Compare the lowest allowable rates for your Pennsylvania health insurance plan coverage (Under age 65) and enroll in 20 minutes. 2021 Pa policies are available through the State Exchange (Pennie) with pre-existing conditions covered. You will not be denied for medical reasons, and an instant government tax credit may help you pay for the policy. Plans are also offered that do not receive a federal subsidy. Easy enrollment, free expert advice, and catastrophic, short-term, and comprehensive options are offered.
Prices are about 2.6% (average) lower than previous year’s rates. UPMC, Highmark, Geisinger, Independence Blue Cross, Capital Blue Cross, Ambetter, and Oscar offer private single and family plans. Silver-Tier plans feature cost-savings options that can substantially reduce the deductible, copays, and maximum out-of-pocket expenses. Often, a Silver-tier plan will feature lower out-of-pocket expenses than a Gold-tier plan.
Senior Pa Medigap plans can also be easily reviewed. Medicare Supplement and Advantage contracts may be able to reduce your copays, deductibles, coinsurance, and specific out-of-pocket expenses not covered by original Medicare. Part D prescription drug coverage is also offered to persons that have reached age 65. Plans A-N are standardized, and also include a high-deductible (G-HD) option. Plan F (HD) is offered to persons that have been previously covered under the policy.
A comparison chart is provided to help understand differences in all plans, including out-of-pocket expenses and benefits. Supplement contracts pay many of the expenses not paid by Parts A and B, including copays and deductibles. Coverage can also include nursing facility care, foreign travel emergency benefits, blood transfusions, preventative benefits, and excess charges from insurers.
Non-Obamacare options are also available. You can review alternative medical plans that offer lower rates without maternity and other previously-required benefits. If your employer does not provide benefits, or you are self-employed, many options are offered, including temporary and catastrophic non-ACA contracts. Several carriers reduced their rates and offer new plans. Commercial, Group, Medicaid, CHIP, and other products are also offered. Family PPO, EPO, and HMO contracts can be purchased along with indemnity plans. Many affordable options have become available for self-employed persons and small business owners.
Pa Pennie Exchange
For 2021, Pennsylvania has transitioned to a state-based Exchange (SBEP). Thus, the Open Enrollment period has expanded, and rates are slightly lower for many plans. The shopping experience is more user-friendly, and as your broker, we provide full plan comparison, enrollment, and policy servicing assistance at no charge. Middle-class individuals and families that don’t have access to group healthcare benefits are some of the main benefactors of the new Exchange, and healthcare.gov is no longer needed to enroll. Most carriers also offer dental benefits.
Pennie allows Pa to retain more control over enrollment, plan design, pricing, and affordability. The length of the Open Enrollment has also been expanded by 30 days compared to the Federal Marketplace. Tax credits continue to reduce premiums for qualified applicants, and medical underwriting has been eliminated. January 1 and February effective dates are available and advanced premium tax credits are offered to all qualified applicants. Special pandemic extended open enrollment periods can be added when needed (COVID).
Regardless if an applicant resides in Pittsburgh, Altoona, Harrisburg, Scranton, Reading, Lancaster, Allentown, Altoona, Philadelphia, or any other city, several policy options are always available. Small business, large group, self-funded, POS, and HSA plans provide additional policy options. Applicants that are between jobs or preparing for retirement can view several cost-savings options. Children may be eligible for CHIP, and wellness benefits are typically covered at 100%. Pediatric dental and vision benefits can be utilized on qualified Exchange (Pennie) plans.
All Pa Residents Eligible
Whether you are working for yourself, working for an employer, uninsured, self-employed, a single person, or a family, our website allows you to research, compare and apply for quality individual health care coverage in Pennsylvania, both on and off the Marketplace. Legislation often changes, and you can always view the most recent policy details and rates here. As current Administrations complete the partial change and updating of Obamacare and the Affordable Care Act, your options will be updated. The 10 required “essential health benefits” continue to be covered.
A new catastrophic option with lower premiums may become available in 2022. Designed to offer major medical and preventative benefits, premiums would be substantially less than Exchange plans. 12-month plans can now be purchased, creating flexible low-cost options. Typically, $2 million of coverage is the maximum offered, although benefits are limited in some areas. In-hospital and accidental expense riders can be added to reduce large out-of-pocket expenses. Hospital indemnity contracts are also available from several carriers.
Seniors can quickly view Medicare plans online. Several carriers that offer Medigap coverage include AARP-UnitedHealthcare, Aetna, Cigna, Humana, Keystone, Geisinger, UPMC, Capital Blue Cross, WellCare, Mutual Of Omaha, and Allwell. During Open Enrollment periods, the process is especially quick. Many additional plans are offered to small and large employers that provide their employees with medical benefits. CHIP and Medicaid coverage may be available through the Department of Human Services, depending on the household income.
Our free online tools and advice allow you to view options for all family members, including dependents and children. Ancillary products (dental, vision, life, disability, and long term care) are also available. You can also compare benefits, prices, service areas, network provider lists, and prescription drug formularies. Young adults can find many low-cost options by utilizing catastrophic and Bronze-tier plans. Pediatric dental benefits are included on all qualified plans. Private dental and vision plans can also be purchased.
Group plans through small and large employers provide flexible options, including high-deductible HSAs, and comprehensive contracts with lower copays and out-of-pocket expenses. Employees may also choose Marketplace plans for their coverage, although typically, a federal subsidy will not be available if a Group plan is offered. Total household income is considered when the instant tax credit is calculated. Also, Group plan Open Enrollment periods may differ from private plan OE periods.
Online Quotes And Rates Are Available 24/7
Your online Pa health insurance quotes are provided by an Agency/broker with more than 40 years of experience. In less than three minutes, you can view the most popular healthcare plans. Your service is provided by a live person, and not an automated website. Inexpensive Keystone State plans are available 24/7 on our website. If you qualify for a “Special Enrollment Period” exception, you can obtain subsidized or traditional coverage at any time throughout the year. It is possible that some family members may be eligible for Medicare, Medicaid, or CHIP. Group employer-provided benefits may also be available.
PPOs, HMOs, EPOs, HSAs, and all comprehensive and catastrophic plans are presented in an easy-to-understand format. If you are a small business owner or your employer does not offer health insurance, we help you purchase the policy that stays within your price range. A special business SHOP Exchange is available at any time and is not subject to Open Enrollment periods. Both comprehensive and high-deductible options are offered. Larger corporations can secure Group discounts for their employees, with multiple choices, including HSAs.
Catastrophic high-deductible plans are available for persons under age 30, and Seniors can choose a Plan F (existing plan) or Plan G HD Supplement option with a $2,300 deductible. These types of plans feature lower pricing, although higher out-of-pocket expenses are required before the deductible is met. During Open Enrollment, the plans can be changed. Maximum allowable deductibles generally change each year. Plan F is the most comprehensive plan, and covers both Medicare deductibles, and all coinsurance and copays. Prescription drug coverage is not included with Supplement plans, so a separate Part D plan will need to be purchased.
