Understanding Pa Health Insurance Exchange and Obamacare

Pennsylvania's health insurance exchange is a marketplace where individuals and families can purchase health insurance plans that meet their needs and budget.

The Affordable Care Act, also known as Obamacare, was signed into law in 2010 and expanded health insurance coverage to millions of Americans, including those in Pennsylvania.

The Pennsylvania Health Insurance Exchange, also known as Pennie, is the state's official health insurance marketplace, established under the Affordable Care Act.

You can enroll in a health insurance plan through Pennie during the annual open enrollment period, which typically runs from November to January, or during a special enrollment period if you experience a qualifying life event.

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Pennie is a state-run health insurance exchange that provides access to information about all the plans available in Pennsylvania.

Starting in September 2020, Pennsylvania residents will be able to access information about these plans.

The SHOP exchange is also available to small businesses with 50 or fewer employees.

In 2013, an estimated 1,242,351 or 12% of Pennsylvania's non-elderly residents were uninsured.

Of those, 1,141,718 (92%) may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if Pennsylvania participates in the Medicaid expansion.

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The Pennsylvania Health Exchange offers a range of plans to meet different needs and budgets. All plans will meet the ACA definition of a qualified health plan (QHP).

Consumers can compare plans on an "apples to apples" basis by looking at the level of coverage for essential health benefits. The four "metal" levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%), and Platinum (plan pays 90%).

Insurance professionals can register with the Pennsylvania Health Insurance Exchange and receive commissions directly from carriers, using their Exchange ID number and NPN.

A Certified Application Counselor (CAC) is an individual staff member or volunteer who is certified by a CAC Designated Organization (CDO). They're trained to help customers navigate health coverage options through Pennie.

A CAC is one type of Pennie-Certified Exchange Assister, which means they have the expertise to guide customers through the eligibility and enrollment process.

Pennsylvania's journey to establishing a health exchange was a bit of a rollercoaster ride.

The Pennsylvania Insurance Department initially took the lead on planning for the exchange in November 2011, suggesting the state would support a state-based exchange.

In January 2012, the Insurance Department released draft legislation to establish multiple private exchanges, but this model raised concerns about meeting the ACA exchange requirements.

Pennsylvania ultimately defaulted to the federally-run exchange in December 2012 due to uncertain federal guidance and cost concerns.

It wasn't until September 22, 2020, that Pennie, the state-run exchange, finally launched.

In Pennsylvania, insurance professionals can register with the Health Insurance Exchange to sell policies and receive commissions directly from carriers using their Exchange ID number and NPN.

The Exchange will follow federal guidelines for insurance professionals selling policies through the Exchange.

Navigators play a crucial role in assisting consumers and small businesses in making informed choices about their health care options.

Navigators will help consumers access their new health care coverage, including premium tax credits for eligible consumers.

The federal government will run the navigator program in Pennsylvania, ensuring a standardized and effective support system for consumers.

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In Pennsylvania, you can choose from a variety of health insurance plans through the exchange. Cigna Health Insurance offers private and senior plans in the state.

The Pennsylvania Health Insurance Exchange offers plans from several carriers, including those that meet the ACA definition of a qualified health plan (QHP). These plans are categorized by level of coverage for essential health benefits (EHB) into four metal levels: Bronze, Silver, Gold, and Platinum.

Bronze plans pay 60% of medical costs, while Silver plans pay 70%, Gold plans pay 80%, and Platinum plans pay 90%. This allows consumers to compare plans on an "apples to apples" basis.

If you're under 65, you may want to consider the best Pa health insurance plans for your needs. Alternatively, if you're a senior, you may want to look into the best Medigap plans in Pennsylvania, which can help supplement your Medicare coverage.

Here are the four metal levels of plans offered through the Pennsylvania Health Insurance Exchange:

Enrolling in the Pennsylvania Health Insurance Exchange, also known as Pennie, has become a much more streamlined process in recent years.

You can enroll in a Marketplace plan in under 15 minutes using Pennie's online platform. Our experienced brokers can also guide you through the process and help you compare plans.

With 44 years of experience, our brokers can determine the most suitable policy for you and quickly calculate your instant tax credit, if applicable. This can immediately reduce the cost of your coverage.

If you miss the enrollment deadline, you can still apply for a Marketplace plan with a qualifying life event, such as a job change or marriage.

Non-Obamacare plans can also be selected, but federal tax credits will not be applied to the premium. These plans often have higher maximum out-of-pocket expenses, up to $9,200.

The application process has become much faster, taking around 10-20 minutes compared to 90 minutes in the past.

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The ACA, also known as Obamacare, is a comprehensive health insurance program that's more than 1000 pages long.

With so much complexity, it's great to have help navigating the details. Policies, carriers, rates, and federal subsidies change each year, so reviewing options annually is essential.

Ambetter and Oscar are relatively new insurers to the Exchange, and additional carriers may join in the future.

All plans must meet specific qualifications, and while they offer many benefits, some may not be necessary. "Essential Health Benefits" are a must-have in each Exchange plan, covering items like preventive care, ER visits, and maternity care.

Waiting periods and surcharges have been eliminated, making it easier to get the care you need.

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The federal government used to manage and operate the Marketplace in our state, a decision made 10 years ago due to Governor Tom Corbett's concerns about the lack of information from the HHS regarding costs and organizational structure.

This decision saved substantial tax dollars, and although the state legislature could have taken over the operation each year, it chose not to, likely due to the millions of dollars saved annually.

Only 12 states operate their own Exchange, and many have experienced major software and website issues, making the federal government's control a cost-effective idea.

There were delays and enrollment issues in the early weeks of the operation, but broker websites like ours use different software and don't have wait times to view prices.

The rates we provide are identical to the .gov website pricing, and we offer simple and easy enrollment options, along with non-Obamacare options.

Short-term plans are offered throughout the year, but require medical underwriting.

To be eligible for a plan through the PA Health Insurance Exchange, you must be a Pennsylvania resident and a U.S. citizen or national, or a lawfully present immigrant.

You must also be 19 years or older, or under 19 and not covered by a parent's health insurance plan, to register for a plan on your own.

You can register for a plan on the exchange if you're unemployed or underemployed, or if you're working but your employer doesn't offer health insurance.

You can also register if you're retired or disabled, or if you're a student.