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Pennsylvania health insurance exchange

pennsylvania guide to health insurance

Pennsylvania health insurance exchange

By contributor
July 24, 2014

By April 19, 318,077 Pennsylvania residents had completed their private plan selections in the exchange, nearly double the number who had enrolled by March 1.  The April total includes people who applied by the end of open enrollment on March 31, as well as people who signed up in the first half of April during special open enrollment windows (triggered by qualifying events as well as the extension HHS granted to applicants who began the enrollment process by March 31).  By the end of the 2014 open enrollment period, private plan Obamacare enrollment in Pennsylvania was the fourth highest out of the 36 states where HHS is running the exchange (trailing Texas, Florida, and North Carolina).  Enrollment has continued to increase in May, June and July due to qualifying events that trigger special enrollment periods;  HHS will release an updated enrollment total in November, which is when the 2015 open enrollment period will begin.

Pennsylvania has not yet expanded Medicaid under the ACA, but an additional 42,335 exchange applicants had been found to be eligible for Medicaid or CHIP under the state’s existing guidelines by mid-April.  There is no open enrollment window for Medicaid; enrollment continues year-round.

Gov. Tom Corbett originally announced that the state would not move forward with Medicaid expansion, but reversed his course in late summer 2013, saying that the state was negotiating with the federal government to create its own version of Medicaid expansion (Healthy Pennsylvania), using the federal funds to subsidize private health insurance for low-income residents instead of enrolling them in Medicaid, and adding restrictions that would remove some people from Medicaid or charge them a “modest monthly premium” (which could mean that people with incomes above 50% of poverty level would end up paying for their coverage). Some media sources have reported this as Medicaid expansion, but it’s a different strategy and the details are not yet worked out.  In addition, it is only expected to cover up to 520,000 of the 600,000 to 800,000 who would have been covered by an unaltered version of Medicaid expansion.

Corbett’s plan has been very controversial in Pennsylvania, among lawmakers and residents alike.  He has continued to push for his version of Medicaid expansion, and is in on-going negotiations with HHS.  On March 5, a letter from Corbett to Sec. Sebelius outlined his loosening of requirement that Medicaid recipients be actively searching for work, but his proposal does still include a work requirement.  By early July, HHS had not yet approved Corbett’s plan, but by late June the Corbett Administration had received a strong response from insurance carriers interested in participating in his Healthy PA program:  for some regions of the state, as many as six insurers had placed bids, while the Administration had been hoping for at least two per region.  In all, nine insurers have been approved by the state to participate in the Healthy PA program if it is ultimately approved by HHS.

Another alternative for Medicaid expansion was introduced by State Rep. Gene DiGirolamo (R-Bucks) in HB1492, and has been attracting a good deal of support so far this summer.  DiGirolamo’s approach is a compromise:  it would allow the state to expand Medicaid under the ACA (with provisions that would allow the state to retreat from expansion if the federal government fails to maintain its promise to fund 100% of the cost of insuring new enrollees for the first three years), but while continuing to pursue Corbett’s Healthy PA alternative.  Backers of HB1492 envision the state’s low-income residents having access to expanded Medicaid for now, but ultimately switching them to a private option, likely by 2016.  The federal funding for Medicaid expansion would alleviate current budget shortfalls, and would eliminate the current coverage gap in Pennsylvania.  Even if Healthy PA is approved by HHS, it wouldn’t take effect until at least the start of 2015, so expanding Medicaid in the meantime would have a very beneficial impact on low-income households in Pennsylvania, without requiring any additional funding from the state.

Pennsylvania allowed insurers to extend existing 2013 policies into 2014 following the policy cancellation compromise that President Obama offered in mid-November.  Prior to the President’s announcement, a quarter of a million Pennsylvania residents – about one third of the individual market in the state – had received cancellation notices.  By the end of November, two Pennsylvania carriers had agreed to extend some existing policies – including one guaranteed-issue, limited benefit plan for low-income residents – for at least the first few months of 2014.  Despite the fact that policies slated for cancellation were allowed to be extended, and the fact that nearly 160,000 people had enrolled through the exchange by March 1 – and another 42,500 off-exchange through just one carrier – Gov. Tom Corbett continued to criticize Obamacare, focusing on the fact that supposedly, 250,000 people “are losing their health coverage due to the ACA.”  Corbett has been opposed to the ACA from the get-go, and continues to rely on his Obamacare opposition as he works to win reelection in PN.