Medical coverage is much less costly than most other states. Currently, our own state has the 10th lowest rates in the US, according to an Administration study that was recently released. One of the primary reasons (as previously stated) is the availability of instant tax credits that immediately lower policy premiums. You may also qualify for Medicaid if your monthly income (single person) is below $1,384. The limit for a family of two is $1,874, a family of three is $2,364, and a family of four is $2,854. Marketplace plans are offered to applicants that qualify for Medicaid and CHIP, although a federal subsidy is not available.
You can also apply for Marketplace plans at these income levels, but no federal subsidy will be offered. CHIP benefits may be offered to dependents in the household. Senior products are offered by more carriers than Under-65 products. For example, Cigna, and Aetna offer Medicare plans, but not private individual medical coverage for applicants that have not reached age 65. AARP partners with UnitedHealthcare to offer Supplement and Advantage plans.
Affordable Healthcare Plans Are Available In All Parts Of Pennsylvania
There are many policies that will fit in your budget, and we provide all of the free research and comparisons. These plans will be available when you need them, and contain the benefits that you are most likely to utilize. National healthcare reform in the last six years has changed many benefits, and we review how they affect you, and what coverage you now will receive. HMO, PPO, and EPO plans provide consumers with multiple network choices regarding their physicians and medical facilities. Typically, emergency (life-threatening) treatment is covered as an in-network claim.
For example, 10 “essential” benefits are included on all non-short-term policies. Maternity, ER, office visits, prescriptions, and pediatric dental are the most common required benefits on qualified plans. However, it is possible that several of these benefits will no longer be required in future years, providing more low-cost customized plans. Individual states may also be provided more funding and decision-making, which may create more local customized plan options.
Each year, new plans become available that often feature very attractive prices. You can keep an existing plan, or choose to enroll in a new policy. Marketplace policies that are offered to under-65 individuals and families are listed below:
UPMC Advantage Catastrophic $8,550/$0
UPMC Advantage Bronze $6,700/$0
UPMC Advantage Silver $0/$85
UPMC Advantage Silver $2,000/$80
UPMC Advantage Silver $3,500/$25
UPMC Advantage Gold $1,000/$10
Highmark Together Blue Major Events EPO 8550 3 Free PCP Visits
Highmark my Direct Blue Major Events EPO 8550 3 Free PCP Visits
Highmark Together Blue EPO Bronze 3800
Highmark my Direct Blue EPO Bronze 3800
Highmark Together Blue EPO Bronze 6900 HSA
Highmark Together Blue EPO Silver 3450 HSA
Highmark my Direct Blue EPO Silver 3450 HSA
Highmark Together Blue EPO Silver 2900
Highmark my Direct Blue EPO Silver 2900
Highmark Together Blue EPO Gold 0
Highmark Together Blue EPO Gold 800
Highmark my Direct Blue EPO Gold 800
Highmark Together Blue Care Advantage EPO Gold 800
Highmark my Direct Blue EPO Gold 0
Capital Blue Cross
Capital Advantage Catastrophic PPO 8550/0/75
Capital Advantage Bronze PPO 80/0/50
Capital Advantage Silver 6000/20/40
Capital Advantage Gold Simple PPO 0/0/25
Capital Advantage Gold PPO 2150/10/20
Geisinger Marketplace All-Access Value
Geisinger Marketplace All-Access HMO 40/80/8400
Geisinger Marketplace All-Access PPO 40/80/8400
Geisinger Marketplace All-Access QHDHP PPO 6850 – HSA Eligible
Geisinger Marketplace Extra HMO 10/50/500
Geisinger Marketplace All-Access HMO 20/40/3000
Geisinger Marketplace All-Access PPO 20/40/3000
Geisinger Marketplace Extra HMO 10/50/4500
Geisinger Marketplace All-Access HMO 30/60/4650
Geisinger Marketplace All-Access PPO 30/60/4650
Independence Blue Cross
Independence Blue Cross Personal Choice EPO Catastrophic
Independence Blue Cross Personal Choice EPO Bronze Basic
Independence Blue Cross Personal Choice EPO Bronze Reserve
Independence Blue Cross Personal Choice PPO Bronze
Independence Blue Cross Personal Choice PPO Silver
Independence Blue Cross Personal Choice PPO Gold
Independence Blue Cross Personal Choice EPO Gold
Keystone HMO Silver Proactive Lite
Keystone HMO Silver Proactive
Keystone HMO Gold Proactive
Keystone HMO Gold
Oscar Bronze Classic
Oscar Bronze Classic PCP Copay
Oscar Bronze HDHP
Oscar Bronze Classic Next
Oscar Silver Saver 2
Oscar Silver Classic
Oscar Silver Classic Next
Oscar Silver Classic Copay
Oscar Silver Classic $0 Ded
Oscar Gold Classic
Ambetter Balanced Care 25 HSA
Ambetter Secure Care 15
Ambetter Secure Care 5
Ambetter Balanced Care 24
Ambetter Balanced Care 26
Ambetter Balanced Care 29
Ambetter Balanced Care 12
Ambetter Balanced Care 11
Ambetter Balanced Care 28
Companies Must Be Licensed, Registered And Approved
Any Agency or individual that offers Pennsylvania plans must be licensed by the Department Of Insurance. Carriers that do business in the Keystone State must register and maintain a license. Any changes in premiums must be approved by the DOI and no broker or agency can offer you a “special price.” You will always be quoted the lowest possible rate on this website. There are never any costs or fees for utilizing our resources and we maintain very tight security.
Financial information is never requested. The DOI also provides comparison tools and many consumer services. Policy, law, and regulation information is available upon request. Complaint ratios and rate filings can also be provided along with local office information. Star ratings and drug formulary lists can help compare Medicare products for Seniors. Consumers can also view the number of members statewide and national) that are enrolled in the plan, along with a formulary drug list.
If you meet specific income requirements, up to 100% of your premium can be paid by the government. If you are uninsurable, you will not be denied benefits. When you apply for a policy, the only medical-related question required is whether you are a smoker or non-smoker. Your zip code and/or county of residence will impact the cost of coverage. And of course, your age and type of plan applied for, will also affect the rate. Senior plans are generally not medically-underwritten, although your age, sex, smoking status, and county of residence can impact the cost.
Moving to a different service area will typically allow you to change plans outside of the Open Enrollment period. A “qualifying life event” (QLE) provides an SEP exception. A 60-day period is provided that allows you to shop, compare, and enroll in a plan offered in your service area. You may also choose a non-ACA plan. If your household does not qualify for a subsidy or Medicaid, these plans will likely offer a lower rate, although benefits will not be identical to a qualified plan. Preventative benefits may be provided, although 100% coverage is not likely. Limitations on non-Exchange plans may impact therapy, non-generic prescriptions, and out-of-network treatment.
Pa Senior Medigap Coverage – Compare Options On Our Website
If you have reached age 65, you are probably Medicare-eligible. Although original Medicare provides comprehensive benefits and covers most expenses, gaps still require you to pay many out-of-pocket medical costs. A Medigap plan (Supplement or Advantage) can help pay many of these expenses, which include deductibles, coinsurance, foreign travel, blood, skilled nursing care facility copays, and prescriptions. Many ancillary benefits and fitness center memberships and incentives may also be included.
