Where?
There are several reputable and trustworthy websites you can visit for free quotes, advice and plan comparisons.Of course, you should not ever provide your social security number or billing information to view prices. But it is acceptable to give out your name, address, phone number and dates of birth. Typically, very few health-related questions should be asked.
Pahealthinsurancecoverage.com is our preference, since we know and are very familiar with their track record and how they operate. The content and advice offered is also very current and insightful. The 33 years of experience of helping consumers is, of course, a big plus, along with their modern software, which coupled with human interaction, yields the lowest available prices. Of course, there are no fees or charges.
Most importantly is the enrollment help you will receive. Whether you need a Jan 1 effective date or a later date, enrolling can be a tedious process that involves calculation of the subsidy, selection of plan, review of cost-sharing options, and matching benefits with needs. Obviously, you want expert help when you are ready to apply for an Obamacare policy.
Even after Open Enrollment expires, specific plans can be purchased through an SEP (Special Enrollment Period). There are also policies that are designed to cover you if OE was missed. Although they are very cheap, coverage is usually limited to hospital and other larger claims, along with some office visit and RX benefits. The avoidance of the 1% (of your household income) ACA penalty does not apply, since you are electing a policy that does not cover maternity and a few other mandated coverages.
 |
| Pa Healthcare Reform Is Here To Stay |
The .gov website has been a popular site for enrollment. But with a steady flow of glitches, delays, security concerns and patches, consumers still are frustrated with the lack of functionality. Perhaps that is why broker websites have become more popular with consumers, since they pay no fees, enroll easier, and receive unbiased assistance. Pa Marketplace information is easy to find. But the quality of that information must be considered.
What?
It's difficult to say "what" the best plans are, since everyone's needs and budget are different. But here are a few thoughts:
The cheapest form of coverage is a "temporary" contract (previously mentioned). It's very affordable (Typically $25-$75 per month) and the carrier often approves benefits either instantaneously or within a day. For unemployed or laid-off workers, it's a very attractive low-cost option. However, since a temporary policy does not meet many of the necessary required mandates of Obamcare, they can only be purchased as an "off-Exchange" plan.
"Golden Rule," who is part of the UnitedHealthOne family, often offers the lowest-priced options. Pre-existing conditions are not covered and this type of plan is designed to be kept in stop-gap situations that are shorter than 12 months. HII is another lesser-known carrier that has very competitive prices. They also offer various riders and enhancements.
The most comprehensive contract is perhaps an HMO (Health Maintenance Organization) with no deductible and low out of pocket expenses. Virtually everything is covered and there is rarely a limit on the number of physician or specialist visits. HealthAmerica (Coventry) and Independence Blue Cross (IBX) offer excellent HMOs through the Marketplace. However, there are many PPO plans that feature lower deductibles and copays.
Highmark is one of the largest healthcare providers in the US. Throughout Western Pa and other parts of the state, they typically offer rates that are among the lowest available in that area. In Western Pennsylvania, Highmark BCBS, along with UPMC, provide the largest selection of low-cost plans. Their network availability of physicians and hospitals is among the largest that is offered through the Marketplace.
A "Primary Care Physician" coordinates all of your needs with an HMO, including determining most of your medical treatment. So you better get along with them! Of course, you can always change PCPs, although the best time would be at the beginning of the calender year. A PPO plan will allow you more flexibility regarding what providers you use and in which areas you can receive treatment.
When?
Actually, it does matter when you apply for coverage. You can apply today, tomorrow, next week or next year. Of course, if you wait too long, you might have to pay for a large claim and that won't be an enviable experience. And Open Enrollment runs only for specific times of the year. For 2014, the last date to enroll is March 31st. If you miss the deadline, you may be subject to a $95 (per adult) tax, or 1% of your income...whichever is higher.
Open Enrollment takes place at the end of every year. There are also special Enrollment periods for persons that left an employer, got divorced or turned age 26 and had to leave a parent's plan. If you qualify for one of these situations (and there are more), you can receive the federal subsidy to help lower premiums.
 |
| Check The Network Provider List |
But will you get approved? Yes, unless you don't meet citizenship requirements. As previously mentioned, when Pennsylvania Open Enrollment began in October (2013), it did not matter what medical conditions you were currently being treated for, or what conditions you were treated for in the past. Quite simply, the only factors that will impact your premium are your age, where you live, whether you smoke, and of course, the type of coverage you are purchasing.
How Much?
Ah yes...How much does it cost? If you're young and healthy, you can afford to take more risk with a catastrophic plan with high out-of-pocket expenses. However, if you're a bit older with ongoing treatment, you will have to pay a higher premium because of your age and also since you may need a plan that pays a higher percentage of your anticipated expenses.
"Bronze" plans are the least expensive since they pay about 60% of the anticipated medical expenses you might incur. Conversely, a "Platinum" plan will pay about 90% of the anticipated expenses, and will be the most costly. Additionally, a "Gold" and "Silver" option is also available.
Silver plans provide a special cost-savings feature that lowers deductibles and copays. Because of this feature, often, it's best to select this option if you meet the subsidy guidelines. It's actually possible to cut the deductible in half (or more) and slash the premiums by as much as 50%-100%. Copays and coinsurance can also drastically reduce.
In many situations, it is more advantageous to pay slightly more for a Silver plan than a fairly similar Bronze plan. The reason is that if your household income is under 250% of the Federal Poverty Level, the reduction in deductibles and copays will easily offset the few extra dollars you may have to pay.
To help pay premiums, a new federal government subsidy is paid to anybody that has household income under 400% of the Federal Poverty Level. For example, for a family of two adults and two children, income up to about $94,000 will result in some form of financial aid. Naturally, the lower the income, the bigger the tax credit. Also, the more children you have, the bigger the subsidy.
Can you get free healthcare? Actually, yes you can! If your income is high enough to be ineligible for Medicaid, but still receive the ACA subsidy, it is possible that a few Bronze plans will not cost you anything. Of course, they will likely have higher deductibles. It's also possible that a Silver plan will feature a subsidy larger than the premium. However, catastrophic policies are ineligible for subsidies.
Obamacare in Pennsylvania. We'll help you compare, enroll and save money! Many of the new legislative changes will help consumers pay less, and enjoy benefits they never had before.
Update January 28 2014 - Poor children in Pa do not have to move to Medicaid for the rest of 2014. The ruling came from the federal government and gives Governor Corbett some extra time to work on a solution for 2015 and beyond. Many of the children are currently enrolled in CHIP.
Many physicians prefer CHIP over Medicaid because of reimbursement and the avoidance of bureaucracy when submitting claims for payment. Medicaid offers more comprehensive coverage and households between 100% and 133% of the Federal Poverty Level were required to change to Medicaid (under the ACA).
Update June 22 2014 - Rate projections for 2015 will start to be published within the next few months. Recently, many carriers requested rate increases for the upcoming Open Enrollment. The DOI will rule on the requests, and determine the amount (if any) of the price hikes can be approved.
