Pa Health & Wellness individual and single healthcare coverage is offered to residents of Bucks, Montgomery, and Philadelphia Counties that are under age-65. Affordable Bronze, Silver, and Gold-Tier Ambetter plans are available through the Marketplace and can be utilized with a federal subsidy for qualified applicants. Senior Medicare Advantage plans are issued through Allwell to qualified applicants that have reached age 65.
Centene Corporation is the parent company, and helps provide managed care, along with Medicaid benefits in Pennsylvania. As a Fortune 500 company, Centene provides diversified services to private and government programs, including Medicare (Special Needs Plans), Medicaid, CHIP, and several others. Marketplace, Medicare Advantage, and Community HealthChoices are three major sources of benefits provided in the Keystone State.
Open Enrollment for applicants under age 65 (and not eligible for Medicare benefits) begins November 1 and ends December 15th. The Senior Medicare Open Enrollment period begins October 15th and ends December 7th. However, throughout the calendar year, qualifying life events (QLE) can create additional enrollment opportunities.
Health Insurance Marketplace Plans From Ambetter (Under Age 65)
Essential Care 1 – $7,900 deductible with 0% coinsurance. Generic drugs not subject to deductible. Copays are $20 and $60 (mail order).
Balanced Care 11 – $30 (pcp) and $60 (specialist) office visit copays. $30 copay for diagnostic tests. Generic and preferred brand drugs not subject to deductible. Copays are $20 and $50 ($60 and $150 (mail order). $6,000 deductible with 40% coinsurance.
Balanced Care 5 – $40 (pcp) and $80 (specialist) office visit copays. Generic and preferred brand drugs not subject to deductible. Copays are $20 and $60 ($60 and $180 (mail order). $7,350 deductible with 0% coinsurance.
Secure Care 1 with 3 Free PCP Visits – First three pcp office visits fully covered. Generic drugs not subject to deductible. Copays are $10 and $30. $1,000 deductible with 20% coinsurance.
Balanced Care 3 – $30 (pcp) and $60 (specialist) office visit copays. Generic and preferred brand drugs not subject to deductible. Copays are $25 and $50 ($75 and $150 (mail order). $3,000 deductible with 30% coinsurance.
Sample Under Age-65 Monthly Rates
25-Year-Old And $20,000 Household Income
$10 – Essential Care 1
$81 – Balanced Care 11
$86 – Balanced Care 5
$128 – Secure Care 1
$134 – Balanced Care 3
40-Year-Old And $30,000 Household Income
$116 – Essential Care 1
$206 – Balanced Care 11
$213 – Balanced Care 5
$266 – Secure Care 1
$273 – Balanced Care 3
50-Year-Old Married Couple And $40,000 Household Income
$17 – Essential Care 1
$270 – Balanced Care 11
$290 – Balanced Care 5
$438 – Secure Care 1
$458 – Balanced Care 3
50-Year-Old Married Couple With Two Children And $82,000 Household Income
$312 – Essential Care 1
$674 – Balanced Care 11
$702 – Balanced Care 5
$913 – Secure Care 1
$941 – Balanced Care 3
Allwell Pa Service Area
Allwell Medicare Advantage Plans
Allwell Medicare HMO – $0 monthly premium and $0 deductible for medical services and Part D prescription drugs. Maximum out-of-pocket expenses are $6,700. Inpatient hospital copay is $295 for the first 6 days, and the outpatient hospital copay is $350 per visit. Pcp and specialist office visit copays are $0 and $40. Urgent care and emergency room copays are $40 and $90. Lab services and outpatient x-rays have copays of $0-$20 and $40. Tiers 1, 2, and 3 prescription drug copays are $0, $10, and $47. Plan CMS numbers are H2915-003, H2915-005, and H2915-006.
Allwell Dual Medicare HMO – $0 monthly premium and $0 deductible for medical services and Part D prescription drugs. Maximum out-of-pocket expenses of $3,400. Designed to cover applicants that are eligible for Medicare and Medicaid. Low or no out-of-pocket expenses for most benefits. Plan CMS numbers are H2915-001, H2915-002, H2915-007, and H2915-009.
Enrollment is available by phone, online, mail, or fax. The Center for Medicare and Medicaid Services (CMS) assigns a five star quality rating system to Advantage plans. This rating system compares performance and quality for several different categories. Several categories include health and drug plan customer service, drug safety and accuracy of prescription pricing, and member complaints. Allwell’s plans are too new to receive a current rating.
