In Pennsylvania, infants, young adults, and teenagers can obtain affordable health insurance coverage from more than a dozen reputable companies. With help from recent changes in legislation and policy upgrades, these plans guarantee major medical benefits along with many other comprehensive features. Marketplace plans with federal subsidies or non-Obamacare options are available.
We provide detailed information, reviews, and a simplified and easy enrollment process for all available Pa policies for young persons, along with expert and unbiased advice. Special policies are offered to students, single parents, and anyone that is no longer eligible to keep their existing plan. In certain circumstances, you can also remain on your parent’s plan if you are married (see below).
Coverage Under Parent’s Plan
If your parent’s private healthcare policy is active, federal law stipulates that you can remain covered or enroll on that policy until you reach age 26. This could apply even if you are living at a different residence, married, or still have eligibility to enroll in your employer’s plan. Of course, at any time you can apply for your own individual policy. Although remaining on the policy is an option to consider, in many situations when a federal subsidy is available, enrolling for an individual plan may be a better choice.
If the policy is a qualified group plan through their employer, Pennsylvania legislation extends the age to 30, subject to specific requirements. Some of these requirements include: being unmarried, no children, living in the state or a full-time student, not eligible for other personal plans and not enrolled in CHIP or Medicaid.
Coverage Through The Pa Health Insurance Exchange (Marketplace)
Pa Exchange Plans Cover 100% Of Preventive Expenses
The Exchange is part of the Affordable Care Act (Obamacare) and features many low-cost plans that require no medical underwriting with pre-existing conditions covered. Open Enrollment usually occurs in November and continues for three months. However, if you are dropped from an existing plan or meet other various criteria, you can purchase coverage at any time through an SEP (Special Enrollment Period). Exceptions include losing credible group (employer-provided) benefits, reaching age 26, moving to a different service area, and divorce.
The “catastrophic” option is the cheapest available policy for young persons. Unless you meet low-income (financial hardship) requirements, only applicants under age 30 can buy this specific plan. Prices are low because it is designed to cover major medical claims and places a deductible on most coverage. It is ideal for a healthy student that wants to minimize costs. However, only three office visits are included without having to meet a deductible. Therefore, children that tend to visit a doctor or specialist quite often, should not purchase plans in this tier. Also, not all carriers offer catastrophic contracts.
Catastrophic Plans Offered In Pennsylvania
UPMC Advantage Catastrophic $6,850/$0 (Partner, Select, and Premium Networks)
Keystone Healthy Benefits Value HMO 6850
Geisinger Health Plan marketplace Value
Highmark myBlue Access $6,850
Independence Blue Cross Personal Choice Catastrophic
Affordable Comprehensive Pa Healthcare Plans
Young working professionals may prefer a more comprehensive plan that still is budget-friendly. Pre-existing conditions are covered, including major illnesses, such as heart disease, diabetes, and cancer. We have listed below several affordable options offered as Marketplace contracts. Prices shown are for a single 26 year-old living in Allegheny County with income of $27,000. Although income is too high for federal subsidy qualification, prices are still fairly low. Rates shown are monthly:
$134 – UPMC Advantage Bronze $6,200/$35 – Copay on all pcp office visits.
$135 – Highmark Connect Blue EPO 5500 – Copays on all pcp and specialist visits.
$146 – UnitedHealthcare Compass 6500 – Copays on all pcp and specialist visits (lower specialist copay than previous plan).
$150 – UPMC Advantage Silver $3,250/$10 – Low $10 pcp office visit copay and deductible is only $3,250.
NOTE: Lower incomes will result in smaller premiums and higher subsidies. Depending on the level of the subsidy, a Silver-tier policy may be the best alternative, since “cost-sharing” can save thousands of dollars in deductible and coinsurance costs.
Marketplace Options If You Have Serious Medical Conditions
If there are serious medical conditions that require ongoing and/or expensive treatment, a more robust plan may be more appropriate. The “Platinum,” “Gold,” and “Silver” Metal plans provide much richer benefits with lower out of pocket costs. Although the premium is higher, because of the young age, rates will be fairly economical compared to someone 20 years older.
The Silver plans are the only policies that offer “cost-sharing,” if applicable. Lower deductibles, copays, and maximum out-of-pocket expenses are possible along with the Obamacare subsidy. This option is a perfect fit for a young adult leaving their parent’s plan with expensive pre-existing conditions, but very little income. Also, if current treatment consists of expensive non-generic drugs, a Platinum or Gold-tier plan will limit your out-of-pocket expenses.
