What You Need to Know
Keystone residents can enroll in Obamacare plans on Pennsylvania’s own state-based exchanged, Pennie.
Pennsylvania’s 2021 Open Enrollment Periods starts on November 1, 2021 and ends on January 15, 2022.
Premiums will drop for 2021 individual health plans.
More than a dozen Pennsylvania health insurance companies offer Obamacare plans for 2021. Most Obamacare enrollees get subsidies to save money on coverage.
The Keystone State is home to 12.4 million people. Close to half of the population receives health insurance from publicly-funded programs like Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP). Another 332,000 or so residents get their coverage from private health insurance under the Affordable Care Act (ACA), commonly called Obamacare.
Read below for an overview of the Pennsylvania health insurance landscape and available coverage options.
Obamacare’s Impact in Pennsylvania
Pennsylvania’s uninsured rate remained unchanged for the first few years after Obamacare took effect in 2010. About 10% of Pennsylvania’s population lacked health coverage at that time, which was lower than the national uninsured rate of 15%.1
By 2015, just 6% of Pennsylvania’s population didn’t have health insurance.2 That coincided with Pennsylvania’s adoption of Medicaid expansion under the ACA. As of October 2019, Medicaid expansion in the Keystone State gave 800,900 more residents access to health insurance.
About Pennsylvania’s Health Insurance Marketplace
Nearly 332,000 residents enrolled in health insurance for the 2020 open enrollment, which ended on December 18, 2019.3 This was the first time Pennsylvania used a state-based exchange on the federal platform. Doing so gave Pennsylvania oversight of enrollments, although Healthcare.gov provided the platform to carry out the process. Before 2019, Pennsylvania operated a federally-facilitated Marketplace.
Estimates project that running a full state-based exchange will cost $25 million a year. This figure is far less than the $95 million Pennsylvania paid to use the federal exchange in 2018.
The cost savings will fund a new reinsurance program designed to make Pennsylvania health insurance more affordable. The reinsurance program, called Act 42, was signed into law on July 2, 2019, by Governor Tom Wolf.
Individual Health Insurance Companies in Pennsylvania
- Capital Advantage Assurance Company
- Capital Advantage Insurance Company
- First Priority Health HMO
- Geisinger Health Plan
- Geisinger Quality Options
- Highmark, Inc.
- Highmark Benefits Group
- Highmark Coverage Advantage
- Highmark Health Insurance Company – HHIC
- Keystone Health Plan Central
- Keystone Health Plan East
- Oscar Health Plan of Pennsylvania
- Pennsylvania Health & Wellness
- QCC Insurance Company
- UPMC Health Options, Inc.
Pennsylvania Health Insurance Premiums
Premiums for the 2021 coverage year are set to decline thanks to the reinsurance program introduced in 2019.
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Pennsylvania health insurance premiums on metal plans have declined for the past three open enrollment seasons (2018-2020). Below is the average cost for bronze, silver, and gold plans sold in Pennsylvania’s Marketplace.
|Average Premium for Pennsylvania Marketplace Plans||2018 Plan Year||2019 Plan Year||2020 Plan Year|
|Average Lowest Cost Bronze Premium||$365||$357||$335|
|Average Lowest Cost Silver Premium||$494||$462||$449|
|Average Lowest Cost Gold Premium||$503||$495||$486|
Pennsylvania Marketplace Subsidies
The majority of people (88%) enrolled in Pennsylvania Marketplace plans received premium tax credits (also called subsidies) in 2019. If you earn between 100% and 400% of the federal poverty level (FPL), you can get help to lower your monthly cost on any metal plan. For example, a family of three must earn between $21,720 and $86,800 to qualify for subsidies in 2020.
The average monthly subsidy among Pennsylvania residents is $540 for 2019; higher than the U.S. average of $514.5
Here are some examples of cost savings with subsidies
A 28-year-old in Philadelphia, PA earning $24,000 a year, could get a 2020 silver plan for $122 per month after subsidies. The same policy would cost $392 per month without premium tax credits.
A family of three in Pittsburgh, PA earning $50,000 a year could pay $259 a month after subsidies for a 2020 silver plan. This policy would cost $780 per month without premium tax credits.
