5 things to know about Pa.’s health insurance marketplace open enrollment
Pennsylvanians shopping for health insurance at healthcare.gov may find the experience as good as—or in some ways even better than—last year's.
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In Pennsylvania, the Affordable Care Act's health insurance marketplace is more than holding its own, despite continued news reports about state and federal policy conflicts and changes. Navigating through all this information can get confusing, even for a health-care policy wonk such as me.
Open enrollment for 2019 is around the corner: Nov. 1 to Dec. 15. Pennsylvanians shopping for health insurance at healthcare.gov may find the experience as good as — or in some ways even better than — last year's.
Here are five reasons why:
1. The same financial help is available — on average, about $625 a month. Healthcare.gov continues to provide the same tax credits and other financial assistance that have helped make marketplace coverage affordable for so many. According to the Pennsylvania Department of Insurance, about four out of every five Pennsylvanians with marketplace plans receive tax credits that subsidize their monthly health insurance premiums. During this year (2018), these households are receiving on average $625 a month in tax credits.
2. Many premiums will increase only slightly. Some are even going down. Here's what we know now about marketplace plan premium rates for 2019:
Three are going down — one by about 20 percent.
One is staying the same.
Two are increasing less than 3 percent, just a bit more than the consumer price index.
Three are increasing 5 percent to 9 percent.
Only one has a double-digit increase (13.5 percent).
These are insurers' requested rates for 2019. The Insurance Department plans to announce final, approved rates soon, likely during the middle of October. As always, consumers should shop carefully to find the best plan for their health needs and financial situations. And remember that most Pennsylvanians will get tax credits that will greatly reduce what they pay for marketplace health insurance.
3. Many Pennsylvanians will have more coverage choices. The number of insurers and health plans participating in the marketplace is growing, not dropping. During 2019:
All insurers who were in the market during 2018 will remain.
Four of the five insurers already in the market have expanded their coverage areas.
A new insurer is entering the market.
The number of counties with just one plan will go down from 20 (this year) to eight (during 2019).
Low premium increases and more coverage choices show that Pennsylvania's marketplace is healthy and stable.
4. Pennsylvania's marketplace provides the same consumer protections as always. The Affordable Care Act's consumer protections apply the same as ever for plans purchased on the marketplace. These protections include coverage for pre-existing conditions (including pregnancy), free preventive care, and no lifetime or yearly dollar amount limits, to name just a few.
5. Consumers can still get help choosing a plan. The Department of Insurance, hospitals and health systems, navigators, and other stakeholders are working hard to make sure that consumers who need help selecting plans and enrolling get that help. Here are some resources that can help with that:
healthcare.gov: To locate a navigator who focuses on marketplace plans (as opposed to an insurance broker, who does not), consumers should close the agent or broker filter in order to view only what the website calls "assisters."
Neighborhood health care clinics: Some have received navigator funding to help with enrollment. Consumers can call 866-944-2273 for more information.
Your local hospital: Hospitals rely on financial counselors, such as the woman who explains in this video how Temple University Health System helps patients find affordable coverage.
A friend, neighbor, or family member who works in health care: They understand the importance of coverage and can either help, or direct consumers to someone who can.
The Pennsylvania Department of Insurance: The department's website has a lot of helpful information. If you still have questions, you can call the department's Customer Services at 877-881-6388.
La Comunidad Hispana in Chester County area: This organization received navigator funding and can help consumers who speak Spanish as their first language.
Your local library: Most libraries have Internet access, and the Department of Insurance is working with some to connect consumers with navigators for open enrollment.
It is more important than ever for each of us to do our best to make sure Pennsylvanians get and stay covered during open enrollment 2019.
Jolene Calla is senior vice president, health care finance and insurance, at the Hospital and Healthsystem Association of Pennsylvania.