Pennsylvania Health Insurance

Pa Health Insurance Exchange enrollment allows you to purchase low-cost medical coverage without answering any medical-related questions. You do not have to take a physical, and regardless of what pre-existing conditions you have (or had),  your Pennsylvania Marketplace health insurance plan will cover the cost (subject to copays, coinsurance, and deductibles).  You may also qualify for a government subsidy that could pay as much as $10,000 of your premium each year, depending on your household income. But what about applying and enrolling for a plan? What about the glitches, the delays, the frustration and hair-pulling? Actually, most of those issues have disappeared, and with our professional assistance, obtaining quality Marketplace coverage at the most affordable price is guaranteed. With most enrollments, we have reduced the time needed from an hour to less than 20 minutes.  And of course, there are never charges or fees to pay when you apply for coverage. What If I Missed Open Enrollment? You aren’t alone since millions of Americans either forget to apply, or procrastinate to the point that the deadline has passed. However, you can still buy a policy, and in many situations, if you qualify for an exemption,  the benefits, prices, and provisions will be the same as if you didn’t miss OE. There is also no “late fee,” although after three months of neglecting to secure a...

More than one million Pennsylvania residents don’t have health insurance. That’s about to change in the upcoming months with Open Enrollment in October that will allow individuals, families and small businesses to purchase affordable medical coverage. Our website, along with other brokers and navigators, will help Pa consumers choose the best plans and assist in determining  eligibility for the federal subsidy. We will provide the most affordable Pa Health Exchange prices from each of the participating companies. Recently, the Administration distributed approximately $3 million to five volunteer groups in Pa to assist in “getting the word out.”  Nationwide, almost $70 million  was spent on promoting community outreach programs, often with the help of “Navigators,” who will have limitations placed on the assistance they can provide. Although they are expected to help explain basic plan descriptions and show how consumers can apply for coverage, they can not make specific recommendations regarding which plans to apply for, or calculate tax subsidy amounts. They will be most helpful in residential areas where residents, who are not comfortable using computers, are using the internet. Also, for many disabled persons, or others that lack transportation, once again, these are prime examples were navigators may help. Consumers that prefer to meet face-to-face may also be aided by...

Expansion of Medicaid in Pennsylvania will have to wait. The State Senate has adjourned for the summer,  after narrowly missing passing a bill that would have provided virtually free health insurance coverage to hundreds of thousands of needy persons. Typically, the federal government pays the entire cost (at first), and then each state must pay for most or all of the coverage in the future. A bill that was mostly related to the state budget did pass this week, but any mention of Medicaid expansion was removed. Earlier in the week, the Senate voted and approved a bill that would have provided the needed benefits. However, the next day, the House removed the Medicaid-related legislation, and seemingly eliminated the chance of expansion. Why The Delay? One of the issues delaying the passage of the bill is the insistence by Pennsylvania Governor Tom Corbett that the federal government give permission to Pa to adjust and make changes to parts of the state Medicaid program. Although requested many months ago, there has been no definitive response from the federal government. Corbett wants assurances that specific reforms and guarantees will be provided. His intentions are positive, since he doesn’t want the state to be responsible for unexpected debt in the future. Corbett has repeatedly contacted Kathleen Sebelius (US Department of Health and Human Services) requesting her not to...

More than half of Pennsylvania’s residents get their health insurance through their employer. While 53% of the state’s population is covered under a group plan, 11% are uninsured, 31% are covered through Medicare or Medicaid and only 5% purchase individual medical plans through private insurers. Many folks also have Pa Medigap plans. The Henry J.Kaiser Family Foundation reported these statistics this month. Some additional interesting statistics regarding healthcare coverage in Pennsylvania: 61.1% of employers offer coverage to their workers. 98.0% of  employers with more than 50 employees offer benefits. 46.7% of employers with less than 50 employees offer benefits. 29.7% of children between the ages of 10 and 17 are morbidly obese, obese or overweight. 81.5% of children with emotional or behavioral problems  were able to receive mental health treatment. 26.4% of children between the ages of 10-17  have current oral health problems. 79% of children between 19 and 35 months are fully immunized for vaccinations. 78.9% of children under age 18 have had a medical AND dental preventive exam within the last year. 62.6% of adults over age 65 have had a flu shot within the last 12 months. 22.4% of adults are smokers. 23.5% of adult males smoke. 21.5% of adult females smoke. 21.2% of adult Whites smoke. 28.7% of adult Blacks smoke. 59.7% of smokers attempt to quit. 64.5% of adults...

