Pittsburgh Vs. Philadelphia - Compare Health Care Options

Pittsburgh and Philadelphia are of course the two largest cities in Pennsylvania. More people buy health insurance plans in these two cities than any other area of the state. There are multiple options, both private and through an employer. So what are the differences and does one side of Pa offer better health care than the other? Let's find out.

But before discussing some of the best options, it's important to recognize the changes from the Affordable Care Act. In addition to instant approval underwriting and mandated "essential health benefits," the federal Obamacare subsidy has provided thousands of dollars of financial relief for many consumers.

Depending on your income (as it relates to the Federal Poverty Level),  your new rates could be considerably less than expected. It's not unusual to see premiums reduced by up to $500-$800 per month, resulting in $1000 monthly rates reducing to less than $300. The federal subsidy is based on your projected household income for that year. If you receive a raise, or lose your job, the amount of the subsidy will change.

Highmark Offers Affordable Western Pa Healthcare Rates

Highmark Blue Cross Blue Shield is available to Western Pennsylvania residents only. So, of course, if you live on the other side of the state, you won't be able to purchase a Highmark plan. And that's a shame, since their rates are very competitive, especially for policies that cover one person. They offer various high-deductible plans which are very popular with small business owners.

Not only are Highmark rates competitive, but they also include maternity coverage on all plans, which is required by the Affordable Care Act. By purchasing a low deductible policy with maternity benefits, you will pay far less than you would for similar coverage in most of the state. Highmark's Network is impressive too, covering a vast number of doctors and hospitals.

When it comes to negotiating lower prices for their customers, they are very adept at it. Of course, they are $50,000 poorer now since they were recently fined $50,000 by the Department Of Insurance for denying claims (considered a minor violation). They are also in the process of merging with Northeastern Blue Cross, which will give them an additional 500,000 new customers.

UPMC is also only available in the Western portion of the state. Although their rates aren't as competitive (in most zip codes) as Highmark, they are indeed a new, but reputable and reliable carrier. Their HSA rates are very attractive to both single and family situations. There are multiple coinsurance and deductible options so there's no shortage of plans.

 UPMC also has comprehensive policies that are suitable for persons looking for "high end" types of options. These plans will offer richer coverage with additional benefits such as office visits (specialists included), prescriptions and  may other needed items. However, they also feature a few policies that are lower in cost and limit the number and type of covered office visit and RX benefits.

Lately UPMC and Highmark have been waging a war of supremacy for the area. UPMC may be making up some market share with some acquisitions, but we'll see how things shake up when Marketplaces are operational. Highmark's purchase of Northeastern Pa Blue Cross will expand their market share further.

Aetna and UnitedHealthcare are two large reputable insurers and both provide medical coverage for individuals and families in all parts of the state. UnitedHealthcare seems to have more competitive rates in the Western and Central parts of Pa. Aetna has very good rates in Reading and the Philadelphia areas, especially their HMO plans with maternity coverage. Both carriers have extensive network provider coverage in most of the state.

In the Eastern part of the state, Keystone (Independence Blue Cross) offers about 8-10 different affordable plans including, HSAs, comprehensive coverage and HMOs. Maternity coverage is available on the HMOs and some of the PPOs and prices are very affordable. Keystone also offers health care in other states. Most physicians and hospitals are very familiar with their policies.

You must live in the Philadelphia area (six counties), but the Network of doctors and hospitals is extensive. Most policies are underwritten although a "Personal Choice" plan can be applied for that is a "guaranteed issue"  contract. This specific plan is ideal if you have been denied by previous insurers or have multiple existing conditions. In 2014, all policies became "guarantee issue." Therefore no medical questions required and pre-existing conditions covered.

So...Which city is the best to buy health insurance? Actually, both Philadelphia and Pittsburgh have multiple insurers that can offer affordable premiums, generous benefits and large provider networks. You can't go wrong with either city! New plans are always being developed and network discounts continue to grow. Blue Cross has great options on both sides of the state.

How Will I Buy My Health Care In 10 Years?

How will you buy your health care in 10 years? Or perhaps, will you not have to buy it? Will it be provided free to you by the federal or state government? These are questions that are hard to answer at this time, but we're very qualified to provide an educated guess. And with more than 30 years of experience in the business, our insight and predictions are usually accurate.