To qualify for a plan, you must be enrolled in both Parts A and B. You also can not have both an Advantage and Supplement plan in-force at the same time. Part D prescription drug coverage can be purchased separately, although sometimes it is included in Advantage contracts. Also, your Part B premium is paid directly to Medicare. Unlike under-65 policies, each individual applies separately for their own plan. Supplement plans allow you to use any approved provider.
Therefore, two different policies may be purchased from two separate carriers. For example, one spouse may enroll in Plan A, while the other spouse selects Plan F. During Open Enrollment, each spouse may continue with their existing plan, or select a different plan. It’s also possible that one spouse will own an Advantage contract and the other spouse is covered with a Supplement plan.
Carriers that offer Medicare Supplement plans in Pennsylvania include Aetna, AARP, American Republic, Avalon, Central States, Colonial Penn, Companion Life, Continental General, Equitable, Geisinger, Gerber, Globe, Highmark BCBS, Humana, Independence Blue Cross, Liberty National Life, Loyal American, Manhattan Life, Medico, Mutual Of Omaha, New Era Life, Oxford Life, Philadelphia American, Physicians Mutual, State Farm, Sterling Life, Thrivent, Transamerica, United American, United of Omaha, UPMC, and USAA.
Medicare Advantage plans are also available. Private carriers contract with Medicare to offer Parts A and B coverage. Prescription drug benefits are also offered with many policies. Shown below are several plan options that received the “Highest Overall Rating” designation from US News & World Report. It is important however, to consider and compare all available options before enrolling. Also, many plans are only offered in specific counties, and not all Advantage plans include prescription benefits.
Each company offering these types of plans have specific provider networks that must be used. Many ancillary benefits are often provided, including dental and vision. Copays and annual limits will vary and network providers must be utilized. Companies offering coverage are listed below:
Lasso Healthcare, AARP, Aetna, Allwell, Community Blue, BlueJourney, Humana, UPMC, UnitedHealthcare, AmeriHealth, Gateway, Security Blue, Geisinger, Vibra Health Plan, Freedom Blue, Cigna-HealthSpring, Clover Health, Health Partners, Personal Choice, Geisinger, and Keystone.
Pa Part D prescription drug plans that are available, include EnvisionRxPlus, WellCare Value Script, Aetna Medicare Rx Select, Basic Blue Rx Value, Cigna-HealthSpring Rx Secure-Essential, Express Scripts Medicare-Saver, Mutual Of Omaha Rx Value, Basic Blue Rx Standard, AARP MedicareRx Walgreens, Humana Walmart Rx Plan, SilverScript Choice, Aetna Medicare Rx Saver, Cigna-HealthSpring Rx Secure, WellCare Classic, Humana Preferred Rx Plan, AARP Medicare Rx Saver Plus, Express Scripts Medicare-Value, Mutual Of Omaha Rx Plus, Cigna-HealthSpring Rx Secure-Extra, Aetna, Medicare Rx Value Plus, SilverScript Plus, WellCare Extra, Humana Enhanced, AARP Medicare Rx Preferred, SilverScript Allure, Blue Rx PDP Plus, Secure Rx – Option 3 (PDP), Express Scripts Medicare-Choice, SecureRx – Option 1 (PDP), and Blue Rx PDP Complete (PDP).
Any broker or agent can show you a health insurance plan. But shopping and researching Pennsylvania is our specialty, and we make certain that you receive the highest quality coverage at the lowest available rates. No “discount” or “limited benefit” policies are ever be used, and we carefully review every page of each policy to make sure there are no “hidden” surprises. Although Senior Medicare Supplement plans have standard features, rates can widely vary. We make it easy to compare all available plans and customize options to match your medical and budget needs.
Please contact us any time for additional information regarding your personal, Marketplace, or Medigap coverage. We find the best plan for your specific situation and thoroughly explain all of your policy benefits. You can compare and review rates 24/7 on our website. If you have missed the Open Enrollment deadline, many options are available.
The Pennsylvania Health Insurance Exchange Authority (PHIEA) offers affordable individual and family medical plans and generous tax subsidies. Many Pennsylvania consumers now pay less for their coverage than before the Affordable Care Act (ACA) was created. But there are still a few surprises along the way. We highlighted most of the major examples, so you won’t be caught off guard when you notice them, and can easily and quickly preview 2021 plans. We enroll you through the new Pennie website.
This Federally-Facilitated Marketplace (FFM) allows you to purchase low-cost plans at affordable prices through our website. Our assistance is always free, and advice is unbiased. For consumers that choose NOT to participate in the Exchange, there are many options for “Off-Marketplace” plans that have large networks and premiums that fit within your budget. Open Enrollment for non-Medicare applicants, begins on November 1st for coverage. The last day is typically January 15th, although year-round enrollment is available with an SEP exception. In 2021, a special COVID OE period (February 15 – May 15) was added.
Pa Senior Medicare products are also available, but not through the Pennie Exchange. A separate Open Enrollment period applies (October 15 to December 7) allows consumers to switch, join, or drop plans. An ANOC (Annual Notice Of Changes) is sent in the Fall (typically September) and provides information regarding changes in rate, coverage, or the service area for the upcoming year. Upon review, consumers should determine if they will keep the plan, or apply for different coverage.
The least expensive (under-65) 2021 plans are UPMC Advantage Bronze $6,700/$0, Highmark Together Blue EPO Bronze 3800, Highmark Together Blue EPO Bronze 6900 HSA, Highmark Together Blue EPO Bronze 3800, Geisinger Marketplace All-Access HMO 40/80/8400, Geisinger Marketplace All-Access PPO 40/80/8400, Capital Blue Bronze PPO 8000/0/50, Ambetter Essential Care 10, Ambetter Essential Care 2 HSA, Independence Blue Cross Personal Choice EPO Bronze Basic, and Oscar Bronze Classic.
A reinsurance program has been established specifically to help applicants that don’t qualify for a federal subsidy. The State is also expected to save approximately $40 million in administration and operating expenses. Online enrollment tales about 20 minutes with the assistance of our website. Consumers can view out-of-pocket expenses, specific benefits, costs of all plans, and specific examples of selected procedures, including maternity stays.
Until three years ago, the penalty for not securing qualified coverage was $695 per adult ($2,085 maximum) or 2.5% of total household income, whichever was higher. However, applicants were exempt from the penalty if your household income was lower than the federal income tax return filing threshold. Generally, this was approximately $10,400 for a single return, and $20,800 for a joint return. You could also bypass the penalty if you were not a US citizen, were incarcerated, or gap in lapsed coverage is less than three months. The tax penalty was repealed two years ago.
Medicare sign-up is not affected since the Exchange offers plans to persons under the age of 65. Seniors that have reached age 65, have a different Open Enrollment period (October 15th-December 7th). Medicare Supplement and Advantage plans are popular Medigap options that can help pay for many expenses that are not covered. Part D prescription drug plans are also offered to Seniors. Long-term care, accident, life, dental, and vision coverage can be purchased separately from several carriers.
Dual eligible special needs plans (D-SNP) are also offered for applicants that are eligible for both Medicaid and Medicare. Examples include Aetna Medicare Advantra Cares, Allwell Dual Medicare, AmeriHealth Caritas VIP Care, Cigna TotalCare, Gateway Health Medicare Assured Diamond, Geisinger Gold Secure Rx, Health Partners Medicare Special, Keystone First VIP Choice, UnitedHealthcare Dual Complete, and UPMC for Life Complete Care.