Help Paying for Health Insurance
Nearly nine out of 10 Pennsylvania residents enrolled in an Obamacare plan received federal help to pay for health insurance premiums.
Best Pennsylvania Health Insurance for Low-Income Individuals, Families, and Self-Employed Entrepreneurs
If you’re self-employed with no employees, you have the same health insurance options as individuals and families. Depending on your income and household size, you may qualify for low-cost coverage through Obamacare, Medicaid, or the Children’s Health Insurance Program (CHIP).
Low-Cost Private Health Insurance Through Obamacare
As you’ve seen, subsidies can significantly lower your monthly health insurance cost in Pennsylvania. If you meet the income limits to qualify for Obamacare, this may be the best low-cost health insurance for you and your family. Obamacare plans include essential health benefits, such as inpatient hospital care, prescription drug coverage, and free preventive care. Plans that cover children must also include dental and vision benefits.
Low-Cost and Free Coverage Through Medicaid and CHIP
Just over a quarter of Pennsylvania’s 12.8 million population is considered low-income. And one in five residents has health insurance through Medicaid and the Children’s Health Insurance Program (CHIP). About 800,900 of those are adults without dependent children who gained coverage through Pennsylvania’s Medicaid expansion.6
You may qualify for low- or no-cost Medicaid coverage if you have a disability or if you’re 65 or older. Other eligible groups include anyone pregnant, younger than 19, a parent or caretaker of a Medicaid-enrolled child, or a childless adult age 19 to 64 (this is the expansion group).7 Under the ACA, residents age 18 to 26 who were in foster care on or after their 18th birthday can also get Medicaid.
The income limits for Medicaid in Pennsylvania vary for each demographic that qualifies. For example, individuals over 65 or who have disabilities can earn within 100 percent of the federal poverty level (FPL). This amount is $12,760 for a single adult in 2020. Meanwhile, those in the Medicaid expansion group can earn up to 138% of the FPL ($17,609 in 2020 for a single adult).
CHIP is available to low-income children 18 and younger. Depending on your household income, your child may qualify for free or low-cost health insurance through CHIP. For example, your child could get CHIP for free if you earn up to $35,173 for a two-person household in Pennsylvania.
Pregnant women under 19 can also get coverage through CHIP as well as benefits for the child upon birth.
Pennsylvania Medicare Plans For Seniors and Disabled Individuals
More than 2.7 million Medicare enrollees live in Pennsylvania.8 That’s roughly 22% of the state’s 12.4 million population.9 Among Medicare enrollees, about 5 out of 6 are 65 or older. The remaining are younger but qualified due to a disability.
Roughly 40% of enrollees get their benefits through private Medicare Advantage plans instead of the federal government’s Original Medicare program.10 Both options include Part A hospital and Part B medical insurance for things like doctor’s visits and emergency room care.
But Medicare Advantage (also called Part C) includes extra benefits, such as Part D prescription drug coverage offered by most plans. If you’re enrolled in Original Medicare, you can add a separate Medicare Part D drug plan. About 1.1 million Pennsylvanians have an individual Part D drug plan as of 2018.11
You can also add Medicare Supplement (or Medigap) to your Original Medicare benefits. These plans offer different options to pay for some or all of your covered out-of-pocket expenses, including copays, coinsurance, and deductibles. Pennsylvania offers the same 10 standard Medigap plans as other states. The benefits remain the same regardless; although, the premiums may vary by company.
Buying Short-Term Health Insurance in Pennsylvania
Pennsylvania defaults to the federal rules for short-term health insurance. You can get coverage for up to 364 days with renewals up to 36 months.
When to Buy Short Term Health Insurance
Buying short-term health insurance can be useful when you need temporary coverage. Some possible situations include missing the Obamacare enrollment window, being in between jobs, or aging off your parent’s health insurance when you turn 26.
Short-term plans are not the same as comprehensive health coverage under the ACA. Policies can exclude ACA protections and deny you coverage based on your health or preexisting conditions.
If you’re looking for Pennsylvania health insurance to fill a temporary need, make sure you read the plan details to understand its limitations. Be sure to compare your Pennsylvania health insurance options to choose the right coverage for you.