Archive for the ‘Pa Health Insurance’ Category

How Healthy Are Pennsylvania Residents Compared To The Rest Of the U.S.?

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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.

Hawaii

Massachusetts

Connecticut

Minnesota

Vermont

New Hampshire

Washington

Utah

New Jersey

Colorado

North Dakota

Nebraska

New York

Rhode Island

Idaho

California

Iowa

Maryland

Virginia

Wisconsin

 

Tobacco Use

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.

 

Obesity

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.

 

Drug Deaths

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.

 

Chronic Drinking

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.

 

Pennsylvania Physical Acivity

Don’t Be A Couch Potato! Be Active!

 

Physical Inactivity

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.

 

Occupational Deaths

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.

 

Air Pollution

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.

 

Infectious Diseases

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.

 

Violent Crime

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.

 

Pa Immunizations

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.

 

Cancer-Causing Death

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.

 

Cardiovascular Deaths

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.

 

Pa Diabetes Information

Diabetes In Pennsylvania Leads To Several Other Conditions

 

Diabetes

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.

 

Mental Distress

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.

 

Physical Distress

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.

 

Infant Mortality

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.

Pennsylvania Health Insurance 2018 Rate Changes – Individual And Group

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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

 

Federated Mutual

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

 

Geisinger

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

 

Highmark Inc.

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

 

UnitedHealthcare

5.70% – Choice Small Group

9.85% – Options Non-Differential PPO Small Group

6.30% – Choice Plus Small Group

 

UPMC

-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.

Compare COBRA Benefits And Health Insurance Coverage Options In Pa

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COBRA  is available in Pennsylvania if you are employed at a business that has more than 20 full-time employees and you recently lost your job.  If  your company has less than 20 workers, you may not be eligible for benefits and will have to seek separate coverage for yourself and any additional family member. The Consolidated Omnibus Budget Reconciliation Act, along with state and federal legislation, is designed to help you find affordable Pa health insurance.

However, there are affordable alternatives that will provide medical coverage until you secure another policy through an employer or become eligible for Medicare. Enrolling for a federal Marketplace policy (discussed below) and applying for private coverage are available.  Some of your options are also provided under the Continuation Health law.

How Cobra Works

Since 1986, under certain conditions, terminated employees may purchase health insurance coverage without any medical underwriting. No physicals or health-related questions are needed, and no waiting periods or special exclusions will be imposed. Coverage is guaranteed, and the premiums charged will be the same (plus 2%) the employer pays to provide the same benefits to current employees. Your spouse and dependents can also take advantage of the offer.

COBRA Pennsylvania Rates And Application Help

Medicare-Eligibility Can Impact Your COBRA Options

To obtain benefits, a “qualifying event” must have taken place, and to apply for coverage, you must be the “qualifying beneficiary.” Common situations that qualify include losing group coverage from your employer, losing significant hours at work, divorce or death of your spouse that was the primary insured, and Medicare-eligibility for your husband or wife. There are also several situations where your child can become eligible.

But your premiums may appear to be substantially higher since the employer is no longer paying any part of the cost of the policy. If your working hours were simply reduced, you would not be eligible. Also, if you were guilty of “gross misconduct,” the same would apply. And of course, life and disability benefits would not be included. Typically, by contacting your human resources (HR) department through your employer, you can view specific prices and benefits.

Dependent Coverage

Although you can exclude your family (spouse and/or dependents) from coverage (assuming you are the eligible person), your dependents can not accept coverage alone. For example, if your wife needs coverage but you don’t, both persons would have to accept benefits to have her covered. However, an easier option is utilizing a “Special Enrollment Period”  for only the persons that need coverage.

Also, children may be eligible for CHIP (Children’s Health Insurance Program) coverage, which is a very low-cost option with excellent benefits. Thousands of youngsters are actually eligible for benefits, but don’t realize how easily they could qualify. When household income is too high for Medicaid-eligibility, CHIP is a perfect solution. Common plan benefits include immunizations, doctor visits, inpatient/outpatient hospitalization, ER and Urgent Care, dental, vision, and prescription drugs.

NOTE: Seniors that are receiving Medicare benefits (and possibly Medigap coverage in the form of a Supplement or Advantage plan), can not receive COBRA benefits at the same time.

Pa Health Exchange (Marketplace)

Open Enrollment for Exchange plans, features many mandatory benefits and guaranteed-approval. When the Affordable Care Act was passed (and subsequently survived a Supreme Court challenge),  a new set of low-cost options immediately became available for persons that lost benefits through their employer. Although an Appellate Court ruled against the Obamacare tax credits in July of 2014, it was later again upheld.

Whether you need to obtain a policy during the official Open Enrollment period (typically from November through January), or outside of that date range, you can take advantage of many of the new provisions in the law, including not having to provide medical details to qualify for coverage.  The instant federal tax credit will immediately reduce your premium if you qualify. You can also obtain guaranteed-issue coverage without a federal subsidy, although the rate will be significantly higher.

How To Enroll For Health Insurance In Pennsylvania

Missed Pa Open Enrollment? There Are Still Affordable Options.

Missed Open Enrollment?

Since most persons become eligible for COBRA outside of Open Enrollment,  a special SEP exemption (Special Enrollment Period) is offered if you lose job benefits. You are provided 60 days to select a plan with full access to the federal subsidy. During this period of time, we can help you choose the best options. Catastrophic, HSA,  and comprehensive plans are offered and they can be kept short-term or long-term.