How safe are health insurance companies in Pennsylvania? Perhaps the most respected and authoritative resource is A.M. Best Company, which has been rating the financial safety and strength of insurers since 1899. Not only do they provide an unbiased snapshot and opinion of large and small carriers, but they also report the latest changes in financial status and alert consumers if a company may be under distress. The security of your coverage and benefits are critical, especially when large claims may be paid, or funds in an HSA are invested. If a bill needs to be paid, or funds need to be released to pay for treatment, justifiably, you want the transaction to be taken care of quickly. And you don’t want your doctor, specialist or OBGYN reminding you that your insurer hasn’t paid their bills yet, or that a reimbursement check bounced. How Companies Are Rated The three major ratings are financial strength, debt and credit. All three could possibly impact the current and future rates that may be charged to individuals or businesses in the Keystone State. A++ and A are considered “superior” and A and A- are considered “excellent.”  B++ and B+ are considered “good” while  B and B- are considered “fair.” Additional classifications are “marginal,” “weak” and “poor.” Typically, any rating below “B” may be a cause for concern. Although a rating this low does not mean the carrier is on...

Pa adultBasic, the state funded healthcare plan for low income adults may be making a triumphant return. Earlier this month, with the help of former policyholders through a class-action lawsuit, Judge Dan Pellegrini declared that it was unconstitutional for the state’s tobacco settlement funds to be diverted away from the program. Although the ruling does not make any retroactive changes, it still is a big win for lower wage-earners Thus, adultBasic must be reinstated or another program must be created that closely mirrors the benefits. And 30% of the tobacco funds are to be used for the fiscal year of 2013-2014. Currently, those funds are earmarked for other programs. However, there should be ample time to make the appropriate changes to those specific affected programs. The Pennsylvania Health Investment Insurance Act 77 was enacted in 2001 and created the program for the needy. Some of the money awarded from tobacco litigation in 1998 was expected to total approximately $375 million and $425 million dollars each year.  However, in February of 2011, the program came to an abrupt halt when funding stopped and money ran out. More than 40,000 Pennsylvania residents were left without medical coverage and another 500,000 were on a waiting list. At that time premiums were less than $40 per month, making it a lifesaver for many of the poorer Pa residents that had no coverage...

Pennsylvania health insurance plans raised premiums for 32% of all applicants that bought medical coverage according to “HealthPocket,” a resource that ranks individual and family plans. The data was obtained by the HHS (Department Of Health And Human Services). More than 10,000 policies were used in the nationwide study that did not include persons that were eligible for Medicare or over age 65. There are many reasons why prices were often higher than the original quote provided to the consumer. Of course, any discrepancies in the submitted application could impact the final premium. Some common examples would be missing medical information, conditions or medications that were not disclosed, and inaccurate statements regarding current or past treatment. Although more than two out of three policies were issued at the quoted rate, Pennsylvania had the highest percentage of issued contracts that cost more than the original estimate. Other states closely behind were Indiana, Ohio, Virginia, Kentucky and South Carolina. Oddly four of the top six states are in very close proximity to each other. Senior Pa Medicare options were not included since there is no underwriting during Open Enrollment periods. Quoting Mistakes Should Reduce The number of misquotes should steadily decline, now that medical information is no longer used in the underwriting of Exchange policies during Open...

So you have the flu. You’re in good company since millions of others get it every year. I’m sure that makes you feel better already. But what role does your health insurance have in your treatment and recovery? We take a close look, so you understand the impact of your coverage and how you can use benefits to pay for treatment. But since we aren’t physicians, we can’t guarantee you’ll recover quicker. Do you even have the flu? Just because you’re coughing and have had a nagging continuous headache for the last four days, may not mean you have it. Typically, it seems to hit hardest in January and February, and continues for about 7-14 days. Of course, if you can stay home, drink liquids and rest, the duration may be less. But as we know, very few people take two weeks off work for anything,  just short of pneumonia. Unless of course, there’s something good on TV, like perhaps the World Series or a Twilight Zone Marathon. Get The Vaccine! Getting the vaccine is highly recommended, although you have to be healthy at the time you get it. If you’re older than six months, studies clearly show it makes sense to be vaccinated. If you work in an environment where there is multiple contact with employees and/or consumers, you’re risk is higher of getting a cold, flu, or another type of infection. Naturally, washing your hands as often as possible at work, and avoiding sick workers...