Find Affordable Health Insurance In Pennsylvania

How To Get Health Care Insurance When You Are Not On An Employer’s Group Health Plan

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State of Pennsylvania Major Medical Plans

The Affordable Care Act (ACA) health insurance popularly known as Obamacare, offers medical coverage beyond doctor visits and surgical procedures. The majority of plans cover all or part of the cost of your prescribed drugs as well as other healthcare-related services including rehab, physical therapy, mental health care, and nursing home care.

What It Is: Traditional health care coverage like you would have through an employer. Provides coverage for pre-existing conditions.

Cost: $400 – 700/month, per person. The national average is $438.

Source: https://www.healthmarkets.com/content/health-insurance-cost-per-month

When Is Federal Open Enrollment?

During the Federal Open Enrollment period, you are eligible to enroll in an ACA health plan. This typically takes place every year from November 1 till January 15.

When Is Pennsylvania’s Annual Open Enrollment Period?

Pennsylvania follows the yearly federal open enrollment period which runs from November 1 through January 15.

Special Enrollment Periods

Outside of the federal Open Enrollment period, you can register for an ACA health plan within 60 days after a qualifying life event.

Types Of Qualifying Life Events:

  • Loss of health coverage. Losing existing health coverage, including job-based, individual, and student plans.
  • Changes in marital status (getting married/divorced)
  • Having a baby or adopting
  • Changes in residence. Moving to a different ZIP code or county

Temporary Medical Insurance In Pennsylvania

During a gap in insurance coverage, a short-term health insurance plan can provide you with basic medical coverage. 

What It Is: These types of plans are for people in good health that do not need to treat pre-existing conditions.

Cost: Dependent on your age and state availability. Compared to ACA, these plans are very affordable.

Who Needs Temporary Health Insurance?

  • Individuals who missed the deadlines for the ACA exchanges and need to wait until the next enrollment period
  • Individuals who have a waiting period before enrollment in an employer’s health insurance or another program
  • People who are temporarily in between jobs or have been laid off
  • Self-employed individuals
  • People looking for a plan less expensive COBRA health insurance
  • Those needing temporary coverage:
    • College students or recent graduates
    • Young adults coming off their parent’s health benefit plan
    • Retirees waiting for Medicare eligibility
    • Coverage for dependents not covered under an employer plan

What Is COBRA Insurance?

The Federal COBRA Act provides workers and their eligible dependents with the opportunity to extend the coverage of their workplace health insurance if that policy would otherwise stop due to a qualifying event.

COBRA is provided for up to 18 months for employees and 36 months for families.

To start a COBRA plan, the employer who offered the work health insurance will provide enrollment information within 45 days of losing those benefits.

What It Is: A continuation of your most recent employer group health plan.

Cost: $400 – 700/month, per person. National average is $438.

COBRA coverage is offered for up to 18 months for employees and 36 months for families.

Within 45 days of losing the coverage, the employer who provides the work health insurance shall provide enrollment details for a COBRA plan.

Low-Income Health Insurance In The State Of Pennsylvania

The Medicaid program in Pennsylvania commonly referred to as “Medical Assistance,” gives low-income people and vulnerable people complete access to health care. Medicaid used to be limited to specific audiences like low-income children and disabled people.  Visit compass.state.pa.us to create an account.

Reporting Health Insurance Fraud In Pennsylvania

Unfortunately, a tiny percentage of clinicians and patients who receive Medical Assistance engage in fraudulent or unethical behavior. Managed care organizations, insurance providers, healthcare professionals, and even concerned people can send cases of fraud or negligence to the Medicaid Fraud Control Section, which uses this information to further its investigations. To report Medicaid fraud visit dhs.pa.gov.

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