Obamacare, officially known as the Affordable Care Act (ACA), was signed into effect nationwide in 2010 and enforcement began in 2014. The intent of Obamacare was to increase access to healthcare through expanding Medicaid programs, protecting consumers from being discriminated against due to pre-existing health conditions, opening a regulated Marketplace to shop for cost-efficient health insurance options, and requiring all U.S. citizens to have minimum health insurance coverage.
Obamacare’s Effect on Pennsylvania Health Insurance
Pennsylvania struggled in the beginning to see a significant reduction in their uninsured population, but this seems to be in relation to the lack of initial Medicaid expansion as requested in the Affordable Care Act. Before Obamacare, Pennsylvania already touted a low uninsured rate. But with the subsidies from the federal exchange with the eventual Medicaid expansion, the state experienced a drop to 7.4%. (The national average is at 11.7%).
What Pennsylvania Residents Should Know About Obamacare in Pennsylvania
The Pros and Cons of Pennsylvania Obamacare
Pennsylvania Obamacare has made health insurance coverage available to thousands that could not previously afford care through subsidies obtained through the federal exchange or Medicaid expansion. They have also been successful in attracting multiple carriers to their market. For 2017, there will be 13 carriers available as options. Finally, Obamacare in Pennsylvania has successfully eliminated denial of care based on pre-existing conditions and has disabled Pennsylvania companies from charging a higher premium based on race or gender.
There are criticisms of Obamacare in Pennsylvania that while access to health insurance coverage has increased, the Pennsylvania middle class has actually suffered significantly due to the increase in high deductible plans. For 2017, most health insurance plans have requested a double-digit increase in rates. This puts a significant financial burden on those that do not qualify for subsidies. In addition, there has been a notable struggle in getting re-enrollments, especially for the healthy young adult population who would rather pay the fine for not having coverage than be responsible for monthly health insurance premiums they cannot afford.
Obamacare Health Plan Categories and How Much You Will Pay
When shopping in the Pennsylvania Obamacare Marketplace, there are four primary health plan categories you can choose from: bronze, silver, gold, and platinum. The categories determine the percentage of healthcare costs that the plan will pay for over a course of a year. The remaining percentage is what you will be expected to pay.
These percentage differences greatly impact how much you may expect to pay for care. For example, if the bronze plan pays for 60% of a benefit, then as the patient, you can expect to pay for the remaining 40%. While this plan will cost you less monthly, it leaves you financially responsible for a larger dollar amount than a platinum plan, which pays for 90% of a benefit.
Here are the different kinds of Obamacare plans as well as the average amount of healthcare services each plan pays for:
- Bronze plan - 60%
- Silver plan - 70%
- Gold plan - 80%
- Platinum plan - 90%
How do I sign up for Obamacare in Pennsylvania?
The Pennsylvania Obamacare Marketplace and exchange can be accessed through the federal government website or by calling (800) 318-2596.
What are the Obamacare Marketplace and exchange?
The Marketplace is a central location to shopping for insurance options and enroll for selected coverage. In the case of Obamacare, Pennsylvania utilizes a Federally-Facilitated Marketplace (FFM), which means that the U.S. Department of Health and Human Services operates and manages the Marketplace where public health insurance plans are offered.
Do I need to use an exchange?
To access public health insurance, you will need to go through the government exchange. The only exception to personally using the exchange to sign up for Obamacare in Pennsylvania is if you are able to seek help from a Pennsylvania certified counselor or a private insurance agent who can discuss your options and select a plan, on your behalf, through the exchange.
How do I use an exchange?
You can use the exchange one of four ways:
- Visit healthcare.gov
- Use the telephone support assistance available by calling (800) 318-2596
- Find a local certified counselor
- Seek help from a private insurance agent
What does it mean to be on-exchange or off-exchange?
On-exchange generally refers to purchasing health insurance coverage from the Obamacare Pennsylvania Marketplace while off-exchange normally refers to purchasing private health insurance coverage from a private company.
When is the Obamacare enrollment deadline and what do I do if I missed it?
The Obamacare open enrollment period for 2017 in Pennsylvania is from November 1, 2016 until January 31, 2017. If you miss enrollment, you would need to qualify for a special enrollment period due to a qualifying life event or purchase short-term individual private insurance to avoid a penalty.
What is the Obamacare penalty if I don’t buy health insurance?
If you do not buy Obamacare or other qualifying health coverage (also referred to as “minimum essential coverage”) you will be subject to a tax penalty for each month you go without coverage. This fee should be paid when you file your federal tax return. In some special cases, there are exemptions to this penalty.
The Obamacare penalty for 2016 is either 1) 2.5% of your household income, with a maximum of the price of a Bronze plan sold through the Marketplace, or 2) $695 per adult and $347.50 per child under 18 yrs of age with a maximum of $2,085. You will pay whichever of the two options is higher.
The Obamacare penalty for 2017 is fairly similar to 2016 with the percentage fee of 2.5% remaining the same, however, the flat fee will be adjusted for inflation.
What if I cannot afford Obamacare?
If you cannot afford to pay for Obamacare coverage, you may be able to qualify for a government subsidy. For more information on government subsidies visit the HealthCare.gov website.
What are the alternatives to Obamacare?
Any health insurance coverage that meets the minimum essential coverage, as set forth in the Affordable Care Act, can be used, whether this coverage is received through an employer, private insurance company, or purchased through a private exchange.
There are several alternatives available when selecting coverage. You can select one of the available alternatives on the Marketplace, purchase one of the many options available on the private exchange, or see if you are eligible for subsidized programs through Pennsylvania’s Medicaid program.
Obamacare Health Insurance FAQs
How Much Does Obamacare Cost in Pennsylvania?
This is dependent on your income level, the type of coverage selected, age, and if you smoke.
Is there a way to decrease my Obamacare cost?
Your cost is impacted by the level of coverage that you select.
What if I can’t afford Obamacare? Is there Cost assistance?
Yes. If you are unable to pay for the cost of Obamacare coverage, you may find that you qualify for government subsidies. Subsidies depend on income and the number of family members in the household.
Does Pennsylvania Obamacare cover pre-existing conditions like maternity, IVF, diseases or illnesses?
Yes, under the Affordable Care Act, it is illegal for health insurance companies to deny coverage due to pre-existing conditions or maternity.
Do I need to buy additional or supplemental insurance on Obamacare?
This depends on the level of desired coverage. You may want to pursue supplemental insurance for specific health scenarios.
Obamacare Health Insurance Plans vs COBRA
COBRA allows you to continue to utilize your previous employer's insurance plan regardless of your employment status for a designated period of time by paying the entire premium. This is generally not cost effective and a similar option can be purchased at a smaller dollar amount via the Federal Exchange.
I’m on Medicare, how does that impact me with Obamacare?
If you are on Medicare A, you are considered covered and do not to seek additional coverage. Medicare B is not considered sufficient and additional coverage would need to be obtained.
How do I qualify for an Obamacare exemption?
There are a few exemptions available due to significant hardships. You can apply for exceptions status through the Federal exchange.