Pennsylvania, nicknamed as “The Keystone State”, is among the top populous states and also rank among the best states for primary education and safety. This state is a prime location for adventurers and explorers, as it has lakes and miles of shoreline, green landscapes of farms and plains, sky-scraping mountains and mountainous city skylines. However, the state ranks in the middle of the pack when its come to state health rankings, so residents certainly need to improve upon their health to climb high in the state rankings. Health insurance is a vital part of the healthcare, which is generally overlooked and so residents of this state need to work upon it. This state is consistently working upon to make health insurance affordable to quite a large number of their residents. In 2019, the state enacted legislation that make ways for the state to establish its own health insurance exchange that will be operational in 2021 plan year. By switching to its own exchange, Pennsylvania is expecting to save up to $50 million per year that can be used to cover the state’s portion of the cost of a reinsurance program. Besides these, the state will also have several other benefits of having its own exchange, as they will have more flexibility and control over the marketplace. The state estimate that with the implementation of the reinsurance program and transition to a state-based exchange that individual market premium will reduce by 5 to 10% in 2021.
Highlights & Updates on Pennsylvania Health Insurance Marketplace
- Residents of Pennsylvania for now enroll through HealthCare.gov, as the state currently has federally facilitated marketplace.
- For the 2021 health insurance plan, the state plans to run its own exchange.
For the 2020 health plans open enrollment has ended in the Pennsylvania, although residents with qualifying events can still enroll.
- The state is working to establish a reinsurance program using federal pass-through funding and the savings generated by switching to a state-run exchange.
- In Pennsylvania, short-term health plans are available with initial plan terms of up to 364 days.
- Through the Pennsylvania exchange, twelve insurance companies are offering coverage in the year 2019.
- Around 366,000 Pennsylvanians enrolled in 2019 coverage through the state exchange.
- Average rates for plans sold in the exchange for 2020 coverage have increased by about 3.8%.
- Rates on some plans have been increased but overall average rates are slightly lower in 2019 and subsidies are smaller compared to 2018.
Individual & Family Health Insurance in Pennsylvania
In Pennsylvania the best way to shop for individual and family health plans is to have a better understanding of all the available plans in the state. Though each and every plan covers the same essential health benefits but they stand out in terms of monthly premium and out-of-pocket costs when healthcare is required. Most of the individual health plans available in Pennsylvania are not medically underwritten and therefore cover pre-existing conditions without increasing the premium. Residents of Pennsylvania have plenty of options in individuals and family health plans, which they can purchase from participating private insurers through the federal exchange, HealthCare.gov.
The following types of individual and family health insurance plans are available in Pennsylvania:
PPO – PPO plans come with more flexibility, as insured have an option to visit any health care provider from a much larger network of healthcare providers. Members of PPO plans do not require to select a primary care provider and are allowed to receive healthcare from both in-network and out-of-network healthcare providers, though visiting out-of-network providers can cost them more. Members of the PPO plan can also visit a specialist without a referral. However, PPO plans usually have higher premium amounts and a deductible that members need to pay before their insurers start paying for the healthcare. PPO plans are ideal for individuals who regularly utilizes health care and often visits specialists, as they can visit specialist without getting a referral.
HMO – HMO or health maintenance organization plans are the most common type of individual plan in the health insurance market, around 56% of individual plans are HMOs. HMO plans stand out among the individual plans due to its low premiums. The plan has limited network of doctors and hospitals, and members are required to choose a primary care provider, who manages and coordinates their health. In this plan members also need to obtain reference from their primary care provider in order to see a specialist. The main drawback of this plan is that members of these plans are not allowed to go outside the network to receive healthcare and if they go then they will have to pay for the care on their own.
High-Deductible Health Plans with HSA – High Deductible Health Plans are generally coupled with a HSA and these plans are ideal for people who wish to save money with low monthly premiums and don’t want to extensively use their medical coverage. These plans have a high deductible which members have to meet before their health insurance coverage become effective. A health saving account is a tax advantaged medical savings account in which tax payers enrolled in a high deductible health plan can contribute funds. The amount saved in this account can be used to pay for qualified medical expenses. If the members of the plan use the HSA money for non-medical expenses and are under the age of 65 or not disabled then they will be liable to pay a 10% penalty in addition to their regular federal income tax on such amounts. If money saved in the HSA is not used for medical expenses then the money accumulate as tax-free savings for their retirement.
Dental Insurance Plans for Individuals and Families in Pennsylvania
It is a well-belief idea that a health mouth benefits the whole body and therefore residents of Pennsylvania should avail the right dental insurance plans that not only provides them coverage for preventive dental care like check-ups and cleanings but also include coverage for some costly and unexpected treatments like root canals and crowns. Dental insurance plans in Pennsylvania is often categorized as:
Indemnity Dental Plans – Indemnity dental plans come with the more flexibility to the members, as they are network of dentists and members are free to visit any dentist of their choice. However, the members are not directly reimburse with the dental care cost and instead their dentist submit the bill to their insurance company, who only pay benefits up to what their network provider would have charged and the remaining amount has to be paid by the insured itself.
Managed Care or PPO Plans – Managed care dental plans have a specific network of participating dentists to whom members can visit to receive dental care. The cost of dental care for members of managed care dental plan is generally less because the participating dentists agree to provide dental care at negotiated rates. However, members can visit out-of-the-network dentists but the dental care costs will significantly increase.
Vision Insurance in Pennsylvania
Vision or eye insurance in Pennsylvania is not exactly like the traditional health insurance plans, as vision insurance consists of discounts schedules and wellness benefit plans. The vision insurance offers significant savings that can be used on progressive lenses, anti-reflective coating along with other vision care services, thereby making the vision care more affordable for the people. Generally there are just two types of vision plans in Pennsylvania namely, benefit plans and discount plans. Both of these vision plans cover almost similar benefits but they majorly differ in the amount of monthly premiums. Vision insurance generally provide coverage for eye exams and prescription lenses. Among the two types of vision plans, discount vision plan is affordable, as members have to pay less for this plan.
Short-term Health Insurance Plans in Pennsylvania
Short-term health insurance plans or limited-duration plans usually availed by individuals to fill the coverage gap. This plan is idea for individuals who are currently not working, just graduated, missed open enrollment, recently divorced or are without coverage. This plan provides inexpensive and immediate coverage to individuals until they find a permanent solution. Short-term plans in Pennsylvania is available with the initial terms of up to 364 days and renewals of up to 36 months, as the state defaults to the federal guidelines. This plan does not comply with the Affordable Care Act, so individuals purchasing this plan need to pay close attention to the plan’s coverage option because it is not essential for the plans to meet the minimum requirements for comprehensive coverage. Short-term plans have limited coverage and people can even be denied coverage or charged more in case if they have a pre-existing condition. At least seven insurance companies are offering short-term plans in Pennsylvania.
Insurance Carriers operating in Pennsylvania
The insurers that sell plans in the Pennsylvania exchange for 2020 are:
- Capital Advantage Assurance
- Geisinger Health Plan
- Highmark, Inc.
- Highmark Benefits Group
- Highmark Health Insurance Company
- Highmark Choice Company
- Keystone Health Plan East
- QCC Insurance Company
- UPMC Health Options
- PA Health and Wellness
- Oscar Health