Individual and family Pennsylvania health insurance plans will be issued through the PHIEA (Pennsylvania Health Insurance Exchange Authority) beginning in 2021. PA HB3 was the passed legislation that established the Exchange Fund. A state-based Exchange (SBE) often saves consumers money by reducing plan premiums, and increases access by making it easier for Keystone State residents to apply for coverage.
The Open Enrollment period is also extended by 45 days, beginning November 1 and ending January 15th. The Federal Marketplace OE period is from November 1 to December 15. More than 400,000 persons are expected to apply for coverage. The average savings should be approximately 5%-10% per consumer. The General Fund is not required to contribute any funds. An SEP (Special Enrollment Period) is granted throughout the year for a qualified life event.
The added flexibility of Pa’s SBE will provide increased coordination with state agencies and programs, outreach to enrollees and persons applying for coverage, better methods to handle consumer concerns and complaints, enhancing and improving the shopper’s experience, and making it easier to analyze application and enrollment data. It’s estimated that by operating the Exchange, the state will be able to lower premiums by approximately 5%-10%.
The new website Pennie will be utilized for 2021 enrollments instead of Healthcare.gov. The comparison and application process should be quicker, easier, and more efficient. And we will continue to help consumers with that process and offer our free expert and unbiased service that continues for the 39th year. With the savings of utilizing a state-based Exchange, a reinsurance program will be created to reduce the cost of coverage for applicants that don’t qualify for a federal subsidy. Heading the Pa Exchange is the past-director of the Rhode Island Exchange, Zachary Sherman.
The reinsurance program saves insurers by providing reimbursement of 60% of the cost of claims between $60,000 and $100,000. By paying the medical expenses for many high-risk members, more affordable plans can be provided. It’s also possible that carriers will expand into additional counties in 2023 and beyond.
GetInsured created the Exchange platform and will be operating the call center. The Mountainview (California)-based company assisted more than one million consumers obtain medical benefits last year. They also created and operate other State-based Marketplaces including Nevada Silver State Health Insurance Exchange (SSHIX), Washington Health Benefit Exchange, Consumer Shopping Experience And Consumer Decision Tool (CDST), MNsure Individual State-Based Marketplace, Your Health Idaho Individual State-Based Marketplace, and Covered California Individual Shopping And Enrollment.
Rate Filings For Pennsylvania Individual Health Plans
Carrier, Exchange-status, and requested increase (or decrease) are shown below:
Capital Advantage Assurance Company (On and off Exchange) – 14.3% decrease
Capital Advantage Insurance Company (Off Exchange) – 15.5% decrease
Keystone Health Plan Central (Off Exchange) – 1.7% decrease
First Priority Health HMO (Off Exchange) – 19.2% increase
Highmark (On and off Exchange) – 0.7% decrease
Highmark Benefits Group (On and off Exchange) – 3.96% decrease
Highmark Coverage Advantage (On and off Exchange) – 3.1% increase
Highmark Health Insurance Company (Off Exchange) – 15.6% decrease
Geisinger Health Plan (On and off Exchange) – 11.28% decrease
Geisinger Quality Options (On and off Exchange) – 13.57% decrease
Keystone Health Plan East (On and off Exchange) – 2.1% decrease
QCC Insurance Company (On and off Exchange) – 2.0% decrease
UPMC Health Options (On and off Exchange) – 1.3% increase
Pa Health And Wellness (On and off Exchange) – 6.6% increase
Oscar Health Plan Of Pa (On and off Exchange) – 6.86% increase
Plan Counts By County – Largest Number Of Policies Offered
Bronze Tier
17 – Centre
15 – Perry, Dauphin, Cumberland, York, Lancaster, York, and Adams.
14 – Columbia, Lehigh, Lebanon, Northampton, Northumberland, Schuylkill, Snyder, and Burks.
13 – Union
Silver Tier
68 – Cumberland and Dauphin
62 – Lehigh and Northampton
61 – Centre
60 – Perry and Schuylkill
59 – Columbia, Northumberland, Snyder, Adams, Lancaster, and York
55 – Clinton and Lycoming
Gold Tier
104 – Centre
98 – Dauphin and Cumberland
95 – Lehigh and Northampton
93 – Schuylkill
91 – Columbia, Northumberland, and Snyder
90 – Perry
Platinum Tier
25 – Carbon, Lackawanna, Luzerne, Monroe, and Wayne
23 – Clinton, Lycoming, Susquehanna, Wyoming, and Centre
22 – Columbia, Lehigh, Mifflin, Montour, Northampton, Northumberland, Schuylkill, Snyder, and Union
21 – Bradford, Pike, Sullivan, and Tioga
20 – Cumberland, Dauphin, and Juniata
Company Counts By County – Largest Number Of Carriers Offering Coverage
8 – Centre, Columbia, Lehigh, and Northampton
7 – Northumberland, Schuylkill, Snyder, Union, Berks, Adams, Lancaster, York, Cumberland, Dauphin, Lebanon, and Perry
6 – Cameron, Luzerne, Mifflin, Montour, Fulton, and Juniata
5 – Elk, Potter, Bradford, Lackawanna, Monroe, Sullivan, Wyoming, Blair, Cambria, Clearfield, Huntingdon, Jefferson, and Somerset
