Pennsylvania Health Insurance

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The Department Of Insurance (PDOI) will increase control in regulating Pennsylvania small group health insurance rates. Gov. Tom Corbett signed a law that allows the PDOI to have more influence in approving and of course, disapproving rate increases of more than 10% requested by health insurers. This law could possibly help keep group medical insurance costs more stable, by persuading carriers to request smaller price hikes.

When Exchanges begin offering plans in 2014, hopefully these rates will remain affordable. However, many business owners have already indicated they will begin laying employees off or cutting the hours of full-time workers. Although not a popular move, it may be needed for the survival of many firms facing higher expenses. The Affordable Care Act is not necessarily  employer-friendly, and despite public assertions, many consumers will not be able to keep their existing plans.

Local Government Gets Boost

The new law also provides more authority to local government and less for the federal government which is what most consumers prefer. Although it is likely rates will continue to increase, the increases may be more modest. This law does not impact individual health insurance rates in Pennsylvania since premium increases are already reviewed by the PDOI. Consumers are always notified in advance of when premiums are going to increase (or decrease). However, with Affordable Care Act changes looming, personal rates are very hard to predict after 2014.

Because small group prices have been substantially increasing, many individuals and families are purchasing their own private medical plans which are offered by the top companies such as Highmark BCBS, Aetna, UnitedHealthOne, Capital Blue Cross, Keystone and Independence Blue Cross. Rates are often substantially lower than group plans and a wide variety of coverage and benefits is available so you can easily customize your own policy.

Cheap large deductible or expensive no-copay policies can be easily purchased. If you only want to buy a policy for a few months…that’s OK too. A temporary contract can be easily written, and also approved within one day.

In many situations, small group medical plans may be the best option (compared to private coverage). For example, if a major condition exists, such as insulin-dependent diabetes, severe obesity, cancer or chronic heart disease, often, acceptance is guaranteed on group plans.

Therefore in these instances, it is the best choice. Of course, each group is different, so enrollment options should be discussed with an experienced broker. And an existing policy should not be terminated before an alternative plan is approved.

Our Website

This website is Pennsylvania’s trusted online source for up-to-date issues pertaining to Pa health insurance rates, information or the Exchange. Our “one-stop” approach combines live experienced broker assistance with the best available rates to bring consumers an easy comparison and application process without paying any fees. The rates you view are “live” and are constantly updated for accuracy.

It is also important to understand that group benefits and prices will differ than private individual plan options. Not only are the carriers different (in some situations), but the level of coverage (especially maximum out-of-pocket maximums) may widely vary, depending on the level of employer-contribution.

The Future

The PDOI has decided to allow the federal government set up the “Pennsylvania Health Insurance Exchange” if future  Court rulings (if there are any) are favorable to recent proposed changes to our health care system. Currently, the Exchange is still being constructed since it is expensive to implement and may actually turn out to be less helpful to consumers than originally planned.  However, with brokers and the PDOI working together, we believe that ultimately the consumer will be rewarded.

Here in Pennsylvania, as previously mentioned, the federal government (instead of the state) will take the lead and create the “Exchange.” This is actually viewed by most persons (including the Governor) as a positive event. Not only are millions of dollars being saved, but the process of establishment is still quite disheveled at this point. We are monitoring the progress and hope to see some improvement in the near future.

Currently, small business group and individual medical coverage is available through many different carriers and experienced broker websites (such as this one) that provide the means to purchase coverage. Hundreds of plans are offered and the process works well. The proposed Exchanges will limit choices and may force insureds to work with inexperienced “Navigators.” But for now, the concept has not been implemented, and we will continue to provide you with the most competitive prices in the marketplace.


The SHOP (Small Business Health Options Program) Marketplace is open for business now. For companies with 50 (or less) full-time workers, it’s now much easier to find and purchase affordable healthcare for employees. There are four levels of coverage and a special tax credit is offered to companies with less than 25 employees.

Under current law, you are not required to furnish medical benefits to your employees if there are fewer than 50 workers. There are also additional available benefits through SHOP, including dental. Of course, a private carrier can also offer additional coverages.

Is “Trumpcare” coming? With Donald Trump’s successful Presidential bid, Obamacare will certainly be tweaked, replaced, or repealed.  Trump is a strong advocate of HSAs and programs that help small business owners. By 2018 or 2019, we should see significant positive changes.