Pennsylvania Health Insurance

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Pennsylvania health care reform information is updated regularly on this website. We provide current and unbiased tips and information designed to keep you current and save you money. There have been many changes, with dozens of additional ideas being discussed. We research and review these changes and discuss how they will affect your health insurance coverage.

Also, while you are visiting the site, feel free to view, compare or apply for affordable health care coverage. Simply add your zip code to the “Get Free Quotes” box at the top of the page. More than one million persons in the state are uninsured and we’re here to help. Both on and off-Exchange policies are offered. The Obamacare subsidy could lower your premiums by up to 50%-100%.

In March 2010, the US House of Representatives passed H.R. 3590 – The Patient Protection And Affordable Care Act and H.R. 4872 – The HealthCare and Education Reconciliation Act of 2010. Legislation started to become effective in 2010, although much of the legislation was not enacted until 2014 and later.

Changes For 2010

No Exclusion For Children

Pennsylvania insurance companies will be prohibited from adding pre-existing exclusion riders to children’s coverage. This will apply to children AND adults in 2014.

Young Adults Can Stay On Parent’s Policy

Young adults may remain on their parent’s health insurance policy until age 26. Currently, many carriers require children that are not full-time students at age 19, to obtain their own coverage. This change will probably raise premiums to cover the extra risk.

No Lifetime Maximum

Lifetime caps will be removed from Pennsylvania health insurance plans. This portion of the reform bill will likely never affect you since individuals and families rarely exceed their maximum limit.

No Health Rescission

Health insurance companies will not be able to rescind policies when a person submits a claim. This practice, however, is rarely used.

Temporary High Risk-Pool For Pennsylvania Residents

Pennsylvania reform will utilize a temporary national high-risk $5 billion pool to provide health insurance to Pennsylvania residents with pre-existing medical conditions.

Indoor Tanning Tax

Starting July 1, there will be a 10% tax on indoor tanning services. No kidding!

Preventive And Wellness Benefit Change

New Pennsylvania plans must offer wellness and preventive benefits without copays or deductibles. Currently, most comprehensive plans feature nominal copays but no deductibles on wellness coverage.

Changes For 2011

HSA Withdraw Change

HSA withdraws made before age 65 for non-qualified medical expenses will be subject to a tax of 20% (up from 10%). Archer Medical Savings Account withdraws will also increase to 20% (up from 15%). We felt this increase was unfair to HSA customers.

Drug Change

Over-the-counter drugs not prescribed by a physician are no longer tax-deductible. This impacts the majority of HSA account owners. For example, several allergy medicines have become available without a doctor’s prescription. Although more readily available, the cost no longer is tax-deductible. Vitamins also are no longer deductible.

Changes For 2012

State Or Federal

The Pa legislature must inform the Department of Health and Human Services whether Pennsylvania will operate a state-run Marketplace or allow the federal government to be solely involved. A partnership is also a possibility. It is expected that the federal government will operate the Pa Exchange.

Drug Companies Pay More

New fees on pharmaceutical companies are imposed. A branded prescription drug charge impacts most manufacturers.

Easy To Read Benefits

A uniform summary of benefits coverage (SBC) must be provided for individual and group coverage. This applies to new applicants that are purchasing a policy. By comparing before enrolling, it is hoped that consumers will be able to make more-informed decisions.

Changes for 2013

Less Paperwork

Plans must contain uniform standards for electronic exchange of medical information to reduce administrative costs and paperwork. If effectively implemented, this change will help lower rates in the future.

Flexible Savings Account Limit

Contributions to flexible savings accounts (NOT HSAs) will be limited to $2,500 per year (gradually increasing after 2013). Obviously, existing Pennsylvania HSAs will not be affected.

Hospital Insurance Tax

For Pennsylvania households earning more than $200,000 ($250,000 if married filing a joint return), the hospital insurance tax will increase 0.9%.

Itemized Deductions

The itemized deduction threshold (unreimbursed medical expenses) changes from 7.5% of adjusted gross income (AGI) to 10%. This results in higher taxes for many consumers with large medical bills.

