Health insurance in pennsylvania
Are you looking to enroll in a new health insurance plan or for more information on health insurance in Pennsylvania?
If so, you’ve come to the right place! On this page you can shop and compare ACA plans, get a free quote, and start the enrollment process. Plus, we go over enrollment dates and deadlines, which health insurance carriers are available in PA, how much you can expect to pay for health insurance, and more.
To compare the most affordable plan options in Pennsylvania, click the button below.
Pennsylvania enrollment dates and deadlines
There is an annual Open Enrollment Period (OEP) when Pennsylvania residents can buy or renew health insurance under the Affordable Care Act. The dates for Open Enrollment change each year but have always started on November 1st.
Enrollment periods for 2021 coverage
Open Enrollment Period: November 1, 2020 – January 15, 2021
Special Enrollment Period: January 16, 2021 – October 31, 2021
If you missed Open Enrollment, you will have to wait until the following year unless you experience a Qualifying Life Event (QLE). Get our free guide to qualifying events here. If you’re wondering what’s considered a QLE, let’s look at a few examples:
- Getting married, having a baby, or adopting a child.
- Losing your health insurance through your employer, a divorce, or legal separation.
- Losing your coverage when moving to a new county or ZIP code.
- Plus more! See the entire list of events
If you experience a Qualifying Life Event, you’ll be able to enroll during a Special Enrollment Period.
Make sure you don’t miss the next Open Enrollment!
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Health insurance carriers in Pennsylvania (2021)
If you’re trying to find a list of health insurance carriers in Pennsylvania or looking for a specific one, we’ve got you covered! Here’s a quick overview of each carrier offering plans throughout 2021.
It’s also important to know each of these carriers meet the state and federal requirements put in place by the Affordable Care Act. That means every plan offered is guaranteed to include “essential health benefits” (emergency services, prescription drug coverage, hospitalization, pregnancy, maternity, and newborn care, mental health services, plus more).
Insurance costs terminology
When looking at how much a plan will cost you, there are a handful of terms you’ll want to know:
- PremiumThis is the amount you’ll pay each month for health insurance.
- CopaymentThe fixed amount for a specific health care service. Example: $15 to refill a prescription.
- DeductibleThis is the amount you’re required to pay before your insurance kicks in. Example: $3,000.
- CoinsuranceThe percentage you’re responsible for paying after you hit your deductible and before you reach your out-of-pocket max. Example: 20%.
- Out-of-pocket maxThe most you will pay during your coverage period, which typically lasts 12 months. Example: $6,000.
Pennsylvania and the Affordable Care Act (ACA)
The Affordable Care Act, also known as Obamacare, is a law that transformed the health insurance industry in Pennsylvania and across the United States. Let’s take a look at how things have changed since the ACA went into effect:
1. Easier access to healthcare
In 2009, over 50 million Americans did not have health insurance. This population typically received only half as much healthcare as someone with insurance. On average, these people were much more likely to end up in an emergency room. They were less likely to receive preventive care for major health conditions and chronic diseases. The ACA changed this by providing health insurance to millions who didn’t have access before.
2. Reduced healthcare costs
The government also understood that healthcare overall was too expensive. The ACA reduced these costs by offering subsidies, i.e. “cost-sharing reductions” and “advance premium tax credits.” A cost-sharing reduction is a discount that lowers the amount you have to pay in deductibles, copayments, and coinsurance. An advance premium tax credit is a credit that lowers your monthly premium. You can enter your zip code on the top of this page to find out if you qualify for one or both of these.
3. Additional rights & protections
Before the ACA was signed into law, health insurance companies were allowed to refuse coverage when someone had a pre-existing condition and cancel coverage when someone got sick or needed a lot of medical care. The Affordable Care Act ended those practices. The ACA also provides more coverage options for young adults, holds insurance companies accountable when rates increase, and includes free preventive care.
When did the ACA become a law?
The Affordable Care Act was signed into law by President Obama on March 23, 2010. Title 1 of the law, “Quality, affordable care for all Americans,” went into effect immediately but most of the ACA’s major provisions rolled out in 2014.
What is the Marketplace?
Once you’re ready to shop for health insurance, or renew your coverage, it’s important to understand the Health Insurance Marketplace. Essentially, this is where you go to compare your options, grab a quote, and enroll in a new plan. Or renew your existing plan.
It’s also important to know the Health Insurance Marketplace is completely based online. Depending on where you live, your state may use the federal site, HealthCare.gov, or run it’s own state-based Marketplace.
There are also privately-run Marketplace options such as HealthSherpa. As a partner of HealthCare.gov, HealthSherpa offers all the same plans, prices, and subsidies. You will also have access to a Consumer Advocate team who can help you enroll and manage your plan.