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A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1994.
Pennsylvania uses a state-run health insurance exchange (Pennie) which has 13 participating insurers offering 2023 coverage.
During open enrollment for 2022 coverage, 374,776 people enrolled in private individual market plans through the Pennsylvania exchange. For 2023 coverage, enrollment was slightly lower, at 371,516 people.
Pre-subsidy marketplace rates in Pennsylvania were essentially flat for 2022, and increased by an overall average of 5.5% for 2023.
Pennie and the PA Department of Revenue have created an “easy enrollment” program that was in use by early 2022.
Pennie will be a good resource for people who lose eligibility for Pennsylvania Medicaid or CHIP in 2023 when the pandemic-era pause on Medicaid disenrollments ends (starting in April 2023). Here’s more about how Pennsylvania is handling this process.
Pennsylvania now operates its own fully state-run exchange, known as Pennie. But this was a transition after several years of using the federally-run exchange.
Pennsylvania enacted legislation (H.B.3/Act 42) in 2019 that called for the state to transition to running its own exchange platform and also create a reinsurance program to help to make coverage more affordable. Both took effect in 2021 (Pennie was operational as of the fall of 2020, for people to enroll in 2021 coverage).
Although Pennsylvania initially opted not to establish its own exchange, the state seriously considered establishing its own exchange in 2015, when the King v. Burwell lawsuit threatened premium subsidy access in states that didn’t run their own exchanges. But the Supreme Court ultimately upheld subsidies for people in states that used the federally-run exchange, so Pennsylvania continue to use HealthCare.gov for several more years.
The open enrollment period for individual/family coverage runs from November 1 to January 15 in Pennsylvania. This includes plans sold through the exchange as well as plans obtained off-exchange.
Outside of open enrollment, a special enrollment period (SEP) is necessary to enroll or make changes to your coverage. In most cases, a special enrollment period requires a qualifying life event.
(For people who lose Medicaid in 2023 or early 2024 due to the end of the pandemic-era continuous coverage rules, Pennie will be an important source of coverage if the person isn’t eligible for an employer’s plan. Here’s more about how this.)
There are also some special enrollment periods, such as Pennie’s low-income SEP, enrollment opportunities for Native Americans, and the tax-time “Path to Pennie” (described in more detail below) that do not require specific qualifying events.
In addition, Medicaid enrollment is available year-round.
Pennsylvania’s state-run exchange, Pennie, has 13 participating insurers, although some share a parent company. But there are still eight distinct entities offering coverage, which was a record high for Pennsylvania’s exchange as of 2022. The following insurers offer plans through Pennie for 2023, with varying coverage areas:
Pennsylvania’s exchange is fairly robust in terms of overall insurer participation, but it’s gone from having four or more insurers offering plans in every county in 2015, to several areas of the state having only one insurer option in 2018 and 2019.
Three carriers that participated in 2014 left the exchange, but four more — including giants Assurant (Time) and UnitedHealthcare — joined the exchange, making Pennsylvania among the many states where consumer choice increased for 2015. But Assurant ceased sales of new policies nationwide on Jun 15, 2015, and UnitedHealthcare exited the exchanges in most states, including Pennsylvania, at the end of 2016. United’s total exchange enrollment in Pennsylvania was 65,159 in 2015.
Aetna also left the exchange in Pennsylvania (and ten other states) at the end of 2016. Aetna insured about 31,000 exchange enrollees in Pennsylvania in 2016, all of whom needed to switch to a new plan during open enrollment for 2017 coverage. Aetna then exited the off-exchange market at the end of 2017. Freedom Life/National Foundation Life also exited the off-exchange market at the end of 2017, but the Pennsylvania Insurance Department confirmed that Freedom Life/National Foundation Life never marketed their plans and didn’t have any enrollees in 2017.
Geisinger Quality Option (PPO) stopped being available on-exchange as of 2017, although Geisinger Health Plan (HMO) continued to be available on-exchange (nationwide, insurers have trended towards offering HMOs and/or EPOs in the individual market, especially in the exchange, instead of PPOs). But for 2019, Geisinger Quality Options has returned to Pennsylvania’s exchange.
Keystone Health Plan Central also stopped offering plans in the exchange in 2017, according to the rate approval notice published by the Pennsylvania Insurance Department. They were not offering silver plans at all in the individual market in 2017, which is a prerequisite of offering coverage in the exchanges under ACA rules. As of 2019, Keystone Health Plan Central is continuing to only offer plans outside the exchange, although they have over 2,000 enrollees.