Previously, UnitedHealthcare (UHC), one of the nation’s largest providers, offered Exchange plans in the Philadelphia and Pittsburgh areas, and several additional states. One of their cheapest policies was a Bronze-tier contract with a high deductible. However, UHC no longer offers private Pa ACA-compliant plans, although their non-ACA portfolio is extensive, including popular temporary plan options. Dental, vision, critical illness, and other ancillary products can also be purchased from UHC.
Ambetter, a national carrier, offers several plans in Philadelphia-area counties. Ambetter’s parent company Centene Corporation provides coverage in 32 states. Oscar began offering Philadelphia-area coverage last year, and expanded the service area in 2021. Oscar offers coverage in 18 states and more than 40 large markets. HSAs and Bronze-tier plans are very popular. Customer-satisfaction is very high with the carrier, and online virtual physician visits generally have a $0 copay.
Aetna has exited the Keystone State for individual coverage but offers off-Exchange, Senior, and Group plans. It is possible that Aetna may return to the Buckeye State with Marketplace options. Other carriers offering either individual (on or off Marketplace) or Group plans include Capital Blue Cross, Independence Blue Cross, Geisinger, UPMC, Highmark, Ambetter, First Priority Life, Freedom Life, Keystone Health Plan Central, Oscar, and National Foundation Life.
Are Rates Higher?
Yes, they are, but don’t get a high temperature over it! Not all companies are raising premiums, and many plans saw moderate or no rate increases. Our website always offers the most recent prices, once each carrier has publicly released their new cost structure, so you’ll be able to easily find the least expensive choices. Since rates can often substantially change, it is important to properly shop and review all available policies in your area. Names of plans often change each year, and it is common for deductibles and maximum out-of-pocket expenses to also change.
Important: Much of your premium may be determined by the amount of government subsidy that you are offered. If you had an increase (or decrease) of income of more than 10%, the most appropriate plan selection this year may not be the best option for next year. For example, you may gain (or lose) an important “cost-sharing” feature on a Silver-Tier plan that could make a difference of thousands of dollars in premiums and deductibles.
Self-employed persons must closely monitor their income to ensure their federal subsidy is close to the original projection.Projected incomes can quickly change and a subsidy adjustment may have to be made. Projected federal subsidies can also change. A recent example was in 2021 when the COVID relief bill provided consumers with reduced premiums.
It’s also possible that you may become Medicaid-eligible if there was a substantial pay reduction. If you reach age 65, a combination of Medicare and Medigap coverage should be properly discussed. Seniors should be aware of the enrollment periods for signing up for Parts A and B benefits, along with Part D prescription drug coverage. Although it is possible to change from an Advantage plan to Supplement coverage (and vice versa), specific restrictions and time-limits may apply.
I Missed Pa Open Enrollment! Now What?
Unless you qualify for a special “lifetime event,” you will not be able to utilize federal subsidies or Exchange options until the next Open Enrollment. However, there are many qualifying events, such as having a baby, losing your employer-provided or private-provided coverage, moving to Pennsylvania from another state, reaching age 26 while covered in a parent’s policy, and getting a divorce. There are also several additional situations that qualify for an exception. These are also referred to as “Special Enrollment Periods” (SEP).
For persons that forgot to apply for coverage or don’t qualify for a special event, there are several low-cost policies that can be purchased, and often quickly approved. However, it is possible they will not contain all of the mandatory benefits that the new ACA legislation requires or cover a condition you are currently being treated for. Note: Senior Medigap (Advantage and Supplement) plans are not required to contain 10 “essential benefits” that are required for persons under age 65. Part D drug plans offer prescription benefits only.
Short-term plans are very cheap and can be approved within 24 hours. These plans can be purchased any time of the year. UnitedHealthcare is one of many reputable companies that offer this type of plan. You can purchase a policy directly through our website at the lowest offered cost. However, they are not designed to cover a condition that you are presently being treated for. Also, since they are “non-compliant,” unlimited benefits are not included. However, up to $2 million per person per year is offered, which is generally sufficient until guaranteed benefits are secured.
Young Healthy Persons Are Needed
Under the Affordable Care Act legislation (Obamacare), everybody is eligible for coverage, regardless if you are in impeccable health or have life-threatening medical conditions that cost hundreds of thousands of dollars per year. Since all plans are “guaranteed approval” with no underwriting (except for smoking), you can not be denied coverage, or charged a higher premium because of a medical condition.
However, since millions of additional claim dollars are paid by Pennsylvania health insurance companies (compared to previous years), for the system to work, additional healthy persons, that file very few claims, will have to be added. Young adults, although their premiums are not high, are becoming a big target for carriers. If more persons under age 25 enroll, the lower prices will become for everyone else. Subsidies are available on non-catastrophic plans, so depending upon the household income, the cost of many plans is substantially below $100 per month, including several $0 premium options.
And why not? Typically, these groups of people (especially males) have very few claims and rarely utilize benefits, even if they are free. So, adding as many young people to the “pool” of persons now being insured is needed to avoid potentially large rate increases for other applicants in the upcoming years. It’s also possible (depending upon legislation) that Medicare could be offered to eligible applicants that have reached age 62 (instead of 65).
During the first three months of the first Open Enrollment, approximately 24% of new applicants were from persons in the 18-34 age range. Although these figures were slightly lower than expected, young persons typically sign up later rather than earlier. 202 enrollment of persons under age 30 has been lower than originally expected. The larger the number, the more likely prices for everyone will remain stable or reduce. The Pa Dept. of Insurance also sets rules regarding the availability of non-Obamacare plans.
No, You Can’t Keep Your Doctor…Or Can You?
Maybe you can, and maybe you can’t. But there is no guarantee that the doctors, specialists and hospitals you used in previous years will be considered a “network provider” this year. For example, if you were covered under a “grandfathered” plan, in many areas, they may not be participating in the Exchange. Therefore, your current physician may not accept your new company, forcing you to choose from a short list of insurers that are acceptable. Often, a doctor or specialist may be listed in a carrier’s PPO network, but not the HMO network. EPO plans have become increasingly popular and will continue to increase in 2022.
However, there are providers that are adding additional carriers, so it is possible that the opposite effect could occur for many Pa consumers. A specialist, for example, that was not “in network” in prior years, may now be acceptable to use. We will always provide a list of available physicians upon your request. Verification of network-participation can also be requested prior to your visit with a physician or specialist. Note: Many bronze-tier plans place a deductible on specialist visits, so a Silver-tier option should be considered if treatment is likely.
Anthem Blue Cross, for example, in Ohio (and other states) has previously utilized the “Pathway” and “Pathway X” networks. The “X” designates it as an Exchange provider list and it is different (and less inclusive) than the non-X network. Thus, it is possible that once you shift to a Marketplace policy, although the carrier stayed the same, the provider list didn’t. Online provider lists are available from all carriers.