You will not lose any of the benefits or tax credits that are available during the standard Open Enrollment period, and you can pick policies from several companies that have large provider networks in your area. You will also avoid the non-compliance penalty (tax) that is imposed if you have a lapse in coverage. Currently, the tax is 2.5% of household income or $695 per adult and $347.50 per child, whichever is higher. The maximum penalty for an entire family is $2,085. with the penalty increasing each year.

Mini-COBRA Law

In 2009, a “Mini-COBRA”  law was enacted. Under this legislation,  workers at small businesses (2-19 employees) can purchase coverage for up to nine months from the date that leave their employer. Spouses and dependents are also eligible to apply for benefits. One of the qualifications is that you must have been working at the company for at least three consecutive months before leaving. Naturally, if you receive Medicare benefits, you are ineligible.

For example, typical health insurance coverage for a family in Western Pa, may be approximately $100-$1,200 per month, depending on deductible amounts, size and eligibility of subsidy, and other copays and coinsurance amounts. For this situation, let’s assume the group policy offered by the employer costs $900 per month. However, if they were paying 50% of the premium, your portion would only be $450 or about $105 per week (since there are four months with extra pay periods).

If you are not able to qualify for a fairly large Obamacare federal tax credit (subsidy) you may be forced to pay the entire $900 when it becomes a private plan. Administrative costs can increase the premium an additional 5%. Of course, if you do not have any serious medical problems, COBRA may not be an ideal solution. And it’s always important to remember to avoid terminating an existing plan without consulting a broker.

Dependents Are Also Eligible

Your dependents (spouse and children) can also enroll, although if you are retired, there may be limitations. However,  not every family member has to apply for coverage. For example, if the spouse and children are in perfect health, there may not be a reason to consider COBRA benefits on them, since the rate might be considerably higher than your own personal plan that you purchase on the open market. Your expected  household income  will be a large factor when determining the best options.

Regardless of which plans are chosen, each policy will be a “guarantee issue” contract with no medical underwriting. So regardless if one member has been previously denied or forced to pay a higher premium, this will no longer occur. Thus, the attractiveness of not selecting a COBRA plan becomes larger. Marketplace policies are also “guarantee-issue” and pre-existing conditions are also covered.

COBRA Pennsylvania medical coverage

Affordable COBRA Alternatives In Pa May Be Available

What often occurs, is that the primary applicant accepts COBRA coverage at a fairly reasonable cost, based on existing conditions and reduced pricing since the full family rate is not charged. The spouse and children can now choose among dozens of different policies from many Pa insurers. It will then be easy to customize coverage based on the needs of the spouse and kids.

In this scenario, the monthly COBRA premium for two adults and two children might be $1,400, which is very high. However, it may be possible to find an adult/children plan for about $400 and elect single COBRA coverage for another $400. Thus, $600 per month would be saved.

If the household income for that specific year is lower than previous years (because of loss of employment), the Obamacare subsidy may be large enough to provide greater savings.

Different COBRA Options

If office visit and RX benefits are a priority, there will be many affordable options. Also, if your family budget is the most important factor, then a high deductible or catastrophic (if you meet ACA guidelines) plan will be the solution. An important feature is that you don’t always have to place all family members under one policy. Naturally, we help you find the most economical choices, and provide a COBRA question-and-answer guide that may be helpful.

Although  a few years ago, the employer-related policy may have provided additional coverage that a private plan did not offer, with the passage of  The Affordable Care Act, this is usually no longer true. Two examples are the comprehensive maternity and mental illness benefits that are covered on the policy you buy. There are many other specific benefits, such as pediatric dental, and chiropractor visits, that are often covered under Marketplace plans.

If you are being treated for those conditions, or feel it is important to continue to have those benefits, then COBRA or a private plan will cover expenses. Prior to 2014, many individual policies that you purchased would limit or exclude maternity benefits. However, any new qualified policy is required to be “guarantee-issue” and eliminate the pre-existing condition exclusion clause.

Declining COBRA AND Marketplace Plan Offers

If you choose to decline offers From COBRA and private Marketplace coverage,  an “off-Exchange” plan that does not contain any of the mandated benefits required by prior legislation, will be your only choice (assuming you do not qualify for Medicaid or Medicare). Often, these “limited benefit” plans are fairly cheap, but leave gaping holes in catastrophic claims, and often limit drug and office visit coverage. However, a new Open Enrollment period typically begins in November of each year, and you can easily apply for coverage through our website.

UPDATES FROM THE PAST:

September 2014 – With Open Enrollment beginning in less than 2 1/2 months, consumers paying a high COBRA rate will have the opportunity to compare 2015 plans and perhaps select better coverage at a lower rate. Although prices will be slightly increasing from 2014, there may be some worthwhile offers in your area.

If your income is expected to substantially drop in 2015, your subsidy eligibility may change and/or you may qualify for a much larger amount from the federal government. If your current plan is already being subsidized by your employer, and you don’t qualify for a substantial subsidy, it’s likely you should keep your current policy.

October 2016 – Since UnitedHealthcare and Aetna no longer offer Marketplace coverage, Independence Blue Cross (IBX) is the only option in the Philadelphia area.