En español | Most Pennsylvanians can buy health insurance through Pennie, the state’s Affordable Care Act (ACA) marketplace, which began Nov. 1, 2022, and runs through Jan. 15, 2023.
If you experience a qualifying life event — such as the birth of a child, a move, a marriage, a divorce or the loss of your employer-provided health insurance — you may be able to enroll or change your coverage outside of open enrollment.
Most people already enrolled in ACA marketplace plans have seen their premiums go down because the 2021 American Rescue Plan Act (ARPA) increased tax credits for insurance premiums and expanded the number of households who qualify for them. Every household that pays more than 8.5 percent of their household income now qualifies for federal tax credits to help them afford health insurance. These enhanced subsidies are now available through 2025.
Prior to the 2021 law, such tax credits were only available to people earning less than a certain salary ($54,360 for one person). Most Americans with a marketplace plan can save an average of about $800 per year, according to the federal government.
First, use the Pennie Plan Comparison Tool or contact a certified enrollment assister to estimate costs and sort through various plan options. Once you’re ready to sign up, you can apply online, over the phone or through an assister or insurance broker, in person or by phone. Once you’re approved for a plan, you’ll need to pay your first monthly premium for your coverage to begin.
To apply and enroll:
You can also call Pennie’s service center (844-844-8040) to ask questions and to help determine if you qualify for financial assistance.
Coverage and cost depend on where you live, the type of plan you choose, your estimated household income, and the age and disability status of you and your family.
If you qualify for Medicaid, you will be able to get free or low-cost coverage and may not need to worry about premiums or copays, depending on your level of income.
All Pennie plans cover 10 “essential” benefits, including:
Insurance companies cannot deny coverage because of pre-existing conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family.
All Pennie plans cover basic dental services for children, including cleanings and exams. But adults who want dental coverage must add it to their policy or get a separate plan. Deductibles and out-of-pocket costs vary between plans.
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income qualifies for federal tax credits for insurance premiums through 2025.
According to Megan O’Reilly, AARP vice president of government affairs for health and family, subsidy recipients ages 50 to 64 have already seen average annual savings of over $950.
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help you pay for such out-of-pocket expenses as deductibles and copays. You must enroll in a Silver-level plan to get this assistance.
Pennie’s plans are organized into four categories:
The Pennie Plan Comparison Tool helps you estimate costs and benefits of various plans and check whether you might qualify for financial assistance. Pennsylvanians younger than 30 can also apply for a catastrophic plan offering low premiums but with high deductibles.
If you already have coverage through your employer or directly through an insurance provider but are eligible for lower premiums, you can switch to Pennie. But you may not qualify for tax credits if you opt out of your employer’s plan — unless those premiums exceed a certain portion of your household income. The premiums would need to be more than 9.12 percent of your household income for individual coverage to qualify for the tax credits.
If you lose coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you may be able to sign up for a Pennie plan during a 60-day special enrollment window. Try to apply and select your plan before your COBRA coverage ends to make sure there's no gap in coverage. If you’re not sure about whether making this switch makes sense for you, you can ask for free advice from a certified insurance broker or assister.
That depends. Major insurance providers, including Capital Blue Cross, Highmark and UPMC, offer Pennie plans, but not all doctors accept them. You can talk to your primary care physician to see whether he or she accepts a particular marketplace plan.
It depends. You can enroll as a family. But in some cases, some family members may also be eligible for subsidies or other programs such as Medicare, Medicaid or the state’s Children’s Health Insurance Program, depending on age, income and disability or caregiver status. Such families may choose to enroll separately. They may still be able to see the same doctor or go to the same medical practice, depending on the types of insurance plans accepted.
This guide was updated on Nov. 3, 2022, with updated information about open enrollment.
This story is provided by AARP Pennsylvania. Visit the AARP Pennsylvania page for more news, events, and programs affecting retirement, health care, and more.
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