All of the insurers that offered plans in Pennsylvania’s exchange in 2018 continued to do so for 2019 — and several expanded their coverage areas — and Ambetter (Centene) joined the exchange. Ambetter from PA Health & Wellness is offering plans in the Philadelphia area (Bucks, Montgomery, and Philadelphia counties). Residents in nearly half of Pennsylvania’s counties had additional plan options for 2019. In 31 of Pennsylvania’s 67 counties, there were more health insurers offering coverage in the individual market in 2019 than there were in 2018. And in addition to a new entrant into the market, four of the five insurers already in the individual market expanded their coverage areas for 2019. Further, the number of counties with just one health insurer offering coverage in the individual market decreased from 20 to eight.
For 2020, all of the existing insurers remained in the exchange, and Oscar joined in the Philadelphia area. Highmark also expanded into 14 additional counties for 2020.
In Pennsylvania, Highmark’s individual market plans are available through several affiliates. One of them — Highmark Choice Company — discontinued its 2020 plans (which were offered on- and off-exchange) at the end of 2020 and is instead only offering one bronze plan outside the exchange for 2021. Highmark Choice Company’s filing indicated that they expected to have very low enrollment (only two members) in 2021. Approximately 3,720 enrollees who had Highmark Choice Company plans in 2020 needed to switch to another plan for 2021.
For 2022, Cigna joined Pennsylvania’s exchange, with plans available in the Philadelphia area. The same 13 insurers continued to offer coverage in 2023.
Thirteen insurers offer individual market plans through Pennsylvania’s health insurance marketplace/exchange (Pennie) in 2023, although several of them share parent companies.
The insurers that offer plans through Pennie implemented the following average rate changes for 2023, amounting to an overall average increase of 5.5%:
Across the entire individual market, including the insurers that only offer plans outside the exchange, the average rate change amounted to an increase of 5.5% for 2023.
For perspective, here’s a look at how average premiums have changed in Pennsylvania’s exchange over the years:
More than 371,000 people enrolled in private plans through Pennie during the open enrollment period for 2023 coverage. This was a little lower than the prior year’s enrollment total. Although nationwide exchange enrollment hit another record high in 2023, the state-based exchanges (of which Pennie is one) saw their 2023 enrollment dip slightly lower than the prior year’s numbers.
Here’s a summary of enrollment numbers during each year’s open enrollment period:
Pennsylvania lawmakers considered House Bill 1030 in 2021, to create an “easy enrollment” program in Pennsylvania, much like the system that Maryland debuted in 2020, and which Colorado will start using in 2022. New Jersey lawmakers passed a similar bill in 2021.
Although Pennsylvania’s legislation did not advance, Pennie’s board of directors noted that the legal authority already existed for Pennie and the Pennsylvania Department of Revenue to implement an easy enrollment program. As of August 2021, the process of implementing the program was well underway, and the new program, dubbed “Path to Pennie,” was up and running in time for the 2022 tax filing season (for 2021 tax returns).
Pennsylvania’s easy enrollment program adds an optional new form (REV-1882) to the Pennsylvania state tax return. Uninsured tax filers can complete this form and include it with their tax return if they would like the Pennsylvania Department of Revenue to share their pertinent information with Pennie. The state noted that data transfer will happen in three batches during the tax filing season, starting in March.
Pennie will then use that information to create a Pennie account for the tax filer. Starting in late March, Pennie will begin sending notifications to these tax filers. The notifications will include an access code so that the person can log into their Pennie account, an estimate of the financial assistance for which they’re eligible, and a 60-day special enrollment period that the person can use to select a plan and get enrolled in coverage. (Medicaid and CHIP enrollment run year-round, so the special enrollment period is not necessary if they’re eligible for one of those programs. But open enrollment for private health plans ended in mid-January, so the special enrollment period is necessary if the person’s income is too high for Medicaid.)
Pennsylvania residents no longer use HealthCare.gov. Pennie — the new Pennsylvania Insurance Exchange — debuted in 2020, and residents began using it to enroll in 2021 health plans starting on November 1, 2020. Account information for people who were enrolled in 2020 plans through HealthCare.gov was migrated to Pennie in advance of open enrollment, enabling a fairly seamless transition. Because the state is now running its own exchange, it had the flexibility to extend open enrollment, which lasted an extra month in Pennsylvania, ending on January 15, 2021 (the following year, for 2022 coverage and beyond, the federal government also extended the open enrollment period for HealthCare.gov through January 15).
Pennie stems from legislation that Pennsylvania enacted in 2019, calling for the state to establish its own health insurance exchange that would be operational in time for the 2021 plan year. This move will save money and also gives the state significantly more control over its exchange.
In August 2019, Governor Wolf announced the appointees for the Pennsylvania Health Insurance Exchange Authority’s board of directors. The group was tasked with overseeing the implementation and operations of the state-run marketplace. Pennsylvania’s Insurance Commissioner, Jessica Altman, was initially the chair of Pennie’s board of directors, although she will become the CEO of California’s exchange as of March 2022. Zachary Sherman, who previously served as the director of Rhode Island’s health insurance exchange, is leading Pennsylvania’s exchange.