An “Extra Help” program is offered to lower-income households to help pay for prescription drugs. The cost of drugs, including copays, coinsurance, and a deductible are partially-reimbursed. To determine if you qualify, Medicaid, the Social Security Administration, or Medicare can be contacted. Part D prescription drug plans in Pennsylvania are not offered by Allwell, although many other carriers provide these benefits.
If you are 21 or older and receive both Medicaid and Medicare, you probably qualify. You can also qualify by receiving nursing home care paid by Medicaid, or if you receive LTSS in Independence, Aging waivers, or COMMCARE. Medicaid eligibility is determined by the PA DHS.
The medically-necessary services listed below are covered with without a required copay. Prior authorization or a referral may be required.
Pcp office visit
Outpatient non-hospital clinic
Certified RN practitioner
Podiatrist and chiropractor services
X-rays, CT scans, and MRIs
Outpatient ambulatory surgical and hospital short procedure unit
Eyeglass lenses and frames
Physical occupational and speech therapy
Additional provided benefits include a cell phone program with SafeLink Wireless, 3-Month prescription refills, Dental advice, nurse’s help line, vision benefits, and choice of your physician.
Pa Health & Wellness serves the Senior and under-65 market in Pennsylvania. Known for compassionate and coordinated care, Centenne’s innovational products should continue to remain popular. It’s also possible that they will expand into other parts of the Keystone State.
You live in Pennsylvania, and you think you are very healthy. You eat your vegetables, regularly exercise, and effectively reduce stress. But how do you and all other Keystone State residents compare to other states? Are folks in Pittsburgh healthier than persons in Indianapolis? Is Philadelphia a better place to live than Baltimore. With the help of the United Health Foundation’s research and annual report, we will provide some extremely interesting statistics.
Four key components greatly impact health. They are clinical care, community and environment, policy, and behavior. Statewide and national trends in public health have been studied for more than 25 years by the Foundation. They have correctly observed and predicted reductions in the number of smokers, along with increases in drug abuse and deaths along with higher incidences of obesity.
How does Pennsylvania rate? Overall, the Keystone State ranks as the 28th healthiest state in the US. Shown below, in order, are the Top 20.
Smoking in the US has decreased in the last four years from 21.2% of the population to 17.5%. Smoking is the leading cause of preventable death (obesity is second). For the last 50 years, the percentage of smokers has been steadily reducing. Many state smoking cessation programs have helped, and passing legislation that prohibits smoking in public and work-related locations has also contributed to the declining number of smokers. Increasing taxes and providing counseling are additional helpful factors.
College graduates are much less likely to smoke than persons with a high school (only) education, and the trend is not showing any signs of changing. Also among the 10 largest US cities, Philadelphia has the highest percentage of adult smokers at more than 25%. Also, more than 7% of high school students use tobacco. One possible reason is the high percentage of their parents who smoke. Tobacco usage costs the US more than $170 billion each year in direct and indirect related expenses.
For the last five years, all states have reduced their percentage of smokers. Illinois has experienced the most significant decrease while Tennessee’s drop has been the smallest. The other states with the biggest reductions (in order) are Nevada, Texas, Arizona, Indiana, Wisconsin, Wyoming, Rhode Island, Massachusetts, Pennsylvania, Oklahoma, Georgia, and Kansas. Currenrly, Pennsylvania ranks 29th of all states when comparing the number of active smokers.
Since 1990, obesity among young adults in the US has increased by a whopping 157%. Currently, about 30% of all adults are considered obese, which is a slight increase from last year. Although the incidence of obesity actually decreased in half of all states, the reductions were generally nominal. Physical inactivity is one of the primary reasons for the weight gain. Small increases in daily exercise can reverse the disturbing trend. NOTE: Adult inactivity, as expected, is much more prevalent at ages 40-60, than 20-39.
As the second-leading cause of preventable death (smoking is number one), obesity also contributes towards many conditions, including heart disease, diabetes, cancer, stroke, and several respiratory diseases. Education level also has a direct impact on obesity risk. Higher educational levels lead to a lower risk of being overweight, especially for females. College graduates have a 40% lower chance of becoming obese than persons that do not graduate from high school.
Pennsylvania’s annual rate of change in obesity prevalence by education level (age 25 or older) from 2012 to 2016 was the second-highest in the US behind only Vermont. The next five highest states were New York, Alaska, Oklahoma, Nevada, and Iowa. Better nutrition education in schools and at home can help improve the results.
The leading cause of deaths by injury in the United States is drug overdoses. More than 40,000 persons die each year, and most of the deaths involve opioids (pain relievers such as oxycodone, morphine, or hydrocodone). The total cost of illegal drug usage in Pennsylvania is hundreds of millions of dollars each year. The only states with higher drug deaths (as a percentage of population) are Nevada, Oklahoma, Ohio, Rhode Island, Utah, Kentucky, New Mexico and West Virginia.