Also, it is expected that many doctors and specialists will continue to choose to retire, sell their business, or limit the number of insurers they accept for their services. When the issue of malpractice was not seriously discussed by Congress, many physicians began looking at other opportunities in the medical profession. Some physicians decided to forgo their practice and become consultants or teachers/lecturers for local colleges and universities.
“Pay As You Go” practices are also starting to appear. Since third-party payments leave out insurance and the government, if you want to continue to use their services, you must pay for everything in cash (check or credit card, of course, is fine also). This is a major cost-saving feature for practices but many patients also like this method. Prices for procedures are published and satisfaction appears to be high for persons that are treated. Christian Ministry plans are also available in most areas.
It’s All About Metals
Often, you hear references to “Metals” in healthcare conversations. No, not sheet metal! The format for comparing qualified Pa Exchange plans names them after metals. Currently, there are four options and they are Bronze, Silver, Gold and Platinum. The differences in the four metals are their actuarial value, which is defined as the approximate percentage of medical expenses covered by the policy. Prices of each of the four options are different.
The Bronze plan (the least expensive) covers about 60% of anticipated expenses. The Silver, Gold and Platinum increase from 60% by 10% respectively. But it’s still important to compare different companies since a Gold policy from one carrier could actually be more expensive than another carrier’s Platinum policy. Also, Silver-tier plans are eligible for unique “cost-sharing,” which can significantly lower your deductibles, copays, and out-of-pocket expenses.
There is also the cheapest contract – the “catastrophic” plan, that diminishes costs, but still maintains a solid framework of benefits. However, you must be under age 30 to qualify for this policy. The exception is if you can prove “financial hardship.” We can review the specific requirements upon request. Since catastrophic plans are not eligible for financial aid, often this low-cost option is more expensive than a Bronze or Silver option.
NOTE: Deductibles and maximum out-of-pocket expenses of catastrophic plans are typically $8,550. Often, up to three pcp office visits are offered with a $0 or low copay. However, specialist office visits are typically subject to a deductible and all prescriptions are required to meet the deductible and coinsurance. Telemed (virtual) office visits are often provided with no out-of-pocket expenses and no limit on the number of covered visits.
Catastrophic plan options are: Independence Blue Cross Catastrophic, UPMC Advantage Catastrophic, Geisinger Marketplace Value, and Highmark my Direct Blue Major Events. Typically, several primary-care physician office visits are provided with low or no copays. However, most other benefits, including specialist visits, ER visits, and Urgent Care visits, are subject to a large deductible. Prescription drugs also must meet a deductible. Qualified preventative expenses are always covered with no out-of-pocket cost. Negotiated network agreements also help reduce the cost of expenses that are subject to a deductible.
The “SHOP” Exchange (Small Business Health Options Program) is designed to offer affordable medical and dental benefits to companies with less than 50 employees. “Dental only” plan options can also be offered. However, all workers with 30 or more hours (weekly) must be offered coverage. For companies with under 25 employees, a special tax credit that potentially pays up to half of the premiums.
If the company you work for has more than 50 employees, your benefits are likely to not be impacted as much as individuals buying new coverage. Although there may be new and revamped coverage added to your group package, there will be no overhaul. If premiums rise, it may be a combination of higher local facility charges and your employer simply paying a smaller share of the group policy.
If your employer has less than 50 workers, there is a greater chance of major changes, including the elimination of healthcare benefits. Although the company would pay a fine, the cost may be far less than providing a group medical policy to all employees.
Companies Available Through The Pennsylvania Health Insurance Exchange Authority (PHIEA)
A wide variety of carriers offer plans on AND off the Marketplace. Therefore, if you don’t want an “Obamacare” plan, you can opt out and enroll without providing financial information for a subsidy calculation or having to visit the government website. Pennsylvania has several participating companies offering plans. We have listed them below: (UnitedHealthcare and Aetna no longer offer Pa Marketplace contracts)
Capital Blue Cross (Keystone Health Plan Central)
Keystone Health Plan East
Independence Blue Cross
But I Don’t Want Maternity Coverage
Of course you don’t want maternity benefits. You’re a 60-year-old male that just had a vasectomy. There is no risk of pregnancy and you’re not even married! Sorry. You have to buy the coverage. It’s automatically included in all eligible policies and there’s no way to delete it. However, it’s possible that more customized options may be offered in 2021, with several plans omitting specific required benefits, such as maternity. These plans would cost less, and would be ideal for healthy applicants that prefer basic major medical benefits. Currently, one-year short-term plans are not available in the Keystone State.
Previously, you could choose plans with or without maternity benefits. For example, an Aetna HMO plan would include it while their PPO plans excluded it. And naturally, you saved money by eliminating the coverage. Many other carriers such as Geisinger, Highmark and Independence Blue Cross also offered the same cost-saving options. Several carriers included maternity benefits with a 270-day waiting period.
But the Affordable Care Act changed maternity benefits. Due to “Essential Health Benefits” now becoming mandatory in all plans, you can’t delete it from your policy. While it’s a very necessary coverage for many families (both young and old), it is expensive, and an unneeded financial burden to others. Typically, applicants that have reached age 50 do not want maternity benefits and would choose a cost-saving plan that excluded this benefit.
However, the extra cost associated with adding maternity and prenatal care has been much less expensive than originally anticipated. Many Bronze-tier plans with higher deductibles don’t pass on the full cost of maternity benefits. Rates for older ages are beginning to reflect the lower incidence of maternity claims.
Other “Essential Health Benefits” that you must accept are pediatric dental and vision, mental health, substance abuse, behavioral treatment, emergency room, baby well visits (even if you have no children), prescriptions and chronic condition coverage. If any of these benefits are not included in a policy, it will not be available for the Pennsylvania Health Insurance Exchange. A complete list of mandatory Pa State Required Benefits can be found here.
Since I’m Retired, Obamacare Does Not Matter To Me
Perhaps it should. If your employer plans on making no changes to your existing coverage that you have carried since retiring, then the impact from the healthcare changes will not have a big effect on you. But there are many large corporations that are going down a different path in future years. Contributions towards coverage are decreasing, and HSA offerings are becoming more popular. With many companies, up to $3,000 is deposited into the Group HSA.
For example, Time Warner, IBM and several additional Fortune 500 companies have eliminated retiree medical benefits, and instead, offer a specified amount of cash for purchasing coverage on the Pa Health Insurance Exchange. The amount of money received is often not enough to buy a policy that duplicates existing coverage. Also, actual benefits may be different than what was previously provided for many years.
The Health Insurance Marketplace in Pennsylvania will offer affordable medical coverage to many consumers. Are you one of those persons? We help you find out. Open Enrollment on the Exchange has already started. Since glitches and delays still occur, but we continue to offer free Obamacare quotes here. You can also easily enroll in a non-Obamacare plan with no deadlines to meet.
UPDATES From The Past:
The deadline for a January 1 effective date is December 15th. Although the enrollment process will not take long (working with an experienced broker helps quite a bit), there is an application to be completed. If you feel you will qualify for a federal subsidy, a few financial-related questions will be asked.
The enrollment deadline has been extended to December 23rd (this year only) for a January 1 effective date. We give you a choice of applying over the phone or online. Also, all plans allow you to send payments through the mail or by credit card or EFT. Previously, the direct mail method was only offered by a few companies (Aetna, Blue Cross and others).