For example, a 26 year-old living in Montgomery County, with an income of $18,000 per year, will qualify for a subsidy of more than $150 per month. Thus, several plans are available for under $100 per month, including the following options:
$24 – Keystone HMO Bronze – $50 and $100 office visit copays.
$27 – Aetna Leap Basic – $6,450 deductible and then 100% coverage.
$38 – UnitedHealthcare Bronze Compass $6500 – $45 and $100 office visit copays.
$63 – Keystone HMO Silver Proactive Value – $10 and $20 office visit copays with $4 generic drug copay. Low $500 deductible with cost-sharing.
$80 – Keystone HMO Silver Proactive – Similar to previous plan but with $0 deductible and higher maximum out-of-pocket expenses.
Pa Temporary Health Insurance
A “short-term” plan is a very affordable option that will minimize costs, and provide a policy that will cover you for up to 12 months (some policies may be only six months). It’s an ideal solution if you missed Open Enrollment or are not eligible for an SEP (Special Enrollment Event). And of course, if you forget to enroll, or suddenly realize you are without coverage, a short-term option may be one of the best available choices.
The Good: The price is right and it’s the most economical way to purchase healthcare coverage. For example, a 42 year-old male that lives in Allegheny County, can find rates as low as $47 per month (IHC Group – $5,000 deductible). UnitedHealthcare offers a higher-deductible option for $59 and for $87, a $1,000 deductible is available. Additional carriers offer a $500 deductible option.
Approval typically take less than 24 hours and depending on the company, you can also obtain instant coverage and receive a pre-approved ID number. Unlike the Marketplace application, which in the past, can take hours to complete, a short-term form takes about 15 minutes. It can be completed online (the easiest way), by fax or by mail. All policies can be terminated at any time upon written request. A small application fee (typically about $20) is often required.
The Bad: Perhaps “Bad” is a bit too harsh. Pre-existing conditions are not covered. Since Obamacare does not apply to these types of policies, carriers can exclude conditions and/or specific benefits. So although it would not impact a new sickness or illness, a condition that you are being treated for, will not be included in benefits.
For Cheap Temporary Healthcare, Short-Term Plans Are The Answer
Currently, the tax for not purchasing the required Obamacare coverage, can be as much as 2.5% of your household income (increases each year). So although a temporary policy provides the coverage you need, you may have to pay a small penalty. Of course, the combination of penalty and your premium is usually far less than expensive than a Marketplace plan without a full subsidy.
Eligible low-income consumers can qualify for Medicaid and the accompanying healthcare benefits. Reimbursement for provided service is payed directly to physicians, hospitals or whomever is treating the patient. Dental and vision benefits are also included.
You can apply by phone, via email (an application is downloaded), through your county office, or through COMPASS, which is the national website for Medicaid enrollment. Eligibility is based on the combination of your household income and number of adults and dependents in the household. You can apply at any time since there are no Open Enrollment deadlines. Also, medical assistance is offered to workers with disabilities.
Coverage is excellent with lower deductibles and copays than most Exchange plans. Availability of physicians may be different than previous plans you have been covered on, so verifying your personal doctors and specialists participation is recommended. However, if you are treated for an emergency condition, and admitted to the ER or hospital, typically, your expenses are considered “in-network.”
Healthy Pa – Pennsylvania’s Medicaid Expansion
Healthy Pa is the state’s Medicaid reform program with a goal is to improve benefits and add financial stability. A combination of innovative changes and a private coverage option (PCO) is designed to add personal responsibility and create more employment in the state. Federal funding financed the entire cost of the expansion until 2017. At that time, the government began paying 95% of costs, with the percentage gradually dropping to 90% in 2020 and later years. Changed in household income that impact eligibility still must be reported.
Primary and specialty care is provided, drug and prescription benefits, and behavioral health coverage, which typically was not provided on individual plans prior to 2014. Family planning is also included and of course, pre-existing conditions are covered. Each year, however, your eligibility should be re-examined, especially if your household income substantially increased.
