Health insurance in Pennsylvania
Pennsylvania is switching to its own exchange (Pennie) in the fall of 2020.
Pennsylvania will also have a reinsurance program as of 2021, using federal pass-through funding and the savings generated by switching to a state-run exchange.
Open enrollment for 2021 health plans is November 1, 2020 to January 15, 2021 (a one-month extension, enabled by the state’s transition to a state-run exchange).
Short-term health plans are available in Pennsylvania with initial plan terms up to 364 days.
About 332,000 Pennsylvanians enrolled in 2020 coverage through the state marketplace.
In 2015, ACA’s Medicaid expansion took effect in Pennsylvania; more than 826,000 people are covered as a result.
Nearly 2.75 million Pennsylvania residents are enrolled in Medicare.
This page is dedicated to helping consumers quickly find health insurance resources in the state of Pennsylvania. Here, you’ll find information about the many types of health insurance coverage available. You can find the basics of the Pennsylvania health insurance marketplace and upcoming open enrollment period; a brief overview of Medicaid expansion in Pennsylvania; a quick look at short-term health insurance availability in the state; statistics about state-specific Medicare rules; as well as a collection of health insurance resources for Pennsylvania residents.
Pennsylvania initially opted not to establish its own health insurance marketplace, so the state has used the federally run exchange at HealthCare.gov. But that’s changing in the fall of 2020, with the debut of Pennsylvania’s new state-run exchange, called Pennie.
The state enacted legislation in 2019 to authorize the transition away from HealthCare.gov. By switching to its own exchange, Pennsylvania expects to save up to $50 million per year, which will be used to cover the state’s portion of the cost of a reinsurance program. The state will also gain numerous other benefits in terms of flexibility and control over the marketplace, described here by Jessica Altman, Pennsylvania’s Insurance Commissioner. Among the most significant from consumers’ perspective is the flexibility to extend open enrollment — which Pennsylvania is doing: Open enrollment for 2021 coverage will last an additional month, compared with what it would have been if the state had continued to use HealthCare.gov.
The marketplace (Pennie) is used by people who purchase their own health insurance. This includes people who are self-employed, people who are employed by a small business that doesn’t provide health insurance benefits, and early retirees who aren’t yet eligible for Medicare. The marketplace is also the only place where people can receive financial assistance (premium subsidies and cost-sharing reductions) that make health insurance premiums and out-of-pocket medical expenses less costly.
Pennsylvania’s reinsurance proposal was approved by the federal government in July 2020. The federal government will provide pass-through funding that will cover the majority of the cost of the reinsurance program (because reinsurance will result in lower premiums, premium subsidies will also decline, resulting in savings for the federal government; pass-through funding refers to the process of using a 1332 waiver to allow the state to use the savings).
Pennsylvania estimated that the transition to a state-based exchange and the implementation of a reinsurance program will result in individual market premiums about 5 to 10 percent lower in 2021 than they would otherwise have been. Insurers that offer health plan options in Pennsylvania’s marketplace have proposed an overall average rate decrease of more than 2 percent for 2021 (versus a rate increase that would have been necessary without the reinsurance program).
Pennsylvania open enrollment period and dates
Open enrollment for 2021 health plans has been extended in Pennsylvania. It will run from November 1, 2020 through January 15, 2021. This gives residents in Pennsylvania a full additional month to sign up for 2021 coverage, versus what they would have had if the state had continued to use HealthCare.gov (enrollment ends December 15 in states that use HealthCare.gov).
The open enrollment period is an opportunity for people to newly enroll in individual market coverage, and for current enrollees to renew or change their coverage for the coming year. It’s also an opportunity to update the income and household information that’s on file with the exchange, to ensure that premium subsidies for the coming year are accurate.
Outside of the open enrollment period, a qualifying event is necessary in order to enroll in a health plan or make a change to current coverage. This is true both in the exchange and outside the exchange (directly through a health insurer; the insurer will require proof of the qualifying event if the application is submitted outside of the open enrollment period).
Enrollment in the Pennsylvania health insurance marketplace grew from 2014 through 2016, but it has decreased each year since then, mirroring a national trend towards lower enrollment under the Trump administration in states that use HealthCare.gov. The enrollment decline continued for 2020, when 331,825 people enrolled in plans during open enrollment.
Read our full overview of the Pennsylvania health insurance marketplace.
Medicaid expansion in Pennsylvania
Although Pennsylvania was a year behind many other states, the state accepted ACA’s Medicaid expansion and it took effect on January 1, 2015. As of late August 2020, enrollment under Pennsylvania’s Medicaid expansion stood at 826,442 people. This was a dramatic increase from early 2020, due in large part to the widespread job and income losses caused by the coronavirus pandemic.
Read more about Medicaid expansion in Pennsylvania.
