Pennsylvania Health Insurance

 Health insurance in Pennsylvania

● Pennsylvania is switching to its own exchange (Pennie) in the fall of 2020.

● Pennsylvania will also have a reinsurance program by 2021, using federal pass-through funding and savings generated by switching to a state-run exchange.

● Open enrollment for 2021 health plans is from November 1, 2020 to January 15, 2021 (a one-month extension, enabled by the state transition to a state-managed exchange).

● Short-term health plans are available in Pennsylvania with initial plan terms of up to 364 days.

● About 332,000 Pennsylvanians signed up for 2020 coverage through the state market.

● In 2015, the ACA's Medicaid expansion took effect in Pennsylvania; more than 826,000 people are covered accordingly.

● Nearly 2.75 million Pennsylvania residents are enrolled in Medicare.

This page is dedicated to helping consumers quickly find health insurance resources in the state of Pennsylvania. Here you will find information about the many types of health insurance coverage available. You can find the basics of Pennsylvania's health insurance market and the next open enrollment period; a brief overview of Medicaid expansion in Pennsylvania; a quick look at the availability of short-term health insurance in the state; statistics on state-specific Medicare rules; as well as a collection of health insurance resources for Pennsylvania residents.

Pennsylvania's health insurance marketplace

Pennsylvania initially chose not to create its own health insurance market, so the state used the federally managed exchange HealthCare.gov. But that's changing in the fall of 2020, with the debut of Pennsylvania's new state exchange, called Pennie.

The state enacted a law in 2019 to authorize passage from HealthCare.gov. Moving on to its exchange, Pennsylvania plans to save up to $50 million a year, which will be used to cover the state's share of the cost of a reinsurance program. The state will also tack numerous other benefits in terms of flexibility and market control, described here by Jessica Altman, Pennsylvania's insurance commissioner. Among the most significant from a consumer perspective is the flexibility to extend open enrollment - which Pennsylvania is doing: Open enrollment for 2021 coverage will last an additional month, compared to what it would have been if the state had continued to use HealthCare.gov.

The market (Pennie) is used by people who buy their own health insurance. This includes people who are self-employed, people who are employed in a small business that does not provide health insurance benefits, and early retirees who are not yet eligible for Medicare. The market is also the only place where people can receive financial assistance (premium grants and cost-sharing reductions) that make health insurance premiums and out-of-pocket medical expenses cheaper.

Pennsylvania's reinsurance proposal was approved by the federal government in July 2020. The federal government will provide pass-through funding that will cover most of the cost of the reinsurance program (since reinsurance will result in lower premiums, premium subsidies will also decrease, resulting in savings for the federal government; pass-through funding refers to the process of using a 1332 waiver to allow the state to use the savings).

Pennsylvania has estimated that the transition to state-based exchange and the implementation of a reinsurance program will result in individual market premiums about 5-10% lower in 2021 than they would otherwise have been. Insurers offering health plan options in the Pennsylvania market have proposed an overall average rate decrease of more than 2% for 2021 (compared to a rate increase that would have been needed without the reinsurance program).

Open enrollment period and dates in Pennsylvania

Open enrollment for 2021 health plans has been extended to Pennsylvania. It will run out from 1 November 2020 to 15 January 2021. This gives Pennsylvania residents a full additional month to sign up for 2021 coverage, compared to what they would have had if the state had continued to use HealthCare.gov (enrollment ends December 15 in states that use HealthCare.gov).

The open enrollment period is an opportunity for people to recently sign up for individual market coverage and for current subscribers to renew or change coverage for the following year. It's also an opportunity to update income and household information that's on file with the exchange, to ensure premium subsidies for next year are accurate.

Outside of the open enrollment period, you need a qualifying event to enroll in a health plan or make a change to your current coverage. This is true both in the exchange and outside the exchange (directly through a health insurer; the insurer will require proof of the qualifying event if the application is submitted outside the open enrollment period).

Enrollment in Pennsylvania's health insurance market grew from 2014 to 2016, but has since declined each year, reflecting a national trend toward lower enrollment under the Trump administration in states that use HealthCare.gov. The decline in enrollment continued for 2020, when 331,825 people signed up for the plans during open enrollment.

Medicaid expansion in Pennsylvania

Although Pennsylvania has been a year behind many other states, the state has accepted the ACA's Medicaid expansion and went into effect on January 1, 2015. As of late August 2020, enrollment under Pennsylvania's Medicaid expansion was 826,442. This has been a dramatic increase since the beginning of 2020, largely due to widespread job and income losses caused by the coronavirus pandemic.