More than 10,000 persons in the state signed up for Exchange coverage in November (We didn’t write all of them!) as the December 23rd deadline approaches for January 1 effective dates. This is just a guess, but we estimate less than 1000 of those persons actually paid their first premium.
Paper applications appear to take the longest to process. Typically, we avoid that method of enrollment.
Children in low-income households can change to Medicaid. The government has granted the extra time at the request of Governor Tom Corbett. this change impacts children over the age of six in households with poverty-level incomes under 133%, but as high as 100%. Currently, many of these children are covered under CHIP.
Businesses with 51-99 employees were granted an extra year to provide mandatory healthcare for their workers. This applies to employees that work more than 30 hours weekly. Although part of the ACA legislation, this is the second consecutive year that the mandate has been postponed. About 2% of all companies and corporations have 51-99 workers.
Open Enrollment ends the end of this month. There is a possibility that the time period will be extended. No word yet from the White House (They have plenty to worry about from Mr. Putin!). But we would not be shocked if we saw a 30-90-day extension announced shortly.
Pa navigators may have to undergo background checks, get FBI clearance and carry clear identification if Senator John Eichelberger’s ideas become law. His legislation will protect consumers from unscrupulous persons that attempt to take advantage of consumers. There is clear evidence that navigators are often poorly-prepared to provide the help needed by many persons. Brokers and agents are still the best resource for explaining Marketplace options.
Although Obamacare Open Enrollment in Pennsylvania has ended, residents can still apply for low-cost plans in two ways. Firstly, short term policies are offered by several carriers. They can effectively provide coverage until the next OE period. Also, “qualified events,” such as losing your job, divorce, and moving, may allow you to enroll in a new plan. Pre-existing conditions would be covered and you can qualify for a subsidy.
Expanding Medicaid is close to becoming a reality. Republican Gene DiGirolamo’s bill, which would provide more than 450,000 persons with subsidized coverage, was just approved by the House Human Services Committee.
The governor’s “Healthy Pennsylvania” proposal to expand Medicaid has still not been approved by the federal government. It appears that January may be the earliest that the legislation could become law. Meanwhile, DiGirolamo’s could be implemented very quickly.
Are you one of the estimated 91,000 consumers that received an unexpected check from your insurer? More than $5 million was returned because of the 80/20 rule which requires companies to spend at least 80% of revenue on treatment of patients and other related costs. UnitedHealthcare, Aetna and Time are the three carriers that refunded the most money. This feature will also continue for current plans.
Plan prices have been released. As expected, rates have gone up for most plans, although several policies have lower costs for the upcoming year. The enrollment period is only three months, which is a few months less than last year. A last-minute change that adds extra time is not expected. However, when we get closer to February, we’ll see what happens.
Although OE is over, an extension was provided to persons that did not previously obtain coverage and were unaware of the penalties imposed for not obtaining coverage. However, in order to take advantage of this special exception, you must have paid the non-compliance tax penalty with your tax return.
About 470,000 Pa consumers enrolled in an Exchange plan. Approximately two out of every five applicants did not previously have Marketplace coverage, and more than 80% of all policies issued were subsidized by the federal government. The average subsidy was between $220 and $230.
The Pennsylvania Medical Society concluded a report that indicates 75% of state residents can see a physician within a week of the first request. More than a third of the respondents to the survey said their out-of-pocket expenses are higher for their current policy compared to last year. The survey covered the entire state.
As the Supreme Court gets ready to rule on a key piece of the ACA (state subsidies) next month, Governor Tom Wolf is preparing for the worst, and hoping for the best. A contingency plan is ready to create a Pa State Exchange that would replace the federally-run Marketplace that is currently used. This would only be implemented if the Supreme Court agrees that federal tax-credit subsidies can only be used for state-based Exchanges.
Rate increase requests are slowly being received by the Pa Department of Insurance. As expected, some hefty price increases are being requested. Geisinger is seeking up to a 40% increase on some plans while Highmark and Keystone requests for selected plans are above 30%.
Several of the larger plan rate increases are listed below:
61.2% – Time Individual Medical
58.4% – Geisinger Choice Individual
40.6% – Geisinger HMO POS
39.7% – Highmark Comprehensive Care PPO
36.6% – Keystone Health Plan West Care Guide Blue HMO
36.2% – Highmark Comprehensive Care Blue PPO
35.0% – First Priority Life my Blue Cross Multi State
34.5% – First Priority Life myBlue Access LP
More news. Conditional approval has been granted to Pa’s application for a state-based Exchange. Governor Tom Wolfe is rightfully concerned that the Supreme Court ruling this month could eliminate federal subsidies for more than 380,000 persons. King vs. Burwell is expected to decide if states that utilize the federal government for their Marketplace, are eligible for financial aid.
Open Enrollment begins in about 70 days and Pa insurers have submitted their requests for rates. Highmark and many other companies are requesting substantial increases. Aetna, like several other companies, will not be offering “on-Exchange” plans.
Although changes have been proposed and discussed by the Trump Administration, negotiations continue. It’s possible that additional high-deductible options will be available.
Open Enrollment has ended, although “short-term” plans are offered by several carriers.
Find free Pennsylvania health insurance quotes so you can compare the most affordable Pa plans from all providers. Whether you are ready to purchase a policy or are shopping for future Exchange or Medicare coverage, we offer a wide selection of options for every individual and family in the Keystone State. Although you are not required to buy healthcare benefits, there are many inexpensive policies that will provide major medical, office visit, ER, Urgent Care, maternity, preventative, and prescription coverage.
Since there are hundreds of websites that will provide rates, what’s so special about our website? We have more than 40 years of experience helping customers, and we understand that shopping for under age 65 or Senior coverage in or outside of the Pennie Marketplace is very challenging and time-consuming. Our fast no-obligation website helps you easily and quickly review all available plans in your area. Prices will vary, depending on your age, household income, and location, but an instant federal tax credit may help reduce your premium. Medical questions are not asked and physicals are not required.
Regardless if you need personal, group, child, Medigap, or family benefits, our experienced staff can help. It’s important to understand the type of benefits you are viewing, and ensure only trusted companies are compared. If you are spending money for prescription drugs, understanding your carrier’s formulary drug list can potentially save you thousands of dollars. Many plans allow you to choose any doctor, specialist, or hospital. Spouse, domestic partner, and dependent benefits are offered by all carriers. AARP-UnitedHealthcare offers many Senior products. UHC underwrites the policies. Independence Blue Cross, Humana, and Aetna are additional large carriers that issue many types of policies.
If buying a policy through Pa Open Enrollment, you can choose from multiple Exchange options that do not require you to answer any health-related questions. You may also be able to qualify for a large federal tax subsidy that can save thousands of dollars per year. We can assist you in determining how large your credit is and the best type of policy you should purchase. If you are Medicaid or Medicare-eligible, you can view the most affordable plans in your area, and utilize 100% covered preventative benefits. Applicants eligible for both Medicare and Medicaid may be available for several available “dual” products.