One of the big variables in the health care equation is who will you buy it from and what will be the cost. Will we have a single-payer system where health insurers are out of the picture? Or will there be many health insurers that effectively compete for your business with the government paying for some or all of your premiums? And what about Universal health care that is popular in Europe?

Pennsylvania Marketplace

You Will Not Be Denied!

Another question mark is the current Pa Health Exchange. Will it be operational in 2016 or will election results in 2014 put the Exchange ideas to an end. That's a big variable and Pa consumers will have to keep a close watch on the developments. The election in 2016 plays a big role in the makeup of the Exchange. We do feel, however, regardless of the results, a repeal is not going to  occur. Perhaps some additional changes and tweaks though.

Although President Obama was re-elected, details about the inner workings are still being worked out. The Marketplace is up and running, but there are many issues that are unanswered. Cost overrun is always a major concern. One of the variables is which carriers will continue to offer plans. Not all companies  participate, which ultimately hurts consumers. And the shrinking size of Networks is always a concern.

More than likely, in Pennsylvania and the rest of the US, we will see a blend of these two concepts. If you are at or near the poverty level, there should be some type of assistance that will help pay for some, most or all of your premiums. But where will the bar be set? $20,000 of household income? $40,000? This will be a very contentious topic. And perhaps it will be a rolling amount...slightly increasing every year.

Your Income And The Federal Poverty Level

Currently, if you make over $96,000 (family income), there will not be a tax subsidy. However, if you fall under that amount, you will be eligible for financial aid from the federal government. These subsidies will be badly needed since prices may be high without them. Purchasing coverage outside the Exchange may also be an attractive option to be considered.

The Federal Poverty Level guidelines greatly dictate how much financial aid you will receive from the government. That, along with the number of dependents you have, can mean the difference of receiving $10,000 in aid or none at all. This Subsidy Calculator will help you determine your financial aid.

Over Age-65 Market

But as people are able to be treated for more diseases and conditions, and thus live longer, the big burden may not be on health insurance for folks under 65. Medicare may bear the brunt of many current and future problems. Invariably, copays will have to rise and mismanagement, fraud and waste will have to be brought to a grinding halt. OK. I know. Maybe not to a grinding halt, but perhaps a bit better controlled. There's a lot of money that can be saved by simply managing our own house better.

The usage and availability of Medicare Supplement plans may change. Of course, currently, there are plenty of options available and the rates are reasonably priced since it just needs to cover "gaps" in coverage. But as these gaps get larger and seniors become older, rates may go up. And the makeup of policy coverages may change if Medicare changes its basic coverage. I can only say "stay tuned" and let's see what happens.

Another variable is if the Medicare-eligibility age changes. Currently it is age 65. For instance, if it were to change to 67, that could put some pressure on individual health insurance rates since the health of older persons is not as good (generally) as younger persons. Someone would have to pay for that and it may be us! We believe that the Medicare eligibility age will remain at 65.

Don't Miss Your Medicare Enrollment

But the Social Security retirement age could increase. In fact, it may have to so it can remain solvent. One possibility is an increase of three months every other year. This nominal jump should placate both Democrats and Republicans, and allow Social Security to continue to safely provide retirement income to millions of senior citizens.

Health insurance won't be free in 10 years or 50 years. So yes, you will still have to buy it. But the double digit increases in premiums will be long-gone with various subsidies keeping premiums to a somewhat reasonable level. Non-generic prescriptions will still be expensive, but hopefully the multitude of generic drugs will allow consumers to cheaply purchase the medications they need. And if major diseases such as cancer and heart disease become less costly to treat, it could have a major impact on long term health care costs.

I'm Self-Employed In Pennsylvania. Now What?

You're self-employed and you live in Pennsylvania. You need health insurance for yourself and your family. You want an affordable plan, but also would like to have top-notch protection, especially if there is an expensive injury or illness. What are your options? Should you purchase coverage through an exchange or through one of the top healthcare websites such as www.Pahealthinsurancecoverage.com? So many questions and the answers aren't easy.

Actually, there are quite a few health care plans in Pa that will help without putting a huge dent in your budget. If you are currently uninsured, and are in reasonably good health, you should be able to qualify for an underwritten plan. Since preventive coverage is included in the vast majority of plans, a great "starter" policy would be a simple policy that covers the big expenses only. It provides rich benefits for big claims and keeps the cost within your budget.

Plans like this are typically the least expensive option and when you view plans on reputable websites (as mentioned above), you can usually view them at the top of the screen. You will notice deductibles between $3,000 and $10,000 and often limited office visit and RX benefits. But if you have no serious medical isuues, it may be a big budget-saver.

