Pennsylvania Health Insurance
Affordable PA Health Insurance Options
It is time to research affordable Pennsylvania health insurance options for next year! If you and your family live in Pennsylvania you face the uncertainties of the Presidential election and the COVID-19 pandemic. Selecting the BEST insurance at the lowest rates is more critical now than ever.
TrueCoverage provides helpful resources and guidance for selecting affordable health insurance that meets your specific needs. Remember, the Open Enrollment Period runs through January 15th (2021).
Select your Pennsylvania Health Insurance coverage soon, and you will save yourself last-minute headaches. The TrueCoverage team is here to help by providing pre-registration services. We will contact you with health coverage packages tailored to you, your family or your small business.
Small Business Health Insurance in Pennsylvania
Suppose you own a small business in Pennsylvania (between 2-50 full-time-equivalent employees (FTEs)). You can purchase qualifying coverage for your employees through the Small Business Health Option Program (SHOP) or, just as with individual plans, through a private insurance broker or insurance agent. Typical policies are for 4-6 employees.
If you contribute to your employees’ premium costs, you will qualify for business tax credits. For a full description of the advantages of employer-sponsored health insurance plans, see truecoverage.com/small-business-health-insurance.
Shopping for Health Insurance in Pennsylvania
You may be looking for cheap health insurance in Pennsylvania, but the lowest cost monthly payment (your Premium) may not be your best option. Lower deductibles, co-pays and other factors, such as premium tax relief and State contributions, could LOWER your total medical expenses. Perhaps you are shopping for Medicare and Medicare Advantage plans. In the USA as a whole, around 14% of the population are enrolled in Medicare. Pennsylvania has 17% enrollment in Medicare, and an above average proportion of those are enrolled in Medicare Advantage plans. When you turn 65 you are automatically eligible for Medicare but you must enroll to take advantage.
TrueCoverage is a Certified Direct Enrollment Partner of Healthcare.com and offers one of the largest selections of health insurance plans (over 50,000). TrueCoverage has the technology to filter these plans to provide you with the ‘BEST VALUE’ plans to meet your specific needs.
TrueCoverage is represented in Pennsylvania by its licensed insurance advisors. They have access to the same proprietary systems and possess the specialized knowledge and insights that enable you to decide on the plan(s) which offer ‘best value’ based on your personal (company) circumstances.
10 Core Health Services Mandated for all ACA Compliant Plans
Before the Affordable Care Act became Federal law, insurers could refuse to cover various health benefits, resulting in overwhelming debt for many people. The ACA fixed those loopholes and required all qualifying plans to carry these coverages (in Pennsylvania and all states):
- Emergency services
- Prescription drugs
- Ambulatory patient services (hospital services that don’t need an overnight stay)
- Laboratory services
- Maternity and newborn care
- Pediatric services (for children), including dental and vision care
- Mental health and substance abuse services
- Preventive and wellness services, including chronic disease management
- Rehabilitative/habilitative services and devices
Pennsylvania still allows the sale of ‘Farm Bureau’ plans. These plans may appear cheaper, but they are non-ACA compliant and do not attract premium tax relief.
Pennsylvania, The Metal Health Insurance Tiers and You
There are four ‘metal’ tiers: Bronze, Silver, Gold, & Platinum. These ‘metal’ categories define how you and your insurance company split your health care costs. Each refers to the portion of medical expenses you must pay besides your premiums. They have nothing to do with the quality of your health care.
Quick Note: Not every insurance company offers all Metal tiers in every state and region. If they provide health insurance in your area, at the very minimum they will offer the Silver and Gold tier plans.
Below is a breakdown of costs for each metal tier. The percentages are averages estimated by your insurer, easy rules for out-of-pocket expenses. Your costs will vary: these are EXAMPLES ONLY.
Which Metal Tier is Right for You? Choosing the Right Health Insurance Plan
When choosing a health insurance plan, the last thing you want to do is choose a low premium, only to find yourself stuck with medical debt later. But there’s also no reason to pay for a high-value plan if you rarely use medical care.
When comparing plans, the most significant factor to consider is whether you and your family have recurring medical issues or expenses. If so, choose a Metal tier or healthcare plan that pays for more of those expenses.
Silver plans have been the most popular in the federal marketplace and state exchanges. 70% of consumers choose them. But the best way to plan is to think about last year’s medical expenses and select the situation matches yours most closely.
- You rarely get sick or need medical services besides an annual checkup and one or two medications you can easily pay for out-of-pocket
- You are very healthy
- You are not elderly
- If buying a family plan, your children are elementary-school age or older, very healthy, and do not participate in risky activities.
Silver (Most Popular! Often qualifies for Premium Tax Credits and insurance subsidies)
- Your family members’ one or two mild conditions require medication and specialist visits but do not need close monitoring or frequent care
- Your family members are healthy
- You are under 70
- All your children are elementary-school age or older, healthy, and play few or no sports that often cause injury (the term “sports that often cause injury” is vague, but presume it includes MOST sports and athletic hobbies).
- You or a family member has a chronic condition, sees doctors often, or needs expensive medication that would be impossible to afford out-of-pocket
- Your children are too young for elementary-school, needing frequent pediatrician visits
- You are older or at a higher risk for colds and flu than most people.
- You or a family member has an expensive chronic condition and takes several medications
- You seek urgent care or emergency care more than once per year, frequently need exams to manage a condition, or see doctors more than once per month
- You are older or at high risk for colds, flu, or injuries.
