You can reduce your Pennsylvania health insurance rate. Changing your coverage to a different company may substantially lower your premium. But the process could take 4-6 weeks (outside of Open Enrollment period) and you may not want to change companies. Also, because of medical reasons, you may not be able to change policies until the new Open Enrollment period begins. Another important consideration is that another policy deductible will begin when a new policy is issued.

Since Open Enrollment occurs just once per year, unless you qualify for a special exemption (SEP), you may only be able to alter your private or group plan during the OE period. And of course, at the time you purchase or renew policies, typically, changes can be made. Since there is no longer a compliance tax penalty for not having a specific type of policy, you have more flexibility when choosing the type of policy and when it is purchased. Senior Medicare coverage utilizes a different period of Open Enrollment, and available coverage and carriers are different than under-65 options.

For an immediate reduction in your rates, consider these recommendations:

· Increase your major medical deductible. With many plans, the deductible does not apply to office visits and prescriptions. So, for example, you may save up to $2,000 per year on a family plan by increasing the deductible from $1,000 to $3,000, or perhaps $5,000. $8,550 is the maximum for qualified Marketplace plans. Many plans have individual deductibles while others have two deductibles for the entire family. Also, the best time to make this change is at the beginning of the calendar year. Marketplace and Group plans will need to be changed in November or December.

· Take advantage of your preventative benefits. Because of healthcare reform, physicals, OBGYN visits, Paps and mammograms are generally provided at no out-of-pocket cost on your policy. By utilizing this provision, it may save you thousands of dollars of future medical expenses. And EACH year, you can use most benefits. Children receive free preventive and well-check benefits. Seniors between the ages of 55 and 64 also receive enhanced coverage.  Many tests, screenings, and procedures are fully covered. However, medical treatment that arises as a direct result of the tests, may be subject to policy deductibles, copays, or coinsurance.

NOTE: Temporary plans may not offer free preventative benefits and/or they may be subject to a large deductible.

· Eliminate unneeded coverages. Maternity benefits are extremely expensive, so if this coverage is not needed, ask your health insurer to remove it from your non-qualified policy. It can not be removed from an Exchange plan. If office visit coverage is not used or needed, eliminate that coverage or request to change to a more appropriate policy offered by your company. You may also be paying for a vision or dental rider that you no longer use. However, since Marketplace plans automatically cover maternity, only limited-benefit plans (which we don’t endorse) may offer the flexibility to have this removed.

· Raise copays on office visits. By raising your copay (if allowed) from $15 to $40, you could save hundreds of dollars each year. Even if you have four or five visits, you should still come out ahead. Eliminating the copay may be a bit drastic but it will save you quite a bit of money, especially if physician costs are very low in your area. Bronze and Silver-tier plans are likely to offer the highest copays. However, it’s important to view specialist copays since they are often significantly higher than a primary-care physician (pcp) copay.

· Increase copays and/or deductibles on non-generic prescription coverage (if you currently do not take any prescriptions). Although your out-of-pocket exposure will increase, in most situations, you will save money. Many “short-term” Pennsylvania health insurance plans allow you to add prescription coverage. Otherwise, typically, a discount card may be offered.

· If you are in perfect or near-perfect health, consider the “Bronze” option, which is the cheapest policy. It still contains “Essential Health Benefits” that are a requirement, but it will save you a lot of money. The “Platinum” option is the most costly plan, and is not eligible for “cost-sharing.”

Don’t Forget Open Enrollment

Since there is an Open Enrollment at the end of every year, if your medical condition changes, you will be able to easily change plans so that a different contract, although costing more, pays a higher percentage of your expenses. And yes, if the condition is gone, you can change back! The subsidies also help you pay premiums if you are considered a “low income” family.

However, it is important to understand the potential costs, especially if you currently take a medication. There is always the possibility that a future illness or accident may require a non-brand medication instead of a generic drug. If it requires ongoing treatment, you may have to adjust your coverage. Thus, changing from a “Bronze” plan to a “Gold” plan may raise your premium but save you thousands of dollars in drug costs. We’ll be happy to discuss those with you.

Medicaid

Depending on your household income, you may be eligible for Medicaid. Applying to Pennsylvania Medicaid State Plan (PA DHS) coverage is offered through COMPASS (online), by phone, or by contacting the local county assistance office. A downloadable application is also available. Benefits include dental, family planning, substance abuse, and long-term care services, assistance to children and pregnant women, and cervical cancer and breast screening and treatment.

The maximum allowed household income is $16,040 (one person), $21,599 (two persons), $27,159 (three persons), $32,718 (four persons), and $38,277 (five persons). Additional programs are Qualified Disabled and Working Individuals Program (QDWI), and Pennsylvania Low Income Home Energy Assistance Program (LIHEAP).

While many of these changes can reduce your rate, it is most important that you strongly consider the impact of each change before implementing them. In some instances, it may be advisable not to make these changes to your policy. We are your experienced resource for state plan information and your Pennsylvania health insurance quotes are always free. Please feel free to contact us if you have any questions regarding your individual or family coverage.