No, we can’t send you free cash from your laptop, but we can provide expert and experienced advice that will save you money. We don’t just educate you about Pa healthcare policies. We also do the shopping for you, so you can spend less time trying to compare side by side hundreds of different options. In just a few minutes, you can buy your policy online and view all benefits for yourself and family members. And there are many other reasons to use our free help:
Low rates are very important, but there are other factors to consider. Your coverage must match your particular needs. It is easy to find the Pennsylvania plan with the lowest premium. A bigger challenge is finding the policy that costs you the least. And that’s our specialty. We want you to be able to use the benefits you pay for, but also not pay for coverage you don’t need. For example, if you don’t travel overseas, you don’t need international coverage. If there are no children in your household, well-baby visits are no longer needed.
If you have an HSA account, an HDHP plan should be selected to allow tax-deductible deposits. 2021 maximum contributions are $3,600 for single plans and $7,200 for family plans. Minimum deductibles are $1,400 and $2,800. Tax-deductible deposits are not permitted into non-HDHP plans. Large network provider discounts on HSA plans can potentially save thousands of dollars of out-of-pocket expenses. Plans are offered by several carriers that also feature large network-negotiated discounts. Senior Medicare options also include a high-deductible (HD) Plan G.
Customized Individual Assistance
We are not an online “call center” that simply quotes a Pennsylvania policy and leaves all future servicing to you. As your personal statewide broker, we offer our expertise at no charge any time you need it. When your policy renews, we’ll review the rate to make sure it is still your best option. Whether you need help with a claim, billing, or making changes to your policy, we’ll be available. You can choose a Marketplace plan that is eligible for a subsidy, or an off-Exchange option that receives no federal assistance.
Non-Obamacare options are also offered at any time throughout the year. Policies are issued though reputable and licensed carriers (including UnitedHealthcare), and flexible high-deductible and comprehensive options can be purchased. Monthly billing without fees and additional dental and vision riders are typically available.
Only “A” rated companies are recommended by our website, and we feel it is important that a health insurer pays claims on a timely basis. We also will not use “discounted limited benefit” policies that often have upfront application charges and high customer dissatisfaction. Quite simply, if a policy isn’t good enough for us, it’s not good enough for you either! The Pa DOI closely monitors ratings and the financial stability of carriers writing policies in the state. They also publish the names of companies that are licensed to conduct business in the Keystone State.
Additional products available include life, critical illness, pet, travel, disability, discount prescription, and accident insurance. These types of policies are designed to supplement existing coverage, or provide temporary limited protection if an Open Enrollment deadline was missed. They are not substitutes for qualified Marketplace or COBRA plans. International plans are also sold by several companies, if coverage is needed outside of the U.S.
The quotes you receive from us are the best rates offered by each company. Since prices are state-approved, no lower premium is available. And we never charge a fee for our services. While applying online is the quickest way to buy a policy, there are also other methods. You can purchase a customized plan that is researched and created just for you. If you need quick temporary coverage today, you can find it here. These short-term plans are designed for applicants that are not eligible for Medicare, and desire benefits for less than 12 months.
Policies are quickly approved, and PPO and indemnity plans can be used. If the policy continues to the end of the calendar year, Marketplace (Exchange) plans should be considered if serious medical conditions need to be covered. Regardless of the reason, you may terminate benefits at any time. However, after the policy lapses, guaranteed coverage with pre-existing conditions covered can only be obtained during Open Enrollment periods (under-65 and Senior).
During OE periods (November 1-Januray 15 through Pennie), Marketplace plan options are available. You can choose to utilize a federal subsidy (if you qualify), or simply compare options that do not use any Obamacare federal aid. Because of the complexity of determining which policy provides you with the best combination of premium and lowest out-of-pocket expenses, we customize quotes to match your specific needs. You can change policies every year to match new budget or health concerns.
Instant Tax Credit Reduces Your Rate
This federal subsidy can potentially save you thousands of dollars per year, and easily tens of thousands of dollars during your lifetime. “Metal” policies along with “Essential Health Benefits” have replaced many older policies. Older “grandfathered” plans have slowly been eliminated. For example, older plans that excluded maternity and mental illness benefits, are now only used for non-Obamacare coverage. Short-term plans are popular options for non-Exchange coverage.
The process of calculating your top offers takes about two minutes (see very top of page for quote request) and quickly, you’ll be able to compare rates from the best companies in the state, such as Aetna, UnitedHealthcare, Keystone, Highmark, Capital Blue Cross, UPMC, Geisinger, Coventry, and many more reputable carriers. Note: Several carriers (UnitedHealthcare, Aetna, Cigna, and Humana) do not offer Marketplace contracts, but can provide ancillary and Senior products.
Medicare Supplement Plans In Pennsylvania
If you have reached age 65 and are enrolled in Medicare Part B, you are eligible to purchase a Medigap or Advantage plan. Although not required, often these types of policies can effectively lower your out-of-pocket costs for hospital confinements and other submitted claims. If you miss the six-month Open Enrollment Period (OEP), you may be able to apply for coverage, although the application will be medically-underwritten. You can also wait until the next OE period in October.
“Advantage” plan options are typically less expensive than Supplement plans, and often feature “$0” premiums. However, it is crucial to understand the differences in policies, and to properly verify that your providers are included in the company’s network. These types of policies are issued by private carriers (instead of the federal government). They have a contractual agreement with Medicare to provide Parts A and B benefits. Often, dental, vision, hearing, and prescription coverage are included in the policy. Both HMO and PPO options are offered.
Pa individual health insurance plans are available at very affordable rates. Most major Pennsylvania companies offer a large selection of personal policies to meet the ever-changing needs of consumers both on and off the Marketplace. Whether you’re not working, self-employed, an early retiree, or uninsured, we will find the best health insurance for you. When purchasing private Pennie “Exchange” plans, there are several new options, and a generous federal instant tax credit.
Typically, in Pennsylvania, United Healthcare, Aetna, UPMC, Blue Cross Blue Shield, Highmark, Keystone, Capital BlueCross, Geisinger and Independence Blue Cross have the most competitive private and Group rates. Oscar and Ambetter, the newest Exchange carriers, offer plans in limited areas. Most individual policies are not medically underwritten, so pre-existing conditions are covered and do not increase your premium. Senior Medicare (Advantage, Supplement, and Part D prescription drug) coverage is offered to help reduce out-of-pocket costs. NOTE: Many carriers (including UnitedHealthcare and Aetna) offer Group and Medigap products, but do not underwrite private individual healthcare plans.
Patent Protection And Affordable Care Act (Obamacare)
It’s been about 11 years since the legislation was signed and implemented. Here in the Keystone State, many persons have been helped, and many persons have been hurt, by losing “grandfathered” plans they expected to keep. The two biggest positive changes are the availability of federal subsidies to help lower rates, and the elimination of pre-existing condition clauses. Access to quality Pa coverage has never been higher, and Medicaid expansion has helped many low-income households. CHIP provides comprehensive medical coverage to many children and young adults, while Medicare and Medicaid help Seniors and low-income households.
