Should you enroll in your employer’s healthcare plan or purchase your own Pennsylvania health insurance coverage? Rates are different. Coverage is different. Underwriting guidelines, however, should be identical.  Which option is best for you? Actually, that depends on many factors. We utilize more than 37 years of  knowledge and experience to help you make the proper and most informed decision. It could save you thousands of dollars and dozens of headaches each year.

Group Health Insurance In Pa

Employer-sponsored medical coverage is very popular. Big companies, such as PPG, Comcast, Heinz, Cigna and US Steel offer comprehensive  benefits and very affordable prices. Of course, once you leave, it might be different, depending on your situation. Typically, you can’t take your group benefits with you unless you retire before age 65. Although COBRA may be available, the rate you pay is likely to be significantly higher than when you were actively working. The difference in premium can easily be as much as $1,000 per month.

Many popular employer-provided medical options are high-deductible plans that are HSA-eligible. Although the employer is not required to deposit funds into your account, it’s not unusual for workers to receive between $100 and $250 per month to utilize for paying deductibles, copays, coinsurance, and other out-of-pocket costs. Since preventative benefits are 100% covered, an individual worker or a family without major health issues, often prefer this concept. Funds can accumulate quickly, and medical, dental, and vision expenses can be paid with tax-deductible dollars.

Private Coverage Through The Pa Marketplace

Thanks to the passage of the Affordable Care Act legislation (also known as Obamacare), you also have the opportunity to choose a private plan if you lose group coverage,  regardless of the time of the year. Although Open Enrollment occurs between November 1 and January 31, an SEP (Special Enrollment Period) is available at any time for workers that no longer have employee-provided benefits as a result of job-loss. Typically, you are provided 60 days to choose a new qualified plan.

Large company plans typically may feature very comprehensive coverage with rich benefits and low out-of-pocket expenses on large hospital claims. Often, deductibles are as low as $250 or $500. If the policy is an HMO, there may be no deductibles to meet. Primary care physician (pcp) and specialist visits may also be covered with very low copays…perhaps $10 or $15. And sometimes there are no copays, which is very costly to the employer. In recent years, large businesses (and especially smaller ones) are tightening their belts and forcing their workers to share some of the costs.

And a few specific benefits such as maternity and mental illness, may be either completely covered or have very small out of pocket costs to the group policyholder. Other unusual coverage such as chiropractor visits may have no limitations and there may be very small copays on ER visits. The smaller the business, however, as previously mentioned, the more likely the employee has to pay more out of pocket money.

Of course, Pa group  insurance plans are more expensive than private coverage because of the excess benefits. If the employer is paying all or most of the premiums, it’s a great situation for the employee. However, if very little (or none) of the expense is paid by the employer, it can be quite expensive. Often, premiums can be as much as $500-$900 per month. And occasionally, the price exceeds $1,000. NOTE: If you leave your employer, and become self-employed, while hiring several employees, the SHOP Exchange can help find benefits for your workers.

Private Health Insurance In Pa

Personal medical plans are easily purchased from many of the biggest and most reputable companies. Large insurers, such as Aetna, UnitedHealthcare, Independence Blue Cross, UPMC, and Highmark, along with smaller carriers, such as Geisinger offer policies for Pa residents with or without coverage. Plans are not underwritten, which means rates will be the same for persons with very few, multiple, or no health issues.

A group or individual plan will accept just  all applicants, which is part of the reason rates can be so high. This “guarantee issue” clause was part of the Obamacare legislation process. Prior to its passage, Keystone was one of the few companies that offered a private policy with virtually no underwriting. The “Personal Choice” plan was available in Southeastern Pennsylvania. It was a great option if you have trouble qualifying for other coverage. The “State Risk Pool” concept may return in 2018 or 2019, as President Trump determines the best method of reducing health insurance costs.

Family Medical Coverage

When you purchase your own family coverage, the selection process is a bit harder than choosing a plan through an employer. The main reason is that there are hundreds of different plan variations with different coverage, deductibles, copays and out of pocket limits. In addition to understanding the different Metal tiers (Bronze, Silver, Gold, and Platinum), calculation of subsidies and verifying new network provider choices can be quite a daunting task if you are handling it yourself.

So obviously, utilizing a website like ours is a must, so we can easily help you compare the best plans and ensure you are applying for the most appropriate and affordable policy. Not all policies are available in every county, and of course, the best choice for you must be based on your projected medical costs, your budget, and amount of federal aid you are eligible for.

For small business owners, one of the best available resources is the State website ( Small Business Champion Network)  that provides answers to frequently asked questions. Typical topics include  workman’s compensation, COBRA, small-business premiums, wellness programs, IRS assessments, and dependent coverage. If you are a small employer, we highly recommend visiting the website. You can also receive help with registering your business, obtaining a a Tax ID, and creating a business plan.

Customized Coverage

Private medical policies allow you to customize your benefits to meet your individual or family requirements. You can pick a plan with a high deductible or purchase an HSA to keep premiums low.  If you need specialized coverage, such as extra accidental benefits, dental coverage or vision insurance, with many carriers, it can be added to your package. Pediatric dental benefits are included with all Marketplace plans, although major expenses, such as braces, are generally not included or are severely limited.

In some situations an extra “add-on”  may be better utilized by using separate carriers. For instance, an Aetna plan may provide the exact benefits you need, include your physicians and specialists in their network, and be offered at a rate that is easily within your budget. But if you wanted extra protection for out-of-pocket expenses associated with a cancer diagnosis, a different company may be the best option for providing a critical-illness contract.

Very importantly, when you own your own policy, it becomes portable. Whether you remain employed with a company or leave them, your own benefits are not impacted. This can be a big factor if you develop a serious condition, since you would not have to utilize COBRA, which would likely be extremely expensive.

You can also  keep your policy until you become eligible for Medicare.  At that time, you won’t need any additional private medical coverage. If you have a gap between your retirement and Medicare-eligibility, a special enrollment period will allow you to choose  Marketplace coverage from several available carriers.