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.
Two new medical plans and one new dental plan will be offered to those in southeast Pennsylvania.
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:
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.
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:
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.
Pennie’s plans are organized into three categories:
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 you’re eligible, Pennie will automatically apply the credits when you enroll.
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.
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.
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.
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.
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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