A significantly-higher number of males lose their life from drug overdoses, compared to females. When comparing race and origin, Asians, Alaska natives, and American Indiana have the lowest rates, while Caucasians have the highest percentage of drug deaths. Alcohol misuse costs the US more than $200 billion each year.
Excessive and binge over-consumption of alcohol are often directly responsible for many medical issues, including liver disorders, hypertension, cardiovascular disease, memory loss, digestive problems, cancer, pancreatitis, brain damage, and osteoporosis. Alcohol misuse costs the US more than $200 billion each year. The higher the income, the greater the incidence of misuse. There is no significant difference when comparing urban and rural statistics.
Pennsylvania ranks 30th of all US states in excessive drinking. The states with the most serious problems are Alaska, North Dakota, Wisconsin, Montana, and Illinois. The states with the least issues (per capita) are Tennessee, West Virginia, Utah, Alabama, and Mississippi.
Don’t Be A Couch Potato! Be Active!
Most of us enjoy relaxing, and perhaps watching TV or sitting in front of our computer. However, when this occurs more than a few hours per day, increased risk of coronary heart disease, type 2 diabetes, breast cancer, and colon cancer occur. Only about one in five persons meet the US Department of Health and Human Services physical activity requirements. Life expectancy increases with increased exercise, especially on a regular basis.
Pennsylvania ranks 37th out of all states for effective physical activity. The five most “active” states are Colorado, Oregon, Washington, California, and Utah. The least “active” states are Mississippi, Arkansas, Oklahoma, Kentucky, and Louisiana. Females, persons over age 65, persons with less than a high-school education, and households with less than $25,000 of income, are the most susceptible.
Pennsylvania does not rank in the top or bottom five of this category. The worst states for occupational fatalities are Wyoming, North Dakota, Mississippi, Oklahoma, and Louisiana. The five states with the least percentage of deaths are Massachusetts, New York, Washington, Connecticut, and California. Note: Statistics included the following industries: construction, utilities, manufacturing, transportation, and business services.
Unclean air can cause respiratory disease, asthma, irregular heartbeat, bronchitis, allergies, heart attacks, and several other serious medical conditions. The annual US cost of air pollution is more than $50 billion, although the Clean Air Act helps reduce some of the expenses. Unfortunately, Pennsylvania is ranked as the second-highest state for air pollution. The other four states are Ohio, California, Indiana, and Illinois. The five states that pollute the least are Wyoming, Vermont, North Dakota, New Mexico, and South Dakota.
Salmonella, Whooping Cough, and Chlamydia are three common preventable diseases that cause death, if left untreated. Children are the most susceptible, although increased treatment and prevention will reduce the number of fatalities. Salmonella causes fever and cramps, and is typically caused by food contamination. Whooping Cough is very contagious and can be slowed by vaccinations. Chlamydia is transmitted by sexual contact, and affects more than 1 million persons each year.
Pennsylvania’s state-ranking is 16th for incidence of Chlamydia, 20th for Whooping Cough, and 11th for Salmonella (lowest is best). The five states with the highest average level of these three conditions are Mississippi, South Carolina, Louisiana, Alabama, and Alaska. The five states with the lowest average levels are West Virginia, Maine, Vermont, Oregon, and Connecticut.
More than one million violent crimes occur in the US each year, resulting in more than $6 billion of medical expenses. The Keystone State is not one of the top-five or bottom-five ranked states. The five states with the lowest (per capita) number of violent crimes are Vermont, Maine, New Hampshire, Idaho, and Virginia. The five highest-ranked states are Alaska, Nevada, New Mexico, Tennessee, and Louisiana. An estimated $65 billion in production is lost every year to violent crimes.
Boosters And Vaccines Can Save Lives
Immunizations – Children And Adolescents
As children and adolescents get older, often the effectiveness of previously-administered vaccines begins to diminish. The proper use of boosters can greatly reduce the number of many diseases, including HPV, meningitis, septicemia, tetanus, diphtheria, and whooping cough. Up to 14 diseases can be prevented with proper immunizations. Black non-Hispanic children and children from poorer households tend to receive the lowest percentage of available treatment.
The Keystone State is ranked 8th among all states for immunizations for all adolescents, 10th for HPV immunizations, 4th for meningococcal, and 8th for Tdap. The top-ranked states (measured by percentage of children aged 19-35 months, who received measles, mumps, rubella, polio and hepatitis vaccines) are Connecticut, North Dakota, Delaware, Massachusetts, and Iowa. The states with the lowest ratings are Virginia, West Virginia, Alaska, Arkansas, and Florida.