Short-term health insurance in Pennsylvania

Pennsylvania has no state regulations regarding the duration of short-term health insurance plans, so the state is not in compliance with federal regulations.

This means insurers in Pennsylvania short-term health insurance plans can have initial terms of up to 364 days and the ability to renew for a total duration of up to 36 months.

How did Obamacare help Pennsylvania residents?

In 2013, before most ACA regulations were implemented, the uninsured rate in Pennsylvania was 9.6%, well below the uninsured national average rate of 14.5% at that point.

Initially, the state did not expand Medicaid, which led to a small drop in its uninsured rate during 2014, the year the ACA is vinegar. About 360,000 people gained coverage, including Medicaid/CHIP and private plans, through the Pennsylvania exchange during the first open enrollment.

Pennsylvania expanded Medicaid in 2015 (initially with a waiver, but then as a direct expansion once Gov Wolf got himself in), and saw even more residents get coverage. In 2017, Pennsylvania's uninsured rate fell to 5.5% and remained at that level in 2018. Nationally, 8.9% of individuals were un insured as of December 2018.

As of December 2020, there are more than 307,000 people enrolled in health plans through the Pennsylvania exchange. All have coverage for the ACA's essential health benefits, and 87% of them receive premium subsidies that make their monthly premium costs much cheaper than they would otherwise be.

There are no more small business health plans available through the Exchange in Pennsylvania, but all new small-group health plans (up to 50 employees) are fully compliant with the ACA, meaning that small businesses that have purchased health coverage since 2014 also have coverage for essential health benefits, with no life limits or annual benefits.

Pennsylvania and the Affordable Care Act

In 2010, both Pennsylvania U.S. Senators, Democrats Robert Casey and Arlen Specter, voted in favor of the ACA. In the U.S. House, eleven Democratic representatives voted yes, while seven Republicans voted no.

Specter has since been replaced in the Senate by Republican Pat Toomey, and the U.S. House delegation from Pennsylvania is uniformly divided, with nine Democrats and nine Republicans

At the state level, Pennsylvania's overall population has a Democratic majority, but Republicans hold a majority in the state's House and Senate. Former Governor Tom Corbett was also a Republican and not an ACA supporter. As such, the state has not been able to obtain a federally subsidized health insurance exchange, even though it is moving to a state-run exchange under the Wolf administration.

But unlike many Republican governors, Corbett pursued the possibility of a Medicaid expansion under the ACA. Corbett presented his proposal for a modified version of Medicaid expansion - dubbed Healthy Pennsylvania - to HHS in February 2014.  It took six months of negotiations, but on August 28, 2014, Corbett and HHS reached an agreement, and Pennsylvania became the 28th state, including D.C., to accept federal funding to expand Medicaid and thus cover residents with incomes of up to 138% of poverty.

Corbett lost the 2014 election to Tom Wolf, a Democrat. Governor Wolf was sworn in on January 20, 2015. Shortly after taking office, Wolf began getting away with Healthy PA in favor of the traditional Medicaid expansion, which had been a campaign promise. Pennsylvania has had Medicaid expanded as required in the ACA ever since, as opposed to the modified version of the expansion Corbett had overseen.

And under Wolf's administration, the state is pursuing a transition to a fully state-run exchange and reinsurance program, which should work in tandem to reduce individual market health insurance premiums in the state.

Medicare coverage and enrollment in Pennsylvania

As of August 2020, there were more than 2.77 million Pennsylvania residents enrolled in Medicare. Most are eligible because of their age, but 15% of people covered by Medicare in Pennsylvania are under 65 and entitled to Medicare due to a disability.

Pennsylvania Health Insurance Resources

● Pennie — The Pennsylvania market (residents use Pennie instead HealthCare.gov to enroll in plans for 2021). It offers private plans and Medicaid enrollment for individuals and families in Pennsylvania.

● Pennsylvania Insurance Department - Oversees, licenses, and regulates health insurance companies that offer plans in the state and brokers and agents who sell the plans.

● Pennsylvania Department of Aging - Can provide a variety of useful assistance for people with Medicare and their caregivers.

● Medicare Rights Center - A nationwide service (a website and call center) that can provide Medicare-related assistance and information.