Health insurance in Pennsylvania

Are you wondering what health insurance in Pennsylvania is like? You’re not alone in this thought.

Choosing health insurance is one of the most critical decisions you’ll ever have to make for the purpose of providing a safety net for you and your loved ones.

No humans plan to get sick or fall into any unforeseen circumstances that’ll warrant access to health insurance, but these incidents are an inevitable part of humans.

So preparing beforehand for these undesirable instances through health insurance is one of the best things you can do for your family and yourself.

There are a ton of health insurance schemes in Pennsylvania you can access, but before we discuss that, let’s quickly look at key information about Pennsylvania’s health insurance.

Background Information about Pennsylvania’s Health Insurance

For the second time, Pennsylvania used a state-based exchange on the federal platform, and more than 337,000 residents enrolled in health insurance for the year 2021 open enrollment. Before this time, Pennsylvania used to operate a federally-facilitated marketplace for the residents.

This year, the state is going to be adopting Pennie for the open enrollment period. Signing up began late last year and ends early this year.

The average amount a full state-based exchange will cost $25 million a year, which means the figure is quite low compared to the $95 million Pennsylvania paid to use the Federal Exchange in 2018.

The idea of the cost savings is to fund a new reinsurance program designed to make state health insurance more affordable and accessible by many residents. This reinsurance program referred to as Act 42 was signed into law by Governor Tom Wolf in 2019.

Now let’s talk about the available health insurance schemes you can key into in Pennsylvania to get yourself and your family covered in times of need.

However, it’s important to state here that this will depend on the types of health insurance you want and the different markets available.

 Available Health Insurance in Pennsylvania

Below are some of the available health insurance options available in Pennsylvania: 

Pennie provides an individual or families with the ability to access high-quality care coverage, coupled with ease of applying for financial assistance.

If you’re a PA resident and are a citizen, U.S. national or you’re qualified for immigration status, you can apply for Pennsylvania’s insurance coverage via Pennie. Enrollment for this coverage opens within November 1 to January 15.

There are also special enrollment periods, which give the opportunity to anyone who’s experienced a recent circumstance in his life and would like to sign up during this Special Enrollment Period to access health insurance coverage.

Some of the changes include losing health care insurance through an employer, moving to a new area, and a change in marital status.


Medicare is a federal health insurance scheme for people aged 65 and above. This type of insurance is administered by the Federal Department of Health and Human Services with the mandate of providing coverage either directly or via private health insurance companies via four distinct levels namely:

  • The Medicare Part A, which is hospital coverage
  • The Medicare Part B, which rotates around the medical coverage
  • The Medicare Part C, which is the Medicare Advantages Part A and B together
  • Medicare Part C, which covers the prescription of drugs

If you’ve decided to key into Medicare, it’s then important that you know the right time to enroll. Also, you should consider enrolling immediately you become eligible for this coverage because enrolling at a later stage may cost a higher amount.

You can start the enrollment process for Medicare when you’re three months away from 65 and ends three months after clocking this age.

You’re still allowed to sign up even if you miss the initial enrollment period and this can be done from January 1 to March 31 each year, but some penalties might apply.

You may still be given an opportunity to make some changes to your plan as part of a Special Enrollment Period. This can be done around October 15 to December 7 annually.

Medical Assistance/CHIP

Based on your income status, you can qualify for free or low-cost health insurance through the Children’s Health Insurance Program or Medicaid.

You can actually enroll for this type of coverage year-round, which means there are no deadlines for applying for this healthcare coverage.

COBRA/Mini-COBRA Continuation Coverage

COBRA gives you the privilege of maintaining the coverage you had while working with your former employer.

It’s not uncommon that when people are laid off, the company’s insurance coverage goes out of the window, which is what the COBRA is trying to bridge the gap here.

As time passes, if you’ll be continuing the COBRA coverage, you should be ready to pay for the portion of the premium your previous employer paid on your behalf for the coverage. You also must note that you can elect COBRA COVERAGE but you don’t necessarily have to do it.

Final thoughts

You don’t have to go through any hassles if you’re looking for health insurance coverage as a Pennsylvanian.

Do the research as there are many insurance coverages you can key into in the state, but this is also dependent on the type of plan you want and how much you’re budgeting for the coverage.

As a couple, the rate of health insurance coverage may be low, as the insurance rate will be based on the youngest partner’s age. So the best bet is to apply for the same plan rather than doing it individually as this may cost you an extra few bucks.

Frequently Asked Questions on Health Insurance in Pennsylvania

Here are some of the frequently asked questions on health insurance coverage in Pennsylvania:

Is it a law to have health insurance coverage as a Pennsylvanian? 

If you’re a resident of PA, you’re supposed to have health insurance coverage in compliance with the Affordable Care Act.

Don’t forget the state is using the federal exchange set up designed by the ACA, which also referred to as Obamacare.

What happens if you don’t have health insurance and you visit a hospital?  

You’ll be billed for every fees of the services you’re seeking for at the hospital if you don’t have an insurer to take this fees off your neck.

You’ll have to pay for doctor fees, hospital and medical costs, coupled with specialists’ payments.

This means you’re liable to pay some high bucks if you don’t own health insurance when you visit a healthcare facility. And sadly, the fees can get so high!

Is short-term health insurance available for purchase in Pennsylvania?

PA uses federal regulations regarding their health insurance coverage. This means the state has no regulation pertaining to the duration of short-term health insurance plans.

When you opt for short-term health insurance coverage in this state, you can have up to 364 days and the option of renewing for a total duration of up to 36 months.

Who is eligible for Medicaid program? 

To be qualified for Medicaid program, you need to be a resident of the state of Pennsylvania, an American, citizen, permanent resident or legal alien in the country and your financial situation must be characterized as low income.

You also should be a pregnant woman or someone that’s responsible for a child 17 years of age or younger to be considered for Medicaid program.

Similarly, you should be a person with disability or a family member within your household with a disability to be eligible for this coverage.


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