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Pennsylvania health insurance

Pennsylvania uninsured rate among the lowest in the nation; 8 insurers continue to offer plans in the exchange

Enrollment update

Pennsylvania health insurance overview

Pennsylvania’s delayed Medicaid expansion in 2015 made a swift impact on the state’s uninsured rate, which was already among the lowest in the nation. By 2016, only 5.6 percent of Pennsylvania’s population was uninsured.

Despite a year of GOP efforts to dismantle the ACA (otherwise known as Obamacare), the law remains intact as of early 2018.  Premium subsidies continue to be available to help eligible consumers reduce their monthly premiums when they buy plans from Pennsylvania’s exchange, and cost-sharing reductions (CSR) are still available to eligible enrollees, despite the fact that the federal government is no longer reimbursing insurers for the cost of that benefit (instead, insurers have added the cost to silver plan premiums for 2018, which resulted in larger premium subsidies).

The GOP tax bill that was enacted in late 2017 will eventually repeal the individual mandate penalty, but not until 2019 (there is still a penalty for being uninsured in 2018).

Health insurance carriers, rates for 2018

Many of the nation’s health insurance exchanges saw carrier exits for 2018, but Pennsylvania’s exchange did not. All of the insurers that offered plans in 2017 continued to offer plans for 2018 (Aetna stopped offering their off-exchange plans at the end of 2017, but those plans had only been available outside the exchange). Pennsylvania’s exchange is still one of the most robust when it comes to carrier options.

The carriers and their approved average 2018 rate increases are as follows (note that these rate increases are much higher than they would have been if the Trump Administration hadn’t eliminated CSR funding; the cost of CSR has been built into silver plan rates, driving the average increase sharply higher, but the rate increase for plans at other metal levels is smaller):

  • Capital Advantage Assurance – 49.2 percent rate increase
  • First Priority Health (HMO) – 13.88 percent rate increase
  • Geisinger Health Plan – 31.3 percent rate increase
  • Highmark, Inc. (EPO and PPO) – 25.27 percent rate increase
  • Highmark Health Insurance Company (PPO) – 9.68 percent rate increase
  • Keystone Health Plan Central (Independence Blue Cross HMO – 21.7 percent rate increase
  • QCC Insurance Company (Independence Blue Cross PPO) – 28.24 percent rate increase
  • UPMC Health Options (PPO and EPO) – 41.15 percent rate increase

Most counties in Pennsylvania have at least two insurers offering plans in the state’s exchange for 2018, but there are several counties in western Pennsylvania where UPMC is the only exchange insurer in 2018 (note that the map from CMS isn’t entirely accurate, as it was last updated in September 2017. For example, Crawford County is shown as having just one insurer for 2018, but they have two — UPMC and Highmark).

Pennsylvania health ratings

In 2015, America’s Health Rankings placed Pennsylvania 29th out of the 50 states in terms of overall health. In the 2017 ranking, Pennsylvania moved up one spot, the 28th. The state’s rating is helped by its number of uninsured, 13th lowest of the ranked states; number of primary care physicians, 5th best; and percentage of adolescents who have had all of their recommended vaccinations, 7th best. But it’s ranked 48th in terms of air pollution, and 42nd for public health funding.

Pennsylvania fared slightly better in The Commonwealth Fund’s 2017 Scorecard on State Health System Performance. The state came in 22nd out of the 50 states and DC, down from 16th in the previous edition of the scorecard. The Pennsylvania Scorecard provides more in-depth details showing how the rating was determined.

Trust for America’s Health has summarized a variety of public health data pertaining to Pennsylvania in their 2016 edition of Key Health Data, which contains information on specific diseases, health factors, and outcomes.

The Robert Wood Johnson Foundation also analyzed public health data at the county level, ranking Pennsylvania’s counties on this interactive map. The southeast part of the state has some of the highest-ranking counties for both health factors and outcomes.

How did Obamacare help PA residents?

In 2013, before the bulk of the ACA’s regulations were implemented, the uninsured rate in Pennsylvania was 9.6 percent — well below the 14.5 percent national average uninsured rate at that point.

Initially, the state did not expand Medicaid, which resulted in a small decline in its uninsured rate during 2014, the year the ACA took effect. About 360,000 people obtained coverage, including Medicaid/CHIP and private plans, through the Pennsylvania exchange during the first open enrollment.

Pennsylvania expanded Medicaid in 2015, initially with a waiver, and saw even more residents gain coverage. By 2016, Pennsylvania’s uninsured rate dropped to 5.6 percent. Nationwide, 8.6 percent of individuals were uninsured as of 2016.