In December 2012, Gov. Corbett announced Pennsylvania would use the federal health insurance exchange rather than implementing a state-run exchange. Corbett said the U.S. Department of Health & Human Services had failed to provide adequate information, making it irresponsible for the state to proceed on its own.

Leading up to the December announcement, Corbett had repeatedly indicated his administration preferred a state-run exchange, and feedback gathered by a consultant showed broad-based public agreement.  Corbett’s administration proposed establishing several, regional exchanges. However, consumer groups and legislators did not support the concept.

Rates for coverage in the Pennsylvania exchange are lower than the national average, and there are nine carriers offering 126 different individual plans throughout the state, although not all plans are available in all areas.

  • Aetna
  • Capital BlueCross
  • Blue Cross of Northeastern Pennsylvania
  • Geisinger Health System
  • HealthAmerica PA (subsidiary of Coventry, which was acquired by Aetna in 2013)
  • Highmark Health Services
  • Independence Blue Cross
  • Keystone Health Plan and QCC Insurance Company (subsidiaries of Independence Blue Cross)
  • University of Pittsburgh Medical Center Health Plan

Of the enrollees who had selected a plan by February 11, 61,372 had purchased a Highmark plan, and 76% of those were Community Blue plans (total private plan enrollment in the exchange stood at 123,681 on February 1, so a significant portion of enrollees are selecting Highmark, and the carrier is also enrolling people at a rapid pace outside of the exchange, all in ACA-compliant plans).  There was some confusion surrounding the Community Blue network, as the new plans do not include UPMC providers.  Community Blue offered insureds a transition period to have one final visit with a UPMC provider, or to complete (out-of-network) appointments that were scheduled before the end of December.  In early March, the transition period ended, and Community Blue plans no longer provide coverage for UPMC facilities or providers.  If you have a UPMC provider and a new Community Blue policy, be sure to check with your carrier and your provider to make sure that you know what providers are in your network.  This issue has caused considerable consternation in Pennsylvania this year.  The state Senate decided in late June to allow senators, staff and retirees in 29 western Pennsylvania counties to opt for either a UPMC policy or a Highmark plan so that they can continue to receive care at a UPMC facility if that’s their choice.

Although the state government has not involved itself in promoting the exchange, $7 million in federal funds went to various organizations around the state that served as navigators to assist people during open enrollment, which ended on March 31.  The 2015 open enrollment period begins on November 15, 2014.

In contrast with the national trend, Pennsylvania had more uninsured residents in 2012 than in 2011 – an increase of  156,000 people.  Nearly 1.3 million people between the ages of 18 and 64 are uninsured in Pennsylvania.  Almost 900,000 Pennsylvania residents will be eligible for tax credits to help them pay for coverage purchased through the health insurance exchange, according to Families USA.

HHS is running the exchange in Pennsylvania.  You can use to get quotes, compare plans, determine subsidy eligibility and enroll in coverage.

Pennsylvania health insurance exchange links

State Exchange Profile: Pennsylvania
The Henry J. Kaiser Family Foundation overview of Pennsylvania’s progress toward creating a state health insurance exchange.

Operated by the Pennsylvania Health Department

Health Care Section, Office of the Attorney General
Serves Pennsylvania consumers with health-related problems.
(717) 705-6938 / Toll-free: 1-877-888-4877 (only in Pennsylvania)

Pennsylvania Consumer Assistance Program
Assists people with private insurance, Medicaid, or other insurance with resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(877) 881-6388 /

Voice your concerns to your
Pennsylvania elected officials

tell your elected officials

Let your Pennsylvania governor and legislators know how you feel about the state’s proposed health insurance exchange.

Pennsylvania Governor Tom Corbett
225 Main Capitol Building
Harrisburg, Pennsylvania 17120
PHONE: (717) 787-2500.
Contact by e-mail
Contact your Pennsylvania State Senator
Contact your Pennsylvania State Representative