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Pennsylvania health insurance exchange

pennsylvania guide to health insurance

Pennsylvania enrollment fourth highest among HHS-run exchanges; Medicaid overhaul still in negotiation

By
March 29, 2014

Open enrollment in Pennsylvania ends on March 31.  But HHS is allowing an extension for applicants who begin the process by that date, but are unable to complete their enrollment by the end of the day on March 31.  The extension is expected to be valid until mid-April, and applicants will have to attest to the fact that they tried to enroll by March 31 but were unable to finish because of technical problems or other extenuating circumstances.

By March 1, after five months of open enrollment, 159,821 Pennsylvania residents had selected private plans in the exchange – the fourth highest total out of the 36 states where HHS is running the exchange, and nearly double the amount who had finalized their enrollment by the end of December.  And nearly 32,793 exchange applicants had been found to be eligible for Medicaid or CHIP.

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.

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 continues 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

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.  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.  

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.

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

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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