Pennsylvania major medical insurance is the least expensive form of health care coverage. Usually, costs are about 25%-50% less than standard policies and as much as 60% less than employer-sponsored medical plans (assuming the employer is not paying any of the premiums). Personal medical rates in the Pittsburgh and Philadelphia areas have remained attractive when compared to other large nearby cities.
While Pennsylvania health insurance rates have been slowly spiraling upward, many individuals and families are turning to “high deductible” or “catastrophic” plans to minimize their cost. The potential savings can be huge, especially over the lifetime of the policy. Also, rates tend to increase less on policies with higher amounts. By selecting deductibles of $2,500, $3,500, $5,000 or higher, premiums could dramatically reduce. If you currently are being treated for a serious ongoing illness, it may not be wise to increase your potential out of pocket costs.
Open Enrollment In Pa
However, because of annual Open Enrollments (OE), you can safely change your policy each year, regardless of any existing medical conditions or future surgeries or treatment that is needed. The OE period for 2015 effective dates is November 15th-January 15th. 2014 OE was much longer since it was the inaugural year and many glitches and delays needed to be repaired.
At Pahealthinsurancecoverage.com, we provide and analyze low cost plans that provide high quality coverage. We focus on the most respected companies in the state, such as Aetna, UnitedHealthOne, Independence Blue Cross, Highmark, Geisinger, Keystone, Capital Blue Cross, UPMC and HealthAmerica. Celtic, although not a major company, does not offer individual coverage any longer.
Assurant is a reputable company but does not offer the most competitive rates (on most of their policies) in all areas at this time. However, their HSA prices recently reduced and should now be considered, especially their higher limits, such as $10,000. And regional companies such as NE Blue Cross and UPMC offer policies in selected parts of the state. NE Blue Cross will be merging with Highmark sometime later in 2014. Also, Coventry purchased HealthAmerica in 2013.
How Does It Work
The concept of major medical coverage is simple. Typically, a “deductible” must be met before any benefits are paid. Naturally, the higher the amount, the lower the rate. In Pennsylvania, most companies will offer options from $500 to $10,000. A few carriers, such as Assurant, will offer higher choices, such as a $20,000 family option (available "off" Exchange). While we strongly encourage lowering your premium, we feel a $20,000 option should only be used in special situations.
If you develop a serious illness, it could be quite costly. About half that amount seems to be the most popular. Once you start reducing the deductible, it becomes less cost-effective, especially over a 5-15 year period. Keep in mind that often the plans you are offered through your employer will feature lower amounts that are not available on private plans.
After the deductible has been satisfied, all policies have a “coinsurance” that must be taken into consideration. This is the percentage of the balance of the health care expenses that the policyholder is responsible for. The most common coinsurance is 20%, although 30% and 50% options are sometimes used on less expensive plans.
0% is the most costly, but has no out of pocket costs once you have paid the deductible. This option is popular on many employer-sponsored contracts. The new Marketplace options that started in 2014 feature many policies with the 0% coinsurance option. Some of the most popular plans are:
Coventry Bronze Deductible Only HMO
UPMC Advantage Value Silver Select
UPMC Advantage Value Silver
UPMC Advantage Value Gold Select
UPMC Advantage Value Gold
Pennsylvania Health Savings Accounts feature 0% coinsurance on many policies. The structure is quite simple and very popular. After the deductible has been met, covered benefits are paid at 100%. (Qualified preventive benefits are never subject to deductibles or coinsurance). An HSA differs from a true “major medical” policy because it offers superior benefits after the deductible. We’re happy to compare the difference in premium and coverage from the top companies. Simply call or email us and we’ll provide personal recommendations for your situation. It is, of course, possible, that this type of plan is not your best choice.
Sample Major Medical Insurance Rates
Our hypothetical family is a married 50 year-old couple with two children. Their household income is $50,000 (modified adjusted gross income). Their medical conditions do not affect the price of coverage. Monthly rates listed below are for the least expensive "Bronze" Metal plans in selected counties:
$44 - Bucks
$44 - Chester
$44 - Philadelphia
$60 - Somerset
$61 - Bedford
$68 - Luzerne
$68 - Bradford
$78 - Elk
$161 - Mifflin
$161 - Snyder
$188 - Allegheny
There are numerous variables to consider in this example such as ages and health of the insured, policy coverage details, pre-existing conditions and underwriting guidelines. Also, rates in other areas of the state, such as Pittsburgh or Philadelphia, will be different. And many Blue Cross plans are only available in specific areas, such as Independence Blue Cross in Southeastern Pa, Capital Blue Cross in the central part of the state and Highmark Blue Cross Blue Shield in Western Pennsylvania. Geisinger and Northeastern Blue Cross are also not available in all areas of the state.
Major medical coverage is a great option for some, and not very suitable for others. We’re always willing to help you determine which type of policy is best for your unique situation. Please call us, contact us (see contact information at the top of the page) or view rates now by using our quote box at the top of the page. Naturally, there is never any cost or obligation when you use our website.