By Louise Norris
February 3, 2014
After three months of open enrollment, applications had been completed for nearly 235,000 Pennsylvania residents. 81,320 of them had selected private plans by December 28 – the third highest total out of the 36 states where HHS is running the exchange. And nearly 18,000 had been found to be eligible for Medicaid or CHIP. Of those who had selected a private plan, 24% were between 18 and 34 years old.
Of the 81,320 applicants who had selected a plan by December 28, more than 37,000 had purchased a Highmark plan, and 80% of those were Community Blue plans. There was some confusion surrounding the Community Blue network, as the new plans do not include UPMC providers. However, Community Blue is giving insureds a transition period to have one final visit with a UPMC provider before March 31, or to complete (out-of-network) appointments that were scheduled before the end of December. 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.
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.
In December 2012, Gov. Tom 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.
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 are serving as navigators to assist people during open enrollment, which began on October 1, 2013 and runs through the end of March, 2014.
Gov. Corbett had also 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. As of January, Pennsylvania was one of three states seeking waivers for a modified Medicaid expansion program. If approved by HHS, Healthy Pennsylvania would go into effect in 2015.
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 Healthcare.gov to get quotes, compare plans, determine subsidy eligibility and enroll in coverage.
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 / email@example.com
Let your Pennsylvania governor and legislators know how you feel about the state’s proposed health insurance exchange.Pennsylvania Governor Tom Corbett