As of 2015, there were still 994,000 nonelderly Pennsylvania residents who were eligible for ACA coverage but remained uninsured – nearly half (48 percent) of them were eligible for Medicaid, and 18 percent qualified for tax credits to help lower their monthly exchange-based insurance premiums.

In September 2015, Pennsylvania was awarded more than $3.1 million in Navigator grants to help six organizations provide outreach and enrollment assistance through 2018. In September 2017, total Navigator grants for Pennsylvania’s six Navigator organizations amounted to just under $2 million. Across the country, Navigator grants were sharply lower in 2017, due to funding cuts made by the Trump Administration.

Pennsylvania enrollment in qualified health plans

In the fall of 2013, the Kaiser Family Foundation estimated that 1,276,000 Pennsylvania residents could potentially buy qualified health plans (QHPs) through the exchange and that 715,000 of them would qualify for premium subsidies. By the end of the first open enrollment period, 318,077 people purchased private plans in the Pennsylvania exchange, and 81 percent received premium subsidies.

As of March 2015, Pennsylvania’s effectuated exchange enrollment was 412,347. About 78 percent of those enrollees were receiving premium subsidies on average of $248 per month. Enrollment continued to grow through 2016, but decreased in 2017 and again in 2018. This mirrored a national trend of reduced enrollment among states that use the federally-run exchange (enrollment tended to increase in states that run their own exchanges). This is due in large part to the Trump Administration’s decision to reduce funding for’s marketing and enrollment assistance, as well as the much shorter open enrollment period that was implemented in the fall of 2017 (people only had a little over six weeks to sign up for 2018 coverage, instead of the three-month window they had in prior years).

Pennsylvania and the Affordable Care Act

In 2010, both of Pennsylvania’s U.S. Senators, Democrats Robert Casey and Arlen Specter, voted in favor of the ACA. In the U.S. House, eleven Democrat representatives voted yes, while seven Republicans voted no.

Specter has since been replaced in the Senate by Republican Pat Toomey, and the U.S. House now includes just five Pennsylvania Democrats, and 12 Republicans.

At the state level, the overall population in Pennsylvania has a Democratic majority, but the Republicans hold a majority in the state’s House and Senate. Former Gov. Tom Corbett was also a Republican and not an ACA supporter. As such, the state defaulted to a federally facilitated health insurance exchange.

But unlike many Republican governors, Corbett pursued the possibility of Medicaid expansion under the ACA. Corbett submitted his proposal for a modified version of Medicaid expansion – dubbed Healthy Pennsylvania – to HHS in February 2014.  It took half a year of negotiations, but on August 28, 2014, Corbett and HHS announced that they had reached an agreement, and Pennsylvania became the 28th state, including DC, to accept federal funding to expand Medicaid and thereby cover residents with incomes up to 138 percent of poverty.

Corbett lost the 2014 gubernatorial election to Tom Wolf, a Democrat. Gov. Wolf was sworn into office January 20, 2015. Shortly after he assumed office, Wolf began to do away with Healthy PA in favor of traditional Medicaid expansion, which had been a campaign promise. Pennsylvania has had Medicaid expansion as called for in the ACA ever since, as opposed to the modified version of expansion that Corbett had overseen.

Pennsylvania Medicaid/CHIP

By July 27, 2015, about 439,000 Pennsylvanians had enrolled in the state’s expanded Medicaid program – expanded coverage did not take effect until January 2015. The state saw a 12 percent increase in its average monthly Medicaid enrollment from 2013 to 2015.

However, the expansion of Medicaid has intensified that increase. Pennsylvania’s monthly Medicaid enrollment now averages 2,956,575 – a 24 percent increase between 2013 and November 2017.

Medicare in the Keystone State

Pennsylvania Medicare enrollment reached 2.5 million in 2015, which was 20 percent of the state’s population. About 17 percent of the U.S. population is enrolled in Medicare. In the Keystone State, 84 percent of Medicare beneficiaries qualify based on age alone and 16 percent qualify due to a disability; this distribution is also on par with the national average.

Medicare spends about $9,179 annually per Pennsylvania enrollee, which is just above the $8,970 per enrollee spent nationally. As of 2009, the state ranked fifth in overall Medicare spending with $23.7 billion per year.

Pennsylvanians that qualify for Medicare can select a Medicare Advantage plan instead of Original Medicare, and about 41 percent do so. About 42 percent of Pennsylvania’s Medicare beneficiaries are enrolled in stand-alone prescription drug benefits through a Medicare Part D plan. Nationally, about 31 percent of Medicare beneficiaries choose a Medicare Advantage plan and 45 percent select a Rx plan.

Scroll to the bottom of this page to see a summary of recent health care reform legislation in Pennsylvania.

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 Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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