If you have existing medical conditions and previously have been turned down, the State Open Enrollment plan has very good prices (under $300 per month) and after 2014, your health history will not be a factor in the underwriting of a policy. And regardless of how large or small your business is, that factor alone may be a big money-saver. However, after March, this program will not be available.

Save Money With A Pa HSA

Often referred to as a "catastrophic" policy, your premium will be low and you'll be protecting the most important thing- the big unexpected claim. You never know when an illness or injury can occur or the amount of money that will be needed for treatment. And since your yearly annual physical is covered, you'll be encouraged to utilize it to stay in good health. You can choose many different plan options that will provide low premiums with higher risk or vice verse.

The Blue Cross (Blue Shield) plans in your area are always a good place to start. For example, if you live in Lebanon or Lancaster, Capital Blue Cross offers some very attractive plan options. There are many PPO plans that feature low premiums. A prescription rider can be added to many of the plans. A higher deductible such as $5,000 will help the premium reduce, although many other lower choices are offered as well. In the middle of the state, Geisinger should also be considered. The Network is not very large outside of the area, but if you rarely travel, it's a nice plan.

Other Blue Cross plans can be purchased in other areas. Independence Blue Cross is available in the Philadelphia area and Highmark plans are great plans to consider in the Western part of the state. Northeastern Blue Cross also offers coverage in that part of the state. For many self-employed individuals and small business owners, BC and BCBS plans are great places to start when searching for new coverage. They have big networks that tend to discount treatment very heavily.

A Health Savings Account should also be considered if cutting costs and reducing premiums is a priority. In addition to tax deductions, a savings element is included to go along with lower premiums. While an HSA should be researched before purchasing, they still remain on of the most popular plans today. You have a much broader control over the way your expenses are paid and what type of treatment you receive. And of course, most importantly, how much you are spending for your healthcare.

Ten Silly Ideas That Would Lower Healthcare Costs

Healthcare costs are too high.  The cost of a specialist or Emergency-Room visit has skyrocketed. What can we do? A lot. I have plenty of ideas and here are 10 of the best ones. I fully endorse all of them and hope to see them implemented soon.

1. Mandatory 10-mile runs for any man caught sitting on a couch longer than four days. This could help speed up metabolism and improve his relationship with other family members...if they're still around. After about four of these runs, he won't be a couch potato any longer!

2. No pasta Tuesdays. Instead, rice cakes, blueberries and pomegranate extract will be served at all college dining halls and hospital cafeterias. And no pizza deliveries at night on Tuesdays.

3. Doogie Howser will become the new caretaker of national health care reform. Medical schools would provide special funding for applicants under the age of 12. Eligibility ages for driving will reduce from 16 to 11. And  Sesame Street and Big Comfy Couch will replace all evening programming.

4.  Routine annual physicals will become "routine weekly physicals." Just as garbage pickup is once per week (and that works pretty well!) routine physicals will occur every Monday or Tuesday, with recycling included.

5. Hospital semi-private rooms will be replaced by a maximum room occupancy of 14.Yes, crowded conditions will make treatment a bit impersonal, but large non see-through curtains would be utilized. Dependents on your policy can stay in the room along with three family pets. No goats or sheep please.

6. Everyone's appendix will be removed by age 24. At the same time, a small computer chip would be installed in its place. This chip would monitor the central nervous system and make subliminal suggestions. Eventually, psychiatrists would not be needed, except during March Madness.

7. Hockey and football players would wear protective watermelons over their helmet to help reduce the number of concussions. This could also help in keeping the players hydrated during games, although I don't know what would happen with the seeds.

They Taste So Good!

8. Fast food restaurants will only sell french fries to customers that agree to eat them in the restaurant while walking on a treadmill. While it won't offset all of the calories, it will help a little. Large fries would require an extra hour of running.

9. Movie theaters will replace long-time favorites popcorn and nachos with bean curd and skim milk smoothies. To offset anticipated lost revenue, the average price of a movie ticket will rise from $9 to $65.

10. The last digit of your license plate will represent the number of prescriptions you take. Therefore, the healthiest drivers will have very low numbers as their last digit. If you are driving behind someone with a number higher than five...Look out!

You wanted lower healthcare prices? Now you have 10 recommendations that will save millions of dollars. And it might make your next visit to the doctor a lot more entertaining.

