How to Sign Up for ACA Health Insurance in Pennsylvania

Posted on 11/08/23 by Andrew Soergel, Elissa Chudwin

En español |

What’s New for 2024 Open Enrollment

  • Key dates: Open enrollment runs from Nov. 1, 2023, through Jan. 19, 2024.
  • Where to apply: Pennie, the state’s Affordable Care Act (ACA) marketplace
  • What’s changed: In 2024, two new medical plans and one new dental plan will be offered to those in southeast Pennsylvania. 
UPMC Braddock
All Pennie health insurance plans cover 10 essential benefits, including
maternity and newborn care and emergency services at hospitals and
medical centers throughout the state.
Keith Srakocic/ASSOCIATED PRESS

Am I eligible?

When is open enrollment?

  • You can enroll at any time of the year if you qualify for Medical Assistance, if your children qualify for CHIP or if you’re a member of a recognized American Indian tribe.
  • If your household income is at or below 150 percent of the federal poverty level, you automatically qualify for a special enrollment period and can enroll or update your plan at any time. For example, a two-person household earning no more than $29,580 annually would qualify.
  • If you have lost or will lose Medical Assistance because of the federal government’s ending of pandemic-era Medicaid rules, you can enroll through Pennie within 120 days of the date you lost coverage, although it’s recommended to enroll within 60 days so you don’t risk a gap in coverage. If you miss that 120-day special enrollment period, you still can sign up during open enrollment. More information is available at Pennie’s website.

What if I miss open enrollment?

If you don’t qualify for year-round enrollment and missed the open enrollment deadline (Jan. 19, 2024), you can buy health insurance if you experience a life event that qualifies for a special enrollment period. Qualifying events include certain moves, births and adoptions, loss of Medical Assistance or employer-provided coverage, marriage, divorce and other special circumstances. You typically have 60 days from that event to enroll. For more information, visit Pennie’s website or call 1-844-844-8040.

Pennsylvania residents who are turning 26 can stay on their parents’ plan through the end of the calendar year before needing to enroll for insurance.

What's changing in 2024?

Two new medical plans and one new dental plan will be offered to those in southeast Pennsylvania.

How do I sign up?

First, use the Pennie Plan Comparison Tool to estimate costs and sort through various plans. Or you can contact a certified enrollment assister or broker. 

Once you’re ready to sign up, you can apply online, by phone, through an assister or insurance broker, by video call or in person. 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:

  • Online: Go to Pennie’s website and click “Get Covered.” You’ll need to create an account and, if you have it, provide your Social Security number and proof of household income, such as recent pay stubs or federal or state tax returns.
  • By phone: You can enroll over the phone by calling Pennie’s service center at 1-844-844-8040.
  • Through an assister or broker: Both can offer free assistance, but only brokers can recommend specific plans based on your needs. Pennie’s  website lets you search for assisters and brokers by zip code. You may be able to meet with an expert in person or virtually.

You can also call Pennie’s customer service center (1-844-844-8040) to ask questions and to help determine if you qualify for financial assistance.

What is covered, and how much will it cost?

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.

You will be able to get free or low-cost coverage if you qualify for CHIP or Medical Assistance, the state’s Medicaid plan. If you begin applying for Pennie and are eligible, your application will be sent to Medical Assistance to process.

All Pennie plans cover 10 “essential” benefits, including:

  • Emergency services and hospitalization 
  • Pregnancy, maternity and newborn care 
  • Mental health services (including counseling) 
  • Chronic disease management and preventive care
  • Prescription drugs 

Insurance companies cannot deny coverage because of preexisting 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.

What plans are available?

Pennie’s plans are organized into three categories:

  • Bronze plans have the lowest monthly premiums and the highest deductibles and copays. They cover roughly 60 percent of care costs. They’re designed to help you in case of serious illness or injury. 
  • Silver plans have moderate monthly premiums, deductibles and copays. They cover roughly 70 percent of costs. They’re the only plans eligible for cost-sharing subsidies. 

  • Gold plans have higher monthly premiums and lower deductibles and copays, and they cover roughly 80 percent of care costs.

Who is eligible for financial assistance for premiums?

The federal government increased tax credits for insurance premiums in 2021 and expanded the number of households that qualify for them. As a result, most people enrolled in ACA marketplace plans have seen their premiums go down. This expanded financial assistance is available through 2025.

  • If your annual income is below 150 percent of the federal poverty limit ($21,870 in 2024 for an individual and $45,000 for a family of four), you may be eligible for zero-premium coverage, depending on the plan you choose.
  • If your income is between 150 percent and 400 percent of the federal poverty level (up to $58,320 for an individual and $78,880 for a couple), you are eligible for a premium subsidy. The amount depends on your income and your plan.
  • If your income exceeds the above limits, you can still get a premium subsidy if your monthly charge for the most popular silver-level plan would be more than 8.5 percent of your income. 

If you’re eligible, Pennie will automatically apply the credits when you enroll.

Is there any other financial assistance available?

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.

Use Pennie’s Savings Calculator to see if you qualify for savings.

What if I already have health insurance?

If you already have affordable coverage — through your employer, for example — you most likely will not qualify for financial help offered through the marketplace plans.

If you’re independently enrolled in a private health insurance plan, not through an employer, you may qualify for significant savings if you switch to Pennie. But you may need to wait until open enrollment begins.

If you were receiving temporary continuation of your health care coverage under COBRA, and that coverage has ended, you may be able to sign up for Pennie 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 already have a marketplace plan and want to adjust your coverage, you'll need to do so during open enrollment, unless you experience a qualifying life event or qualify for year-round enrollment.

Will I need to get a new doctor?

That depends. Major insurance providers, including Capital Blue Cross, Highmark and UPMC, offer plans through Pennie, but not all doctors accept them. Talk to your primary care physician to see whether he or she accepts a particular marketplace plan.

Will my family members qualify for the same health plan that I do?

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, Medical Assistance or CHIP, 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. 8, 2023, with new information about open enrollment.

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    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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