Pennsylvania Health Insurance

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The Pennsylvania Health Insurance Exchange Marketplace provides guaranteed health care coverage to Pa residents regardless of medical conditions.  Open Enrollment begins  November 1 for all eligible applicants and ends January 31st. You can qualify for an Obamacare federal subsidy while easily comparing multiple policies from the top-rated companies. Plans are offered to small business owners through a separate SHOP Exchange.

Policies are available with or without federal financial assistance. If your household income falls below 400% of the Federal Poverty Level, you are likely eligible for an instant tax credit. However, you are not obligated to accept the funds, and can enroll in an “off-Exchange” plan. These plans still provide the required 10 “essential benefits” including preventive, maternity, mental illness, prescription, ER,  and  other required coverage. However, the enrollment process is often much quicker, since the government  website is not involved, and income verification is not required.

Brief History

The Pa Exchange (2014 was the first year) was created under the “Affordable Care Act” (ACA), and provides the “Marketplace” that allows for the purchase of individual, family and small business coverage. Pre-existing conditions are no longer considered in the underwriting and approval of new plans. Generally, lower-income households pay less than prior to Obamacare, while households that don’t qualify for a subsidy, pay more. Customization of policies has been severely curtailed, since applicants are often forced to purchase benefits that they don’t want, or anticipate never utilizing.

Several Supreme Court decisions have been needed to allow the ACA (Affordable Care Act) to continue. Although many tweaks, exceptions, and variations have changed parts of Obamacare, the core legislation has remained (most of it) in tact. It’s not anticipated that a repeal will occur before 2016, even with one specific political party controlling both the Congress and the Presidency. However, a replacement of the ACA is very possible after that date, perhaps in 2017 or 2018.

We simplify the enrollment process (it only takes about 10-20 minutes) and help you determine your subsidy-eligibility, compare and choose the best available plans, and act as a liaison between the carrier and yourself. Because of the instability and difficult navigation of the government website, we continue to offer simple sign-up through our website, with no cost or fees. You can choose a phone, online, or email enrollment. Usually, an initial down-payment is not required at the time the application is completed.

Pa Marketplace Companies

For 2015, 15 carriers are represented (up from 14 in 2014). Only a handful of other states have more (16). Neighboring Ohio is one of those states. There are also additional specialty carriers that offer specific plans such as “short-term” and critical illness” benefits. Although they are legitimate policies, they  are not designed to cover the combination of major medical and essential health benefits. Chronic conditions and expensive non-generic prescription drugs are often barely covered, and  can create large medical bills.

The Exchange represents the bulk of the top carriers including Independence Blue Cross, Keystone, Highmark Blue Cross Blue Shield, Aetna, UnitedHealthcare, Capital Blue Cross, HealthAmerica, Geisinger, Coventry, Northeastern BC, and Assurant. Each year, companies are expected to be added and subtracted from the list. Smaller carriers will not be able tosustain losses for more than one or two years.

Currently, the federal government operates the mechanics of the program, although the  legislature will still be able to play an active role if they choose. We expect this role to expand in years 2016 and 2017. Most states choose not to run their own Exchanges, since the cost is often hundreds of millions of dollars (that residents have to pay), and plan availability does not substantially change when the Department of Health And Human Resources “runs the show.”

NOTE: The future of the ACA may be determined by the Supreme Court. King Vs. Burwell  questions the legality of financial subsidies that are provided to states that do not operate their own Exchange. Pennsylvania is one of those states. One of the main issues is whether the IRS in 2011 illegally issued a rule authorizing all states to offer subsidies. If subsidies are determined to be illegal, the framework of Obamacare will implode, since premiums will substantially increase for millions of Americans.

Subsidy Calculations

State-regulated, but broker-friendly, the new method of purchasing healthcare benefits is much different than five years ago. Federal subsidies  help reduce premiums persons with moderate incomes that qualify and meet Federal Poverty Level guidelines. For example,  a single 42-year old in Delaware County with income of $30,000 per year, would qualify for about $840 of annual subsidy assistance. A single Mother with the same income (assuming child is CHIP-eligible) would qualify for about $1,560 of subsidies. Family members that are eligible for Medicare, must also include income in the subsidy calculation.  Persons that are Medicare-eligible, can not enroll in a Marketplace plan.