Aetna Pa Health Insurance Rates

Aetna Pa health insurance options are very popular for consumers wanting to purchase affordable medical coverage. As one of the nation's largest insurance companies, Aetna offers every imaginable type of health care plan. PPO, HMO, short-term, high-deductible, HSA, Comprehensive etc... If you have a specific need, chances are they will be able to cover you at a low rate.

Exchange Options

Aetna is participating in  the Pa Exchange Marketplace and also offers plans through Coventry, a company it acquired last year. Coventry's rates are very competitive in most areas. UnitedHealthcare and Cigna, decided not to participate in the Exchange in 2014, although they can consider entering the Marketplace in the future. UnitedHealthcare has stated they will participate in many more states in 2015.

One of Coventry's most popular 2014 Marketplace plans was their Silver $10 Copay HMO policy. Primary care visits are subject to a low $10 copay while specialist visits are subject to a $75 copay. The generic prescription copay is only $5 and since it is a "Silver" plan, "cost-sharing" is provided based on your household income.

For instance, if you qualify for the 87% cost-sharing level, the deductible drops to $1,750 and the specialist copay reduces to $50. The maximum cost-sharing level of 94% totally eliminates the deductible and primary care physician visits. Additional cost-sharing is offered at the 73% and 87% levels. Any time a subsidy is available, the Silver Metal plans should always be considered first.

HMO Plans

In Pennsylvania, Aetna HMO policies are often used. Not only are their rates very competitive in most areas of the state (especially the Philadelphia and Pittsburgh areas), but they, like all companies, must offer affordable maternity coverage. The HMO 20 and HMO 30 policies from pre-2014 have been replaced by Affordable Care Act plans that comply with all required mandates. Prenatal benefits have also been vastly improved.

Details on these plans along with the lowest available prices can be found at this website. Pahealthinsurancecoverage.com is one of the state's most reputable websites for comparing and enrolling.

Since their is no waiting period, prenatal expenses can be covered very quickly along with most other accidents or illnesses. Maternity is now a mandated benefit, which means it is required on all Marketplace plans.

Aetna Offers Comprehensive Maternity Benefits

Depending on which HMO policy you choose, a "per day" expense is required for maternity and certain other major claims. However, after five days, your "per day" expense ends and out of pocket expenses are much lower. HMO plans also benefit families with many dependents by keeping copays low on high-usage items such as office visits, lab tests/x-rays and specialist expenses. Typically, you pay between $20 and $40 on these types of visits.

PPO policies are the most popular individual plans offered to residents of Pennsylvania. A "Preferred Provider Organization" utilizes a network of health care providers to negotiate discounted costs for its users. Almost all insurers have this type of policy in their portfolio since it provides personal medical coverage at low costs. When Exchanges started operating in 204, this type of plan became even more popular so consumers could choose from a wide range of doctors.

Non-Network plans are also sometimes available that allow you to utilize any provider, regardless of their affiliation with an insurer. However, since the cost to your health care carrier is higher, you will pay a much higher premium. For that reason, these plans are not very common unless you are located in a non-service area. Naturally, we don't encourage the utilization of non-network providers unless absolutely necessary.

Deductibles

Aetna's plan options include deductibles ranging from $0 to just above $6,000. Usually, the higher limits are the most popular, since they tend to be very cost-effective over a long period of time. If the policyholder is not paying the premium, then the lowest possible out of pocket expense option is best. That would perhaps be a $750 deductible. But if you rarely utilize your coverage, it's simply a waste of money to choose lower deductibles and 0% coinsurance.

One of the major acquisitions for Aetna was the purchase of Coventry, which marketed plans in Pa under "HealthAmerica." Coventry also offers Medicare Advantage and additional Medicare products.

In addition to policies for applicants under age 65, contracts are also issued for persons 65 or older. Often referred to as "Medicare Supplement" plans, these contracts provide coverage to Seniors to help pay with expenses not covered by Medicare. There are many types of available options and an experienced agent is very helpful in explaining the specifics. Of course, with Seniors, a face-to-face meeting is more appropriate than email or phone.

Pennsylvania is the home to many health care companies. Of course, some are bigger than others. And some have better rankings and rates than others. But Aetna is a very reliable carrier that offers many affordable contracts to individuals and families. They will likely remain a very respected insurer for quite a while and have a major presence on the state Exchanges which started in 2014.