In November 2019, Pennsylvania’s exchange board approved a seven-year contract with GetInsured, the vendor that created the state’s exchange platform and is running the call center. GetInsured is the exchange vendor for several other state-run exchanges, including Nevada’s transition away from HealthCare.gov in the fall of 2019 and New Jersey’s transition to a fully state-run exchange in the fall of 2020.
In a press release in 2019, Governor Wolf’s office noted that the user fee that was being collected by the federal government (for the use of HealthCare.gov, the federal call center, etc.) amounted to $98 million in 2019. It was set at 3.5% of premiums in 2019, and although that dropped to 3% in 2020 (actually 2.5% for Pennsylvania, since the state had transitioned to a state-based exchange using the federal platform, as described below), it was still going to be $88 million (now $73 million) that Pennsylvania insurers — and thus, Pennsylvania insureds — had to send to the federal government to use the federally-run exchange.
Wolf’s office noted that the state-run exchange was expected to cost “as little as $30 million per year,” likely in the range of $30-$35 million per year. As described below, Pennsylvania is using the savings to fund the state’s portion of a reinsurance program that is reducing the cost of coverage for people who aren’t eligible for premium subsidies.
Pennsylvania already switched to having a state-based exchange on the federal platform (SBM-FP) as of the fall of 2019. This means Pennsylvania had taken responsibility for a variety of exchange functions and oversight, but used HealthCare.gov for enrollment (six other states had the same exchange model as of 2021). This change reduced Pennsylvania’s exchange user fee to 2.5% of premiums for 2020, instead of 3%. The state had indicated that they would likely keep the fee at 3% of premiums and use the excess for “any unexpected transition costs” that might arise as the state switched from HealthCare.gov to its own enrollment platform.
In addition to financial savings, states that run their own exchanges also have flexibility regarding their open enrollment schedules (Pennie’s first enrollment window continued until January 15, 2021, which is an extra month beyond what it would be if the state had continued to use HealthCare.gov), call center operations, and navigator grants. They also have much better access to enrollment data, which can be used to better understand enrollment trends and seek opportunities to better serve the state’s population (they publish a vast amount of enrollment data). Jessica Altman, Pennsylvania’s Insurance Commissioner, testified before the PA House Insurance Committee in May 2019 and outlined the myriad benefits of switching to a state-run exchange.
In addition to the new state-run exchange, Pennsylvania also implemented a reinsurance program, and is funding the state’s portion of the cost of the reinsurance program with the savings (roughly $42-66 million) that come from switching to a state-based exchange. The state plans to keep a 3% exchange user fee assessed on insurers that offer plans in the exchange. The cost to run the state-based exchange will be covered by that fee, and the leftover revenue will be used to cover the state’s share of the cost for the reinsurance program.
The state published its 1332 waiver proposal for the reinsurance program in mid-November 2019, and submitted it to CMS in February 2020. It was approved in July 2020, and will be in effect from 2021 through 2025. The reinsurance program will reimburse insurers 60% of the cost of claims that fall between $60,000 and $100,000.
Actuarial modeling in the state’s proposed waiver indicated that with the reinsurance program in place, unsubsidized premiums in the individual market would be 4.9% to 7.5% lower in 2021 than they would otherwise have been. In announcing that the waiver proposal had been approved, Gov. Wolf clarified that premiums were expected to be 5% lower in 2021 than they would have been without reinsurance. The proposed rates that insurers filed for 2021 amounted to an average decrease of about 2.6% from 2020 rates, and the approved rates ended up being even lower, with an overall average decrease of 3.3%; without the reinsurance program, average rates would have increased instead.
Reductions in premiums primarily benefit people who pay full price for their coverage, as premium subsidies (for those who are eligible) rise and fall in line with premiums. With the reinsurance program in place, Pennsylvania estimated that the number of subsidized enrollees in the state’s individual market would remain roughly level from 2020 to 2021, but that the number of unsubsidized enrollees would grow by about 4,000 people. (Ultimately, the number of subsidized enrollees grew significantly, due to the American Rescue Plan‘s subsidy enhancements, which are in effect through at least 2025.)
The federal government will provide a substantial amount of pass-through funding for Pennsylvania’s reinsurance program. The state’s final waiver proposal projected total funding of about $139 million in 2021, with the federal government paying about $95 million of that via pass-through funding. But the actual federal funding for 2021 ended up being larger than anticipated, at more than $120 million. (Federal funding stems from the fact that when a reinsurance program results in lower premiums, the necessary premium subsidies are also lower, resulting in savings for the federal government; pass-through funding refers to the process of using a 1332 waiver to allow the state to use the savings, instead of having the federal government keep the money).
State Exchange Profile: Pennsylvania< The Henry J. Kaiser Family Foundation overview of Pennsylvania’s progress toward creating a state health insurance exchange.
Health Care Matters, Pennsylvania 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 protected]
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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