CHIP (Children’s Health Insurance Program) can also be considered in low-income households. It is designed to cover children and young adults that are presently not covered, and are not eligible for “Medical Assistance.” Routine physician visits and vaccinations are always covered, and availability of providers is high. This is extremely important since long waiting periods are common in other states. And also, there is no “waiting list.” Immigrants and grandparents may also be able to secure coverage.
The program is still available despite the creation of the Pa Health Insurance Marketplace. If you are currently not covered, under the age of 19, and not eligible for assistance, you may qualify. In addition to the benefits previously mentioned, hospitalization (both inpatient and outpatient), dental and eye coverage is included. The networks are huge so availability of doctors (and specialists) will not be a problem.
If you are the legal guardian of your grandchildren, you also may be eligible. And just like Exchange plans, pre-existing conditions will be covered, not excluded. However, it is possible that some more serious conditions may be referred to Medical Assistance.
The companies that can provide CHIP are determined by the county that you live in. For example, listed below are participating CHIP carriers in some of the larger Pa counties:
Montgomery, Bucks, and Philadelphia – Aetna, Keystone Health Plan East (IBC), Kidz Partners and UnitedHealthcare.
Allegheny, Beaver, Lawrence, Westmoreland, Washington and Greene – Keystone Health Plan West, UnitedHealthcare and UPMC.
Dauphin, Lancaster, York and Adams – Aetna, Capital BlueCross, Geisinger, Highmark BS, UnitedHealthcare and UPMC.
Franklin, Berks, and Fulton – Aetna, Capital BlueCross, Geisinger and Highmark BS.
Bradford, Susquehanna, Lackawanna, Luzerne, and Sullivan – First Priority (BCNEPA), Geisinger and UnitedHealthcare.
Armstrong, Indiana and Clarion – Keystone Health Plan West, UnitedHealthcare and UPMC.
NOTE: It is possible (and fairly common) that when applying for Marketplace benefits, to retain the federal subsidy, dependents will have to enroll under the CHIP program while the parents maintain conventional coverage. For example, a family of four (40 year-old parents and two teenagers) living in Allegheny County with $35,000 of household income, will need to place kids in CHIP to keep a $3,264 subsidy. Income of $60,000 does not qualify for a subsidy since both children would be CHIP-eligible.
Student Health Plans
Many School-Sponsored Student Health Plans Are Affordable
If you’re a full-time or part-time student and are not covered under a parent or government-provided policy, it’s possible that the college or university you are attending, will offer an affordable plan. Typically, these policies are offered during the summer, and sometimes other times throughout the year, depending upon when you are enrolling for classes.
Most instate and out-of-state college medical plans are Affordable Care Act-compliant. So although there may be many benefits you don’t need (perhaps maternity), they will be covered. You also won’t have to qualify since they are “guarantee-issue” contracts and pre-existing conditions will not be excluded, unless that specific coverage is not included.
But what about the rates? We have listed below the approximate annual cost of student health plans at several of the most popular Pa universities. Prices are for single (one person) policies. Adding a dependent or spouse will substantially increase the premium. The provider is also listed.
California State/Nationwide – $1,888
Drexel/Aetna – $1,901 and $2,631
Duquesne/Highmark BCBS – $1,767
Penn State/Aetna – $2,838
Pitt/UPMC – $2,460
Shippensburg/Nationwide – $1,888
Slippery Rock/Nationwide – $1,888
Temple/Keystone – $2,820 and $4,740
University Of Pennsylvania/Aetna – $3,140
Villanova/ UnitedHealthcare – $1,545
Student and young adult health insurance in Pennsylvania is very affordable and easy to apply for. It only takes a moment to compare multiple plans from the top-ranked companies in the industry.
December 2014 – Medicaid eligibility is often the principal determinant of whether a young person receives a large federal subsidy or must accept Medicaid coverage. For example, a 23 year-old with income of $18,000 will receive a subsidy of about $145 per month. Thus, several plans will be available at under $100 per month. And actually, there are several options offered at rates less than $50 per month.
However, if the income is only, accepting Medicaid or purchasing a more expensive unsubsidized policy are the only options. However, obtaining a denial from Medicaid could possible result in subsidy-eligibility.
August 2015 – More benefits will be provided to CHIP members so that coverage closely matches other Marketplace plans. Without the increase in benefits, some families may have been subject to the non-compliance tax penalty. Although rates will increase, the change is not expected to be significant.