Short-term health insurance in Pennsylvania
Pennsylvania does not have state regulations pertaining to the duration of short-term health insurance plans, so the state defaults to the federal regulations.
That means insurers in Pennsylvania short-term health insurance plans can have initial terms up to 364 days and the option to renew for a total duration of up to 36 months.
Read more about short-term health insurance in Pennsylvania.
Find a short-term health plan in Pennsylvania.
How did Obamacare help Pennsylvania residents?
In 2013, before the bulk of the ACA’s regulations were implemented, the uninsured rate in Pennsylvania was 9.6 percent — well below the 14.5 percent national average uninsured rate at that point.
Initially, the state did not expand Medicaid, which resulted in a small decline in its uninsured rate during 2014, the year the ACA took effect. About 360,000 people obtained coverage, including Medicaid/CHIP and private plans, through the Pennsylvania exchange during the first open enrollment.
Pennsylvania expanded Medicaid in 2015 (initially with a waiver, but then as straight expansion once Gov Wolf took office), and saw even more residents gain coverage. By 2017, Pennsylvania’s uninsured rate dropped to 5.5 percent, and it remained at that level in 2018. Nationwide, 8.9 percent of individuals were uninsured as of 2018.
As of 2020, there are more than 307,000 people enrolled in health plans through the Pennsylvania exchange. All of them have coverage for the ACA’s essential health benefits, and 87 percent of them are receiving premium subsidies that make their monthly premium costs much more affordable than they would otherwise be.
There are no longer small business health plans available through the exchange in Pennsylvania, but all new small group health plans (up to 50 employees) are fully compliant with the ACA, which means that small businesses that have purchased health coverage since 2014 have coverage for the essential health benefits as well, without any lifetime or annual limits on the benefits.
Pennsylvania and the Affordable Care Act
In 2010, both of Pennsylvania’s U.S. Senators, Democrats Robert Casey and Arlen Specter, voted in favor of the ACA. In the U.S. House, eleven Democrat representatives voted yes, while seven Republicans voted no.
Specter has since been replaced in the Senate by Republican Pat Toomey, and the U.S. House delegation from Pennsylvania is evenly split, with nine Democrats and nine Republicans
At the state level, the overall population in Pennsylvania has a Democratic majority, but the Republicans hold a majority in the state’s House and Senate. Former Gov. Tom Corbett was also a Republican and not an ACA supporter. As such, the state defaulted to a federally-facilitated health insurance exchange, although it’s transitioning to a state-run exchange under the Wolf administration.
But unlike many Republican governors, Corbett pursued the possibility of Medicaid expansion under the ACA. Corbett submitted his proposal for a modified version of Medicaid expansion – dubbed Healthy Pennsylvania – to HHS in February 2014. It took half a year of negotiations, but on August 28, 2014, Corbett and HHS reached an agreement, and Pennsylvania became the 28th state, including DC, to accept federal funding to expand Medicaid and thereby cover residents with incomes up to 138 percent of poverty.
Corbett lost the 2014 gubernatorial election to Tom Wolf, a Democrat. Gov. Wolf was sworn into office on January 20, 2015. Shortly after he assumed office, Wolf began to do away with Healthy PA in favor of traditional Medicaid expansion, which had been a campaign promise. Pennsylvania has had Medicaid expansion as called for in the ACA ever since, as opposed to the modified version of expansion that Corbett had overseen.
And under Wolf’s administration, the state is pursuing a transition to a fully state-run exchange and a reinsurance program, which are expected to work in tandem to reduce individual market health insurance premiums in the state.
Medicare coverage and enrollment in Pennsylvania
As of August 2020, there were more than 2.77 million Pennsylvania residents enrolled in Medicare. Most are eligible due to their age, but 15 percent of the people covered by Medicare in Pennsylvania are under the age of 65 and eligible for Medicare due to a disability.
You can read more about Medicare in Pennsylvania, including residents’ choice of Original Medicare or Medicare Advantage, as well as the state’s requirements for Medigap plans.
Pennsylvania health insurance resources
Pennie — The marketplace in Pennsylvania (residents use Pennie instead of HealthCare.gov to enroll in plans for 2021). Offers private plans and Medicaid enrollment for individuals and families in Pennsylvania.
Pennsylvania Insurance Department — Oversees, licenses, and regulates the health insurance companies that offer plans in the state, and the brokers and agents that sell the plans.
Pennsylvania Department of Aging — Can provide a variety of helpful assistance for people with Medicare and their caregivers.
Medicare Rights Center — A nationwide service (a website and call center) that can provide Medicare-related assistance and information.
Pennsylvania health care reform legislation
Scroll to the bottom of this page to see a summary of recent health care reform legislation in Pennsylvania.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.