If married with two children, and household income of $60,000, the estimated annual subsidy would increase to about $1,800 per year, although both children would be covered at little or no cost through CHIP. Amounts will vary, depending on age, income, size of household and county residence. Allegheny County would generate  lower subsidy amounts than surrounding counties. Other states, including neighboring Ohio and New York,  would also show different amounts of financial aid. For example, since rates are not the same in Cincinnati and Pittsburgh, subsidy amounts may also slightly differ.

Our Website And How It Helps You

We continue to assist Pennsylvania consumers find low cost medical coverage that provides the benefits needed for each individual or family situation. Our website will provide free online quotes that allow you to easily compare the best  policies. We will provide personal and expert guidance  so that you are paying the lowest possible premium for the maximum amount of available benefits. The comparison and enrollment process has changed, and you may not be able to keep your existing plan (despite what President Obama said).

There are many popular plans that will contain the required essential health benefits, and we’re always happy to explain the specific details. We show you all available plans (that’s the law), even if we know that particular policies are quite expensive. However, we will fully explain and disclose differences in policy rates and benefits, and why we feel one option may be more beneficial than another. If the health history of any family member has changed since the last time we spoke, we highly recommend that you contact us.

It’s The Law!

Two of the most critical aspects of the legislation are the requirement that all individuals must purchase healthcare coverage and making available federal subsidies that will substantially reduce premiums for many single persons, families and owners of small businesses. The tax (penalty) for not buying a policy in Pennsylvania is $325 per person or 2% of income, whatever is higher.

Thus, if you make $50,000 per year and don’t buy a qualified plan, the tax is $1,000. In 2016, the penalty increases to $695 and 2.5%. Thus, in this example, the penalty would become $1,250. And whether you live in Allentown, Scranton, Lebanon, Dillsburg, or any part pf the state, the tax still applies. These amounts are “per person” so the numbers are doubled for two adults. Children are only charged 50% of the tax.

The more positive change is the addition of tax credits (subsidies) that can potentially save thousands of dollars per year on the coverage you are forced to buy. The concept is simple. The less money you make, the bigger the amount of the subsidy. If you make too much, you are penalized by not qualifying for a subsidy. Yes, the concept could use a little tweaking! However, purchasing coverage away from the Marketplace may result in lower rates for some consumers.

Is Obamacare A Good Piece Of Legislation?

It has yet to be determined if healthcare costs will reduce from the establishment of this program. Although many government officials feel consumers may initially pay less for their medical benefits (see CBO reports), there have been exhaustive and reputable studies that show costs will indeed continue to rise. As more information and data is studied, perhaps we’ll have answers to these questions.

By 2017, there should be enough quantitative data to determine how effective the legislation has been in driving down expenses. However, it’s not just personal and corporate health insurance premiums that are being studied. But also, the cost of providing  treatment, and the expense of developing new products for consumers as well. If healthcare expenses continue to increase, then policy premiums will also continue to rise.

The Mandate

One of the major concerns among economists is that the new tax on consumers that don’t buy medical insurance, is too low. It essentially invites consumers to easily go out without coverage and pay a small tax until a major condition appears. Then, during Open Enrollment, coverage is purchased. Although it may benefit the consumer short-term, it causes long-term rates to dramatically rise for everyone else.

Would raising the non-compliance tax to 5% of household income reduce the number of uninsured, and bring in added revenue that will keep the legislation from costing hundreds of millions of dollars in potential tax increases? 5% might be too high of a burden, but undoubtedly, changes to the ACA legislation will have to be made. The Supreme Court may actually hold the “trump” card.

Our free online tools and expertise (and live help) will make comparing and applying for Pennsylvania Health Exchange plans much smoother. Our goal is for you to quickly find the best option, understand your benefits and pay as little as possible. Compare multiple plans now.


The “American Health Care Act” was passed by the House Of Representatives on May 4. However, the Senate is expected to recommend several changes that will make the legislation difficult (but not impossible) to pass. Within a few months, we will know if a final version has reached President Trump’s desk.