Changes for 2014

Pennsylvania Health Insurance Exchange

The Pennsylvania health insurance exchange must be created by 2014 and administered by a non-profit entity or government agency. The exchange will offer plans that meet stated required guidelines. We do not charge any fees for helping you find a plan in the exchange and the rate you receive will be the guaranteed lowest rate allowed by the state. Small employers will also be able to shop for plans. However, if you have no medical conditions, purchasing coverage outside of the exchange may be a better option. We will review all possible scenarios with you. Of course, The Exchange may never get off the ground. We’ll wait and see.

Change In How Your Rate Is Determined

Companies will be prohibited from denying coverage or charging higher rates based on medical condition, health status or prior claims experience. Premiums will vary by age, smoking status and other factors. Existing individual plans will not be subject to the new guidelines. This will help persons with chronic illness and/or multiple conditions. It’s still unclear who will pay for the extra benefits that will be paid.

Tax Credits Will Help Pay Premiums For Exchange Plans

Tax credits will be given to individuals to help pay their Pennsylvania health insurance premiums. To qualify, household income must be between 100% and 400% of the federal poverty line. A family of four earning less than $88,000 per year would qualify for a partial credit. To receive the credit, you must purchase the policy. We will be happy to guide you through the process.

Get Health Insurance Or Pay A Fine

Citizens will be required to have “acceptable” coverage or pay a fine of $95 in 2014, $325 in 2015 and $695 in 2016. Children’s fines are half of those amounts with a cap of $2,250 per family. The government will decide what constitutes “acceptable coverage.” Failure to maintain coverage, however, will not result in criminal actions or fines. Penalties are absurdly too low and enforcement will have to be modified. The Supreme Court, however, may rule this to be unconstitutional.

Health Insurance Exchange Requirements

Any health insurance plan issued through the Exchange (or Marketplace) must provide medical benefits that include cost sharing limits. Coverage will be available in four benefit categories: Bronze (60% Coinsurance), Silver (70% Coinsurance), Gold (80% Coinsurance) and Platinum (90% Coinsurance). A lower-cost major medical catastrophic policy must be offered to individuals under 30 or any other individual that is exempt from the insurance requirement.

50 Or More Employee Requirement

Companies with 50 or more employees, must offer medical coverage to their employees or pay a $2,000 penalty. The fine is levied per employee (after 30) if at least one employee is receiving a tax credit. Waiting period for coverage to be effective is limited to 90 days.

Company Employee Exemption

Employees of a company who are exempt from individual responsibility for medical coverage, but don’t qualify for tax credits, can receive their employee contribution and buy coverage through the exchange. We offer free assistance when buying coverage through the health insurance exchange.

Changes For 2015


CHIP (Children’s Health Insurance Program) in Pa receives a 23% increase in federal matching funds. NOTE: Pa Marketplace Options can be found throughout our site. Economical policies are offered to all persons, regardless if you qualify for financial aid.

Guess Who?

You’ll never guess who is back on the 2015 Exchange after sitting out 2014. Aetna and UnitedHealthcare! Several low-cost plans are offered and enrollment numbers are fairly high.

Changes For 2016


“Compacts” are permitted to be formed and insurance companies may offer policies in these states. Product availability will increase, although it’s not expected to make a significant difference in available choices.

Changes for 2017

Although the Trump Administration proposed several changes, a House or Senate Bill was unable to get passed, and no major changes occurred. Short-term plans are capped at 3-months per contract, although expansion is likely in 2018.

Changes for 2018

No new carriers offer Exchange products in 2018, although many major insurers (UnitedHealthcare and Humana) continue to offer ancillary products, including dental, vision, and critical-illness coverage.

Changes for 2020

The state is preparing for the creation of its own Insurance Exchange in 2021. The Board of Directors has been appointed with Zachary Sherman leading the process. “GetInsured” will create the platform and handle many of the administrative tasks. They also have assisted other State Exchanges in California, Minnesota, Washington, and Nevada. Along with saving millions of dollars, Pa can utilize their own Open enrollment period and create a reinsurance program.