your Rate Is Determined
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. This will help persons with chronic illness and/or multiple conditions. It's still unclear who will pay for the extra benefits that will be paid.
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 will be happy to guide you through the process.
Get Health Insurance Or Pay A Fine
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. The Supreme Court, however, may rule this to be unconstitutional.
Health Insurance Exchange Requirements
Any health insurance plan issued through the Exchange (or Marketplace) 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.
Changes For 2015
CHIP (Children's Health Insurance Program) in Pa receives a 23% increase in federal matching funds. NOTE: 2015 Pa Marketplace Options can be found throughout our site. Economical policies are offered to all persons, regardless if you qualify for financial aid.
You'll never guess who is back on the 2015 Exchange after sitting out 2014. Aetna and UnitedHealthcare! Several low-cost plans are offered and enrollment numbers are fairly high.
Changes For 2016
"Compacts" are permitted to be formed and insurance companies may offer policies in these states. Product availability will increase, although it's not expected to make a significant difference in available choices.
If you have any questions regarding Pennsylvania health insurance exchanges, reform, or Pennsylvania plans, please call us at (888) 513 6446. You may also email us at firstname.lastname@example.org
4-12-10 - 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 - 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 - A federal judge in Florida has ruled that 20 US states can proceed with their lawsuit seeking to overturn Obamacare. US District Judge Roger Vinson disagreed with the Justice Department argument that the individual mandate requiring Americans to purchase health insurance in 2014, was a tax.
11-1-10 - 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 - 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 - A Federal Appeals Court in Cincinnati ruled that the proposed 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 - 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 - 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 females to rise, especially ages 18-50.
12-19-11 - March 26, 27 & 28 (2012) will be "debate week" as the Supreme Court hears arguments about Obamcare. The final ruling should take place around June. Stay tuned.
2-19-12 - The House Of Representatives committee that was discussing the contraception issue abruptly stopped when two members walked out, objecting that there were no women on the Panel. No doubt, this will be a very hotly-debated topic between now and the election in November. 5-18-12 The Supreme Court will be ruling on the legality of the "mandate" of requiring persons to buy health insurance. The ruling should be announced within the next six weeks.
9-8-12 - The Supreme Court did not strike down the mandate that requires consumers to purchase health insurance. As a result of the ruling, a tax will be levied against persons who do not comply starting in 2014. Of course, we'll help you find the most affordable options, so you are not subject to this extra tax.
11-10-12 - With the Obama victory in the election, reform will continue. The "Exchanges" have been delayed since many states are balking at paying the hundreds of millions of dollars it will cost to set them up. But the Federal government did not anticipate having to pay for the setup of so many state Exchanges.
03-6-13 - Medicaid expansion is the hot topic right now. Will Gov. Tom Corbett is considering an offer from the federal government that would expand benefits to about $500,000 Pa residents. But the major concern is that the government's 90% reimbursement of the cost could potentially reduce or terminate. A decision is expected within a month.
03-16-2013 - AdultBasic may be returning. A Commonwealth court decision has stipulated that adultBasic (or a similar program) should return with the aid of funds from a $200 billion tobacco settlement (that was being used until 2011). This could be great news for low-income earners in the state.
11-16-2013 - Obamacare enrollment has begun. Four Metal options (plus a high-deductible catastrophic policy) have been rolled out. We offer the most current rates from the participating companies. It's also important that your federal subsidy is correctly calculated. It is based on your 2014 anticipated household income.
2-8-2014 - Open Enrollment continues until April 1st. However, you can still purchase coverage after that date. If you have a special enrollment situation (divorce, job layoff etc...) you can still qualify for a subsidy. Otherwise, short-term policies and limited-benefit plans will be offered.
12-13-14 - Several new companies are offering policies for 2015. UnitedHealthcare and Aetna have entered the Marketplace in most areas of the state. Aetna's HMO and UnitedHealthcare's HSA options offer very competitive prices. In Allegheny and Western counties, UPMC is offering the lowest rates, utilizing their PPO and EPO networks. As expected, Independence Blue Cross is still one of the top two options in the Philadelphia area, including Montgomery County.