The second-leading cause of death in the United States in cancer. More than 1.5 million new cases are reported each year, with almost 600,000 persons dying from the disease. Although stopping the usage of tobacco helps reduce the incidence of lung cancer, it is still one of the leading causes, along with colon, breast, and prostate. Pennsylvania ranks only 36th in cancer deaths when compared to other states. Regular screening tests allow effective early treatment (if needed).
The five states with the lowest percentage of cancer incidence are Utah, Hawaii, Colorado, New Mexico, and California. The five states with the highest incidence are Kentucky, Mississippi, Louisiana, West Virginia, and Arkansas. Additional information can be found in this report.
Stroke and heart disease are major causes of death. Black males are 30% more likely to die from cardiovascular diseases than white males. Non-Hispanic blacks also have much higher avoidable deaths than non-Hispanic whites. Pennsylvania ranks 35th among all states for cardiovascular deaths in the US. The five states with the lowest percentage of deaths are Minnesota, Colorado, Massachusetts, Hawaii, and Oregon. The five states with the worst numbers are Mississippi, Alabama, Oklahoma, Arkansas, and Louisiana. Note: Cardiovascular disease is very effectively treated by Pennsylvania’s best hospitals.
Diabetes In Pennsylvania Leads To Several Other Conditions
Diabetes is the nation’s seventh leading cause of death. Its chronic condition leads to several other serious conditions, including stroke and heart disease. The three types of diabetes (Type 1, Type 2, and gestational) can be managed with improved diet, increased exercise, and properly managing weight. Medical costs associated with the disease, are very high, which explains why most carriers deny coverage on their medically-underwritten products.
The Keystone State ranks 30th in the US for incidence of Diabetes. The five states with the lowest numbers are Utah, Colorado, Alaska, Minnesota, and Montana. The five states that rank the highest are Mississippi, West Virginia, Alabama, Kentucky and Tennessee.
Health Status Imbalance
Typically, highly-educated persons tend to be healthier. Thus, staying in school and earning high school, college, and post-graduate degrees may actually improve your health. Every increase in level of education improves health status. More than $1 trillion would be saved if these disparities were substantially diminished. Pennsylvania ranks 37th in the “disparity index,” compared to other states. Up to $1 trillion can be saved if the imbalance is reduced.
The states with the greatest disparity are California, Vermont, Colorado, Rhode Island, Massachusetts, Delaware, and Florida. The states with the smallest disparity are Hawaii, Oklahoma, Tennessee, Wyoming, Kentucky, Missouri, and Indiana.
Frequent mental distress (FMD) is a metric that takes into account emotional and mental disorders, and severe stress caused by environmental factors. Lack of sleep and economic and healthcare hardship can contribute and increase stress levels. Mental health issues that are untreated at young ages, often lead to future adverse events as an adult. Continued and prolonged untreated illness generally results in serious consequences. When considering the percentage of adults that stated their mental health was not favorable for at least 14 of the last 30 days, Pennsylvania ranks 28th of all states.
The states that reported the highest levels of mental distress are West Virginia, Arkansas, Mississippi, Louisiana, Tennessee, Alabama, Kentucky, and South Carolina. The states that reported the lowest levels are South Dakota, Minnesota, Hawaii, Nebraska, North Dakota, Iowa, Illinois, and Kansas. The true economic cost is more than $300 billion, which does not include early mortality and homelessness. Females are more likely than males to suffer from this ailment.
Severe and constant physical stress is common with persons (mostly adults) with chronic medical conditions, especially heart disease and stroke. Often it leads to less physician visits and additional or worsening conditions. Pennsylvania ranks in the middle (25th) when comparing state disparities in frequencies of physical distress. States with the highest physical distress are West Virginia, Tennessee, Mississippi, Alabama, and Kentucky. States with the lowest physical distress are North Dakota, Alaska, Minnesota, Utah, and Hawaii.
The US infant mortality rate (under five-years-old) continues to rank higher than many developed countries, including Iceland, Finland, Norway, Japan, Sweden, Israel, Spain, Italy, Ireland, Australia, Greece, France, Germany, United Kingdom, and Canada. The leading causes of death are injury, SIDS, birth defects, maternal complications, and pregnancy complications. Unmarried mothers and non-Hispanic Blacks have higher rates. The states with the highest infant mortality ratios are Mississippi, Alabama, Louisiana, Arkansas, and Oklahoma. The states with the lowest infant mortality rates are Vermont, Washington, Iowa, Massachusetts, New Jersey, and California.