Implementation of these changes will begin in December and will impact about 150,000 children. Some of the expanded benefits include 100% coverage for qualified preventative benefits (annual physicals, check-ups etc…), and increased coverage for hearing aids and dental procedures.
May 2016 – Student medical plans for the upcoming academic year will be available in a few months. Rates will increase for most school plans, and maximum out-of-pocket expenses and/or deductibles may also go up.
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 qualified plan, you may be subject to an IRS penalty of up to 2.5% of your household income.
Did You Forget To Get Covered During Pa Open Enrollment?
A “Special Enrollment Period” allows residents of the state to purchase subsidized and unsubsidized policies if they meet specific criteria. For example, if you reach age 26, and are no longer eligible for parent’s coverage, an SEP situation exists. Likewise, if your employer terminates coverage or you lose your group benefits as a result of leaving the workplace, once again, an SEP will be available (for approximately 60 days).
There are several additional situations that allow Pa consumers to take advantage of guaranteed approval and federal subsidies after Open Enrollment. If you are pregnant, when your baby is delivered, he/she will be eligible for almost immediate coverage. Also, if you divorce, and subsequently lose your existing benefits, you qualify for an SEP.
If you don’t meet the requirements of the SEP, you can apply for a very inexpensive temporary policy, which usually costs less than $100 per month. For younger persons, the premium is often less than $60. However, short-term contracts, although approved within 24 hours, have maximum benefit caps, and do not contain all benefits required to be considered “qualified” coverage.
Also, The Department of Health and Human Services (HHS) has recently moved to limit short-term plan coverage to a maximum of three months without the possibility of renewal. This change can potentially leave healthy persons without medical coverage, if they miss OE deadlines.
The Beginning Of The Application Process (It Doesn’t Take Long!)
We ask a few questions so we have the necessary information to determine the best plan options. The only information required is the age of all persons to be covered, the household income (to determine the subsidy level), your county of residence, and your smoking status. No questions will be asked about your medical history, what prescriptions you take, or any surgeries that need to be scheduled.
If you have just been diagnosed with a major illness, or prescribed an expensive specialty drug, it does not impact your premium. Also, if you have scheduled a surgery that will be completed after the new policy begins, it has no impact on the rate you pay.
Your height and weight (BMI) are no longer needed since they have no impact on prices. Unless you don’t meet citizenship or residency requirements, your policy should be quickly approved. If you need immediate medical treatment, there is no waiting period from the effective date.
If you are over the age of 65, then you need to look at Pa Senior Healthcare options, which we discuss in the article linked in this sentence. The Exchanges do not offer coverage to persons that are eligible for Medicare or Medicaid. However, seniors can easily purchase Medigap or Medicare Advantage plans that will pay for many Part A and Part B expenses, along with other uncovered costs.
NOTE: Medicaid expansion (not Medicare) is also providing residents with more low-cost choices. “Healthy Pa” provides premium assistance vouchers that can be used to buy coverage. More than 500,000 consumers will be able to take advantage of this new program, which should be more cost-effective than traditional programs in many other states.
What Companies Are Available For 2016 and 2017 Pa Marketplace Coverage?
Highmark Blue Cross Blue Shield, UPMC, Coventry, UnitedHealthcare, Aetna, Geisinger, Independence Blue Cross Keystone Health Plan Central, Capital Blue Cross, and Highmark BC.
Calculating Your Subsidy
Don’t Gamble With Your Subsidy Calculation. We’ll Do It For You.
Determining how much money the government will give you to pay your health insurance premium is a very quick calculation. The subsidy is based on the modified adjusted gross income ( MAGI) of your household. Also taken into account is income from anyone listed on your tax return. Thus, your older spouse’s income will be counted, even is he/she is Medicare-eligible.
Members of your household that are not to be covered will actually increase the amount of the subsidy. For example, if your spouse is covered through an employer, although you do not need benefits for them, it will increase your eligible subsidy amount. If you have children that are covered on other policies (or CHIP), but they are listed as your dependents, this can also potentially generate a larger subsidy.
But don’t worry. We perform all of the calculations for you. Typically, it takes less than one minute to determine if you are eligible, and the monthly amount that can be deducted from the premium. NOTE: It is possible that your children may be eligible for CHIP or Medicaid while you can enroll in a Marketplace plan. As your income changes each year, you may also gain or lose eligibility. You may also qualify for a different plan.
