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Pennsylvania health insurance exchange

PA 28th state to expand Medicaid, gains new exchange carrier for 2015

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  • By
  • healthinsurance.org contributor
  • October 12, 2014

More choices for enrollees in 2015

Pennsylvania’s federally-run exchange will have 15 carriers participating when open enrollment begins on November 15.  Three carriers that participated last year are leaving the exchange, but four more – including giants Assurant and United Healthcare – are joining the exchange, making Pennsylvania among the many states where consumer choice is increasing for 2015.

15 insurers puts Pennsylvania’s exchange near the top in terms of the total number of participating carriers, but in some cases the total represents multiple affiliates of a single parent company.  And most of the carriers focus on a single region rather than the whole state, so local competition will vary from one area to another.  Nearly all regions of the state had at least three carriers available in 2014, and the overall trend is towards more consumer choice in 2015.

Rates increasing, but not yet finalized

Final rates for 2015 have not been released in Pennsylvania yet, but Highmark Blue Cross Blue Shield, which garnered a third of the market share during the first open enrollment period (Highmark had 104,324 exchange enrollees, plus an additional 43,679 enrollees outside the exchange) has said only that premiums will be increasing for 2015, and that the carrier’s network will be narrower.

The trend nationwide is towards increasing premiums (and networks are almost universally narrower than they were in 2013), but it’s unclear at this point how significant the rate hikes in Pennsylvania will be.  For states where final rates have been released, the average increases are generally lower than they’ve been over the past several years.

In 2014, rates for coverage in the Pennsylvania exchange were lower than the national average.

2014 enrollment numbers

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.  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 throughout the summer 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.

In contrast with the national trend, Pennsylvania had more uninsured residents in 2012 than in 2011 – an increase of  156,000 people.  But thanks to the ACA, the uninsured rate declined – albeit only slightly – during the first half of 2014.  A recent Gallup poll found that the uninsured rate in the state was 11 percent in 2013, and had declined to 10.1 percent by mid-2014.

Prior to the first open enrollment period, Families USA estimated that almost 900,000 Pennsylvania residents would be eligible for tax credits to help them pay for coverage purchased through the health insurance exchange.  During the 2014 open enrollment period, more than 257,000 people received tax credits (81 percent of the total exchange enrollment) in Pennsylvania.

PA 28th state to expand Medicaid

On August 28, 2014, Pennsylvania became the 28th state (including DC) to expand Medicaid under the ACA in an agreement reached with HHS after many months of discussion.  Governor Tom Corbett’s office announced the details of the approved Healthy Pennsylvania program, and HHS released an extensive explanation of how the state’s Medicaid waiver will work (a waiver is required if a state is doing anything other than straight Medicaid expansion as laid out in the ACA).

Although expanded coverage doesn’t take effect until next year, 42,335 exchange applicants had been found to be eligible for Medicaid or CHIP under the state’s existing 2014 guidelines by mid-April.  There is no open enrollment window for Medicaid; enrollment continues year-round.

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 he initially proposed to mean mean that people with incomes above 50% of poverty level would end up paying for their coverage).

Corbett’s plan has been very controversial in Pennsylvania, among lawmakers and residents alike.  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 did still include a work requirement.  Ultimately, the work requirement was dropped from the Healthy Pennsylvania program, but the state is running a voluntary job training and career coaching program that could let participating enrollees have lower cost sharing.

There will be no premiums charged for Healthy Pennsylvania in 2015, but starting in 2016 the program can charge up to two percent of income for enrollees with incomes between 100 percent and 138 percent of poverty level.

In 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 that was approved by HHS in late August.

Through these private insurers, newly-eligible Healthy Pennsylvania enrollees will be covered under a private, managed care Medicaid program – very similar to what Pennsylvania and many other states already use for existing Medicaid coverage.  Although by early October, there were some indications that the carriers providing the managed care Medicaid coverage were having difficulty getting enough providers to participate in their networks because of the relatively low reimbursement rates compared with commercial plans.

Grandmothered plans

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.

Pennsylvania is among the states allowing pre-2014 plans to be renewed again this fall and remain in force in 2015.

Community Blue, UPMC network controversy

During the 2014 open enrollment period, Highmark BCBS enrolled a total of 148,003 members in Pennsylvania, and 80 percent of them – about 120,000 people – chose a Community Blue plan.  33 percent of the total private plan enrollment within the exchange in Pennsylvania was with Highmark, and the majority of them selected a Community Blue plan.

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 2013.

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.

Exchange history

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

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.

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.

Pennsylvania health insurance exchange links

HealthCare.gov
800-318-2596

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

PAHealthOptions
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 / ra-in-consumer@state.pa.us