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There are millions of Pennsylvanians just like you who are searching for medical coverage during these uncertain times. Whether you suffer from a jarring fall, a stroke, have a disease, or simply feel “not right,” having health insurance can help reduce the stress of receiving medical attention. There is no denying that a visit to the doctor or the hospital is expensive, but when you are protected, you don’t have to worry about medical bankruptcy on top of everything else.
Simply having medical insurance grants access to preventative care, so you can stay healthy longer, as well as a chance to see doctors sooner. Now is the time to start searching for the best coverage available to you and your family.
Here is everything you need to know about health insurance in Pennsylvania to get you started:
An HMO is the most popular type of insurance for most Americans. This plan allows you to select a primary care physician from the provider’s network. If you wish to see a specialist, you will need to visit your primary care provider first to receive a referral. There is a small copayment, then insurance covers the rest. If you go outside the provider’s network, you pay the full amount for care.
More expensive than an HMO, a PPO plan gives you the flexibility to not choose a primary care provider. You also do not need referrals. You may visit any doctor you wish, even those who are not part of the preferred network and receive your policy’s benefits.
The mandated benefits of medical insurance in Pennsylvania do not apply in situations where the employer pays for all benefits without needing an insurance policy. This is called “self-insured.” While self-insured plans can contact a third-party administrator (TPA), such as an insurance company, claims do not need an insurance company to be processed.
There is also short-term insurance for those who missed the open enrollment period. This is an excellent option to cover you until the next period of open enrollment. Pennsylvania does not have its own regulations for short-term insurance, so it uses federal regulations. In other words, insurers may offer short-term insurance for up to 364 days with a 36-month renewal option.
Why You Should Have Pennsylvania Medical Insurance
One of the main reasons people enroll in health insurance is for peace of mind. With the rising costs of medical care and prescriptions, you need a policy that has your back. Pennsylvania does not require its residents to enroll in medical insurance like some other states, including its neighbor, New Jersey, but it is always a smart choice to check your options and compare Pennsylvania health plans regularly. You never know when a better deal—with more comprehensive coverage—is going to show up!
Pennsylvania health insurance laws have a requirement—that certain benefits are considered a standard. Individual health insurance and family health insurance in Pennsylvania both contain the following “essential health benefits”:
Some of these services are also covered by group insurance plans that are offered by employers, but some of them, like maternity services, may be deemed as an extra and cost more money.
Here is what Pennsylvania medical insurance does not cover:
- Cosmetic surgery
- Alternative/complementary care, such as acupuncture
- Weight loss surgery
- Over-the-counter medication
- Fertility treatments
No one can be turned away from receiving health insurance for a preexisting condition or their gender. Furthermore, anyone who is a United States citizen, US National, a resident within the US, and is not currently incarcerated may purchase health insurance in Pennsylvania.
What You Need To Know About Pennsylvania Health Insurance
Pennsylvania is a large state with around 12,400,000 residents, with many of them spread throughout urban, suburban, and rural communities. This means that Pennsylvanians require flexibility. No wonder that there are 12 insurers offering medical coverage in the state. Presently, around 6 percent of residents in PA are insured, while 3,789,856 people are enrolled in a Pennsylvania HMO. If you are one of those who is currently uninsured, then know this: the average cost of one inpatient day at a Pennsylvania hospital is $2,397.
The average annual premium of an employer-sponsored policy is around $6,500 (or around $564 a month). In Pennsylvania, there is no law saying that employers must offer their employees’ group health insurance, but most employers do offer it as a benefit. Yet, you might find that you want more options to suit your needs or budget.
For an individual health plan (HMO), the average cost in 2020 is around $370.30 per month. The annual premium would then be around $4,443.60, which is an 8.20 percent decrease from 2019. Because of the reform happening in the state, it is predicted that costs for Pennsylvania health plans will continue to drop in 2021 and beyond.
Unemployed, Part-Time, and Self-Employed
If you find yourself unemployed, one of the last things on your mind would be your health insurance—unless you have a chronic disease. Fortunately, you do not have to be without insurance for long. Health insurance for unemployed citizens is attainable in PA! Instead of using the expensive COBRA plan that your previous job may have offered, you can either opt into the Pennsylvania Unemployment Insurance (UI) program, or you can check out short-term insurance policies while you search for another job.
Unlike some other states, health insurance for self-employed and small business owners is very affordable in PA. Within the federal Marketplace, you may find that you are even eligible for a tax credit by filing for a self-employed insurance policy. Part-time employees generally follow the same route. Because most companies that over a group or employer-sponsored health insurance do not cover part-time employees, you are responsible for finding your own.
Afraid you can’t pay? In 2019, 80 percent of Pennsylvanians who applied for Marketplace Coverage received financial assistance. There are also plenty of budget-friendly medical insurance plans available in Pennsylvania, depending on your lifestyle and zip code.
Differences Between 2020 Open Enrollment and 2021
One way consumers can purchase Pennsylvania health plans is through the recently introduced federally-facilitated Marketplace. The online resource is loaded with information on various healthcare options available to you. If you do not want to use the Marketplace, there are other ways to compare Pennsylvania health plans.
The open enrollment period for most healthcare plans, including Obamacare, runs between November 1, 2020, and December 15, 2020. One of the major changes between the 2020 enrollment period and 2021 is that the state is planning on running its own exchange for 2021 Pennsylvania open enrollment. The state is also working on establishing a “reinsurance program.” This is expected to be fully enacted as of January 1, 2021.
If you happened to miss the open enrollment period, then you should consider short-term insurance, which we had mentioned earlier. Otherwise, you may be able to qualify for the special enrollment period. This pertains to those who have experienced a major life change, which includes losing health insurance through your occupation, marital status change, or if you have moved.
The best time to search for your new Pennsylvania medical insurance is today. Compare 2021 health insurance quotes from insurance providers throughout the state to see who offers the best coverage at the best price.
Keep Yourself and Your Family Protected
Don’t wait to start researching which policies are available for you. There is no better time than now to make sure you and your family are protected. That includes your physical and mental health. With the right insurance policy, you will be able to move ahead with less stress, because you know that if something should happen, you will be financially covered.
Our goal at Affordable Health Plans is to streamline the process of getting quotes from insurance companies by providing you a way to compare costs on dozens of affordable and comprehensive options for individuals, small group, family, and more. Get started today by entering your zip code.