Picking A Plan
Platinum. Gold. Silver. Bronze. Catastrophic. Not only are there four Metal options and a catastrophic policy to choose from, but the total number of available policies is usually 40 or more. This is where our three decades of experience helps. Although securing affordable rates is important, the benefits you are most likely to be used, must be covered with the lowest available copays and deductibles. Maximum out-of-pocket expenses are extremely important if any family member is being treated for a serious illness or disease.
NOTE: UnitedHealthcare is slowly exiting the Pennsylvania Marketplace coverage after offering coverage in previous years. UHC is one of the largest carriers in the country, and maintains one of the largest provider networks in the state. They are also one of the few companies that offers a short-term policy that can be purchased any time of the year. However, it does not contain many of the benefits that Metal plans offer. And this type of policy does not count as having “credible” coverage.
We are able to effectively research all available plans and determine (based on your budget, income and health) the best policies for you and every other family member. We explain, in detail, the coverages these policies will provide, and what your likely cost will be for the calendar year (both premium and out of pocket costs). If you have existing conditions, we will show you the plans that pay for most/all of the expenses associated with your condition.
Doctors, Specialists And Hospitals
A healthcare plan is only as good as the network providers you can use. Selecting larger carriers usually means you won’t have trouble finding a doctor within 10-20 minutes of your residence. The companies with the largest networks include Highmark, UPMC, UnitedHealthcare, Aetna, Independence Blue Cross (Keystone), Capital Blue Cross and Coventry.
However, smaller companies, such as Geisinger, should not be ignored if you reside within their service territory. For example, in Dauphin, Lebanon, Lancaster, and nearby counties, Geisinger facilities are readily available, and their rates are usually quite competitive.
Highmark and UPMC have large networks, and in many situations, you may not be able to use a UPMC provider on a Highmark plan, and vice versa. If you live in Allegheny County or the western portion of the state, before enrolling for a Marketplace policy, verify that the doctors and facilities you use, are accepted by the insurer you are applying with.
The Application And Enrollment
Need Help With Pa Healthcare Enrollment? Call Or Email Us!
Firstly, you don’t have to answer any medical questions. Your height and weight doesn’t matter and your medication information remains private. You will be asked if you use nicotine, but that’s the only information that is somewhat medically related. Since pre-existing conditions are covered, and your cost is not dependent on your health, the actual application is significantly shorter than the typical eight-page form from before 2014.
You may be asked to “verify your identity.” This involves one (or a few) questions requesting you to perhaps identify a street you used to live on, a mortgage company you did business with, or an old phone number that you once used. Although a bit unusual, this step does help with protecting your privacy. This step is ONLY needed when a subsidy is used and the .gov website is involved.
Once the plan is chosen, and the application is completed and submitted, it may take approximately 3-15 days to receive written confirmation from the insurer. Certain companies tend to be a bit quicker than others. For example, Highmark and Aetna seem to be among the fastest Pa carriers to send out billing statements and ID cards. You can also manually pay a bill online with our assistance.
You can terminate coverage at any time and also modify and/or apply for a different plan at the end of every year during a new Open Enrollment. It is possible that additional carriers will be available during the next period. While you have coverage, you will never be subjected to the hour-long waits at the government website or customer-service number. NOTE: Admittedly, the wait times are much shorter in 2015 compared to 2014. But our own direct-enroll link is still much faster.
Simply call or email us. As your broker-of-record, we’ll be able to quickly help you with your Pa Health Care Exchange issues or questions.
July 2014 – More than $5 million of refunds will be sent to customers in Pennsylvania that purchased individual or group policies in 2013. Why? The “80% MLR” (Medical Loss Ratio) rule requires companies to spend at least 80% of their revenue on patient-care expenses. Any excess spending on administrative expenses, salaries and other unapproved costs must be refunded.
UniteedHealthcare’s Golden Rule will send checks for about $1.7 million while Aetna will refund about half of that amount. Many other large companies, such as UPMC and Highmark, met the 80% MLR rule. The average refund will vary, but is typically between $50 and $100.
October 2014 – If the Ebola crisis in Africa becomes an epidemic in the US (and specifically Pennsylvania), Marketplace plans contain no exclusions that would prohibit necessary treatment. Vaccines, as they become available, and hospital quarantines are typically a covered expense.