Cost-sharing reductions make Great Health Care possible for everyone
The PA Health Insurance Marketplace offers cost-sharing reductions (CSR) that are “extra savings” opportunities: discounts that lower the total amount you pay for health insurance deductibles, copayments, and coinsurance.
Once qualified for the additional cost-sharing reductions, you must enroll in a Silver Metal tier health plan. The Silver plans in Pennsylvania are the ONLY plans that receive these “extra savings.”
When you fill out the Marketplace health insurance application, you’ll discover if you qualify for premium tax credits and extra savings.
You can use your premium tax credit for ANY plan in the Metal Tier category. But if you also qualify for the extra savings, these will only apply to the Silver plans.
With a Silver plan you will also have a lower annual out-of-pocket maximum. After you reach your out-of-pocket maximum, your insurer pays 100% of the covered services.
Note: If you are a member of a federally recognized tribe or an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder you may also qualify for additional cost-sharing reductions.
The Coronavirus Pandemic, COVID-19 Testing, and the FFCRA
COVID-19 is a hot topic health insurance issue in South Carolina. If you lose your health insurance due to COVID-19 or your employer closed because of the Coronavirus, testing is available at no charge. The Families First Coronavirus Response Act (FFCRA), passed in March 2020, ensures that everyone can receive COVID-19 testing. You also qualify for an SEP (Special Enrollment Period).
See our 5 top Pennsylvania health insurance companies at the bottom of this page.
Key Details about Health Insurance in Pennsylvania
Pennsylvania has legislated to protect consumers from the practice of ‘balance’ or ‘surprise’ billing. You should read our blogs When is a surprise not a surprise? When it’s a SHOCK! and Joe Biden –“ building on Medicare”).
Kentucky is one of the few remaining states which has not expanded Medicaid.
Exploring the Pennsylvania Health Insurance Marketplace
Pennsylvania residents can sign up for health insurance using private insurance exchanges. These marketplaces offer more choice of ACA-compliant plans than the state exchange.
With Health Insurance Exchanges like TrueCoverage, you gain access to ancillary insurance such as:
- Accidental Death
- Critical Illness
- Medicare Advantage, Medicare Supplemental
Benefits of Working with a Health Insurance Broker
TrueCoverage is a Certified Direct-Enrollment Partner of Healthcare.gov. We offer more affordable health insurance plans than any other resource in PA, and our unique technology quickly delivers the ‘BEST VALUE’ insurance policies that address your needs.
Like brokers in every state, TrueCoverage operates without bias. Our job is to find you the best health insurance options, regardless of the insurance carrier. Brokers search for policies that best meet your needs. We are there for you throughout your contract. For example, if a dispute arises with your insurer, TrueCoverage steps in to help.
TrueCoverage is familiar with your state’s unique insurance rules, and we understand the Pennsylvania health insurance options from the largest carriers to the smaller specialty health insurers.
The Top 5 Health Insurance Companies in Pennsylvania
Choosing from over 50,000 plans is daunting without independent, expert advice. That is where TrueCoverage shines. To help, we have listed the top five health insurance companies in PA.
Gathered by the National Committee for Quality Assurance (NCQA), these ratings use Consumer Satisfaction, Preventive Care, and Medical treatment options to determine the score.
More details about the top 5 health Insurance companies in Pennsylvania
The NCQA rates these ACA-compliant health plans as the BEST in Pennsylvania
- Martin’s Point US Family Health Plan (NH, NY, PA, VT)
- UPMC Benefit Management Services, Inc.
- UPMC Health Coverage, Inc.
- Aetna Health Inc. (Pennsylvania)
- Capital Advantage Insurance Company
All ACA-compliant and Medicare plans have a star rating based on similar criteria.
Click below to learn more:
Don’t leave it too late. NOW is the best time to select your ACA Affordable Pennsylvania health insurance, BEFORE Open Enrollment closes on January 15th.
Connect with the health insurance experts at TrueCoverage now to find the BEST health insurance for you, your family, and your business.
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From the Fall of 2020, Pennsylvania has had its own health insurance exchange and among other things used its freedom to extend. It does not regulate short-term health insurance plans. They are a useful option in some circumstances. These plans are NOT bound by the Affordable Care Act that mandates the 10 essential health benefits and, they are NOT eligible for premium tax relief.
Pennsylvania is not participating in the Texas-led attempt to invalidate the ACA. The case is still before the courts and will almost certainly not affect the health insurance plans for 2021.
Did You Know?
Pennsylvania, the keystone state, may have been second to sign (1776)
the Declaration of Independence but it has a long history of being first. Here are just a few of them.
- In 1775 in Philadelphia, Johann Behrent built the first piano in America
- The earliest successful experiment of Thomas A. Edison with electric lighting was made in Sunbury (patented 1880)
- In 1909 the first baseball stadium was built in Pittsburgh
- In 1920 the first commercial broadcast station in the world was KDKA in Pittsburgh
- In 1940, Pennsylvania opened the first high-speed, multi-lane highway in the nation, the Pennsylvania Turnpike, which set the pattern for modern super-highways throughout the nation
- In 1946 Philadelphia became home to the first computer.
If you want see more of Pennsylvania’s firsts, check awesomeamerica.com
Sources: National Geographic; Infoplease; coolkidfacts