2018 Pa Health insurance premiums are going up in 2018. How much? Carriers authorized to conduct business in Pennsylvania have submitted their new rates, which will be reviewed by the Department of Insurance (DOI). Individual, family, and group policies charge different rates each year. It is also possible that several plans that were offered in 2017, will be replaced by different options in 2018.
Below, we have listed the proposed price changes for ACA (Affordable Care Act) compliant policies. Although the DOI often approves rate change requests, it is possible that the entire increase (or decrease) may not be granted. Participating companies offer increased transparency by publicly requesting price changes. Subsequent changes throughout the year are also publicly requested.
Capital Advantage Assurance Company
9.90% – PPO Individual
11.65% – PPO Small Group
9.53% – PPO PHS Individual
15.90% – PPO PHS Small Group
13.24% – Small Group
First Priority Health
7.39% – my Priority Blue Flex HMO Individual
10.26% – my Lehigh Valley Flex Blue HMO Individual
10.55% – my Priority Blue Flex HMO Individual
First Priority Life
5.70% – AffordaBlue Small Group
-.98% – Lehigh Valley Flex Blue PPO Small Group
3.38% – Lehigh Valley Flex Blue PPO HDHP Small Group
7.03% – BlueCare Custom PPO Small Group
9.54% – BlueCare QHD PPO Small Group
6.32% – BlueCare PPO Small Group
10.38% – myBlue Access Individual
8.10% – HMO Individual
11.93% – HMO POS Individual
11.82% – POS Small Group
9.96% – Small Group
8.79% – Individual
13.42% – No Referral Small Group
Highmark Benefits Group
1.88% – Lehigh Valley Flex Blue PPO Small Group
8.20% – Lehigh Valley Flex Blue PPO QHDHP Small Group
10.72% – Health Savings PPO Small Group
6.81% – Premier Balance Small Group PPO
14.65% – Health Savings Flex PPO Embedded Small Group
16.74% – Balance PPO Small Group
13.74% – High Deductible PPO Small Group
11.25% – Health Savings PPO Embedded Small Group
10.45% – Flex PPO Small Group
Highmark Choice Company
1.95% – Keystone HMO Small Group
-23.01% – my Direct Blue HMO Individual
Highmark Coverage Advantage
1.98% – Health Savings PPO Embedded Small Group
8.64% – Balance PPO Small Group
2.15% – High Deductible PPO Small Group
5.55% – Health SAvings PPO Small Group
0.41% – Premier Balance PPO Small Group
Highmark Health Insurance Company
7.23% – Health Savings PPO Small Group
0.75% – Shared Cost PPO Small Group
-0.48% – Shared Cost PPO Small Group
5.82% – Health Savings PPO Small Group
4.19% – Shared Cost PPO Individual
11.35% – Health Savings Blue PPO Individual
11.61% – Health Savings PPO Individual
13.56% – Shared Cost PPO Individual
1.79% – Premier Balance PPO – a Community Blue Plan Small Group
0.89% – Shared Cost PPO a Community Blue Plan Small Group
3.98% – Health Savings PPO a Community Blue Plan Small Group
-1.16% – Flex PPO a Community Blue Plan Small Group
1.01% – Health Savings PPO Embedded Small Group
4.65% – Connect Blue EPO Small Group
9.83% – Balance PPO a Community Blue Plan Small Group
18.43% – Major Events Blue PPO a Community Blue Plan Individual
Independence Blue Cross
13.10% – Personal Choice Exchange EPO Individual
14.29% – Personal Choice OFFX PPO Individual
7.96% – Personal Choice OFFX EPO Individual
14.72% – Personal Choice Exchange PPO Individual
9.37% – Personal Choice Small Group
Keystone Health Plan East
6.52% – KHPE OFFX Individual
55.10% – IND HMO QHP Individual
15.44% – HMO Small Group
3.53% – Keystone HMO Exchange Individual
10.79% – Keystone DPOS Small Group
9.86% – Keystone HMO Small Group
6.52% – KHPE OFFX Individual
5.70% – Choice Small Group
9.85% – Options Non-Differential PPO Small Group
6.30% – Choice Plus Small Group
-8.85% – Marketplace SHOP Small Group HMO
3.69% – Off Marketplace Individual
-4.66% – Marketplace SHOP Small Group PPO
10.24% – Marketplace Individual EPO
10.14% – Marketplace Individual PPO
Note: Proposed premium changes reported by “Rate Review” are updated yearly.