Adding additional money to the state budget for public health emergency preparedness is being discussed, especially since current allocated budget amounts are at their smallest level in more than 10 years. But as the state of Texas knows and understands, Ebola can easily transfer from one state to another, without proper precautions.
November 2014 – Prices from all major companies, including Highmark, Aetna, Keystone and Coventry are expected to be released within the next 10 days. Plan choices in 2015 will change from 2014, along with deductibles and copays for many policies. December 15th is the deadline for obtaining a start date of January 1.
December 2014 – Less than one week remains to secure a January 1, 2015 effective date. So far, the most popular low-cost plans we are enrolling include Advantage Bronze $6,000/$25 and Advantage Silver $1,750/$30 (UPMC), SharedCost Blue PPO 5500 and Health Savings Blue PPO 2750 (Highmark), and Bronze $20 Copay (Coventry).
June 2016 – 2017 rate-increase requests have been received by the Pa DOI. Some of the largest are Aetna’s 26.41% for their HMO Small Group plans, Aetna’s 41.93% for Group Fee-For-Service plans, Highmark’s 40% for many of their individual plans, and Geisinger’s 41.36% for individual health plans. Independence Blue Cross has requested a 20%-24% hike for its individual plans. UPMC rate increases are expected to be between 6% and 17%. You can view all requests here.
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 navigators.
However, they still are not able to provide the in-depth comparison and research that a broker-website like ours can offer. The lack of comprehensive training, insurance experience, and overall knowledge of current carriers and plans, means that customized policy recommendations will not be offered. Only our website, and other experienced and registered resources can provide this type of data.
HHS Will Try To Help
Health and Human Services Secretary Kathleen Sebelius is hoping that a combination of elected lawmakers, industry leaders, and community church and civil groups, can help brokers (and websites like ours) contact persons that prefer face-to-face communication instead of internet or email. The amount of allocated money is less than anticipated, since many states have chosen to let the federal government operate their Exchanges. About 34 states have declined to operate their own Exchanges, although most will re-consider next year.
Get Help With Applying For Pa Health Insurance Exchange
Here in Pennsylvania, like most states, possible security breaches are major concerns. The flow of personal information, including social security numbers, medical records, tax information and other personal items will be a challenge to keep secure. Already, Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner is facing criticism regarding the Data Services Hub, which is the source of all information and data for the new Health Exchanges.
With Open Enrollment only a month away, testing still has not been completed, and numerous vulnerabilities still remain. CMS has indicated that all bugs and security issues would be fixed by October, when consumers can start applying for coverage. But there are many complex tasks that have yet to be completed, including independent analysis of system procedures, and explaining how secure subcontractors (that were recently hired) will be with the flow of information they provide.
Federal Money Helping Pa Consumers Enroll
“Resources For Human Development” received almost $1 million of free government money. This was the biggest donation given to any entity in Pa for this type of work. They will mainly focus on 10 counties, with special attention given to the Pittsburgh area. About five persons will be hired, which leaves little time to train, do thorough background checks and monitor past activities. The steep $200,000 per employee price tag has been harshly criticized by both Democrats and Republicans, especially when much more reliable and experienced brokers are available for a fraction of the cost.
A 20-30 hour training module is required along with taking an passing a test. While this type of requirement is, of course, badly needed, it simply does not go far enough. The problem may be that the six-week allotted time limit is too short. Six months of supervised classes, training and testing would have improved both the knowledge and confidence of the new workers and navigators, and provided an opportunity to view mock enrollments.
Also, having an active license from the Department of Insurance would have been the ideal requirement, if time was not a consideration. Passing the state exam involves many hours of reviewing materials, and also updating requirements every other year. The substantially more-rigid licensing would certainly help consumers.
So get ready! The Pennsylvania Healthcare navigators may be coming to a community near you. They are there to help, although licensed experienced brokers, and websites such as ours, will provide a much broader base of updated information and policy recommendations that will help you with the Pa Exchange Marketplace.
November 2013 – Delays and confusion continue to plague the .gov healthcare website. Of course, navigators are finding it difficult to help, since the enrollment process has been considerably slowed down. and their tasks have become more difficult. However, broker websites (such as this one) continue to provide perhaps the best method to view online quotes.
August 2016 – Has the situation improved? It has, although experienced brokers and websites (ours is a perfect example) continue to be the most reliable and trusted option for reviewing rates, plans, and easily enrolling online.