However, provider networks are not nearly as robust as they were during the pre-Obamacare days, and several new taxes and penalties have a direct or indirect impact on consumers. Despite all of the changes, many affordable options are available, and our website helps you find and compare the best options, and easily enroll. By 2022, additional plans with increased flexibility may be offered if Congress can pass specific legislation. More robust short-term plans are unlikely to be introduced unless the Pa DOI approves additional options. The duration of these plans may reduce to less than 12 months.
Different Types Of Individual Healthcare Plans
The three types of Pa individual health insurance are “Catastrophic,” “Comprehensive,” and “Health Savings Accounts (HSAs).” Of course, the newer terminology is “Metal” plans that are available on the State Marketplace. Bronze, Silver, Gold, and Platinum are your new benchmark definitions for available policies. Small and large business owners also have additional alternatives through the “SHOP” (Small Business Health Options Program) Exchange. Tax credits for small businesses are offered. Employees can opt out of employer-provided coverage and purchase plans privately. However, a federal subsidy may not be offered if Group healthcare benefits were declined.
Catastrophic plans previously only covered the major medical expenses, and rates were usually very low. However, they have evolved in recent years to include three non-preventative office (primary-care physician) visits that are typically subject to copays of between $20 and $50. However, specialist visits, which are often more expensive, generally require a large deductible ($8,550 or more) to be met first. Although generic drugs may be offered with only a copay, most other Tiers require a deductible to be met.
Also, unless you are under age 30, you will not qualify for these types of plans. A financial “hardship exemption” is sometimes granted if you can prove you are homeless, experienced domestic abuse or violence, filed for bankruptcy within the last six months, recently had a family member die, or received a utility company shutoff. There are also several additional exceptions that can be granted.
Individual and family catastrophic plans continue to provide preventive benefits that are not subject to a deductible or any other out of pocket costs. Once a policy is approved, you can immediately utilize these benefits. Many plans for young adults (under age 30) provide three free primary-care physician visits and discounted or free telemed online coverage.
If you want the cheapest price, this is the type of contract you should have. Many temporary needs are covered by short-term policies. For example, if you have guaranteed medical coverage in 90 days, and just need a cheap contract to fill the gap, then perhaps a temporary solution is the best idea. BIG CAVEAT: They are not considered compliant since pre-existing conditions are not covered, federal subsidies do not apply, and prescription drug and mental health benefits may be limited. UnitedHealthcare provides several popular temporary plans including Medical Copay Select, Medical Plus Select, Medical Plus Elite, and Medical Value Select.
Temporary medical plans require limited medical underwriting and a physical or extensive application is never required. The initial payment is typically for only the first month, and subsequent billing can be made on a monthly basis. A spouse and dependents can be added to the same policy as the primary insured, unlike a Medicare Supplement plan. The rate is guaranteed until the next policy renewal. However, once an applicant reaches age 65 or becomes Medicare-eligible, a temporary plan may not be available.
Short-term plan monthly rates are shown below. Applicant is a 40 year-old non-smoking male. Plan is UnitedHealthcare Short Term Medical Value Select A $5,000 Deductible)
Allegheny County – $106.60
Cambria County – $125.20
Dauphin County – $125.20
Erie County – $125.20
Fayette County – $106.60
Lancaster County – $115.60
Northampton County – $125.20
Philadelphia County – $115.60
Comprehensive plans offer rich office visit and prescription coverage and are the most expensive type of Marketplace coverage. Platinum and Gold-tier plans feature smaller copays, coinsurance, and deductibles, but do not necessarily provide richer benefits. Like Medicare benefits, most policies for persons under age 65 are closely standardized, with 10 “Essential Health Benefits” required.
The removal of lifetime caps (or maximums) on all qualified policies has eliminated the possibility of a specific illness or injury forcing the insurer to stop paying benefits until the following calendar year. Although the cost of several new specialty drugs is incredibly expensive (Soliris, for example, costs more than $400,000 per year), insurers, drug manufacturers, and patients generally find a way to make the prescription available. As patents expire, cheaper generic options become available. Also, the cost of many Tier 2 and Tier 3 drugs has reduced.
How To Lower Comprehensive Plan Premiums
Raising the deductible on the major medical items can keep the premium quite affordable. Specific personal insurance plans in Pennsylvania will offer a lower rate, by limiting the number of covered office visits. These are issued under the catastrophic-tier (discussed above) and generally limit the number of covered non-preventative office visits (per person) to three per year. Increasing deductibles and copays on ER and Urgent Care visits will also lower rates..
Another available option to reduce premiums is limiting the type of prescriptions that are covered by copays. By selecting a plan with a deductible on most non-generic drugs, rates will reduce. However, because of required essential benefits, you can not remove many benefits, including non-generic drugs. But by selecting plans that have higher copays on prescription coverage you may not use, premiums will reduce.
Comprehensive policies are very similar to the options you generally receive from your employer. HMO, EPO, and PPO options are offered along with some blended options that utilize the best features from both concepts. Generally, you find these plans in the Gold and Silver tiers. Bronze-tier plans often have maximum out-of-pocket costs as high as $8,550. $0 deductible options are also available but the maximum out-of-pocket costs and coinsurance are high.
Health Savings Accounts
HSAs, a popular private insurance plan, are most effective when major medical and preventative coverage are priorities. Rates are often quite low, and additional tax advantages help make the HSA an attractive option to consider. The amount of premium saved by purchasing the lower-premium higher-deductible policy can be deposited into an account to pay for qualified medical expenses.
You do not forfeit any of your deposited money if it is not used by the end of the year. You can find more Health Savings Account information here. This type of policy continues to be very much in demand, since it is still one of the least expensive ways to keep your premiums low. If your household income is above $100,000 (or close to that amount), an HSA should be at the top of your wish list! “Bronze” Tier plans often feature several HSA options.
HSA Plans Available In Pennsylvania
Ambetter Essential Care 2
Ambetter Balanced Care 25
Oscar Bronze HDHP
Highmark Together Blue EPO Bronze 6900 HSA
Highmark my Direct Blue EPO Bronze 6900 HSA
Highmark Together Blue EPO Silver 3450 HSA
Highmark my Direct Blue EPO Silver 3450 HSA
Geisinger Marketplace All-Access QHDHP PPO 6850
Medicare Supplement Coverage For Seniors
If you are approaching or have reached age 65, your primary medical benefits will be provided by Medicare, or, if you choose, a private insurer through a Medicare Advantage plan. Unless you are receiving a very large federal subsidy for your existing policy, premiums should reduce while coverage remains very strong. Also, you do not have to purchase a Medigap plan. In many households, the extra cost may not justify the benefits received.
NOTE: The Open Enrollment period for Seniors is different than the Marketplace OE period. It begins on October 15th and ends on December 7th each year. During that time, you can change (although not required) existing coverage or purchase a new plan. However, once you reach age 65, and are covered under Part B, for the next six months, you may choose any available supplementary coverage offered in your County.
Get Quotes Now!
Pa individual health insurance quotes are available by using the “Get Free Quotes” button at the top of this page. Only the highest quality Pennsylvania companies are considered. You can view, compare and even purchase your ideal benefits. We believe you’ll find our website quite dependable and a great resource for free helpful information.
When shopping and comparing Pa Marketplace plans, you can enroll in less than 20 minutes, and choose a policy that is subsidized, or an alternative policy that does not receive federal funding.