Next Friday — Dec. 15 — marks an important deadline for obtaining government-assisted health insurance in Pennsylvania: It’s the last day to sign up and have coverage in place on Jan. 1.
People can still sign up until Jan. 15, but coverage won’t begin until Feb. 1.
The coverage is available through Pennie, the Pennsylvania-run electronic marketplace selling plans that became available as a result of the Affordable Care Act, also known as Obamacare.
Here’s the most important thing to know about Pennie: It automatically connects people to income-based subsidies to make coverage affordable and, for some, to help with deductibles and co-pays.
State officials say nine in 10 people qualify for financial help worth an average of $500 per month. Many people pay well under $100 in monthly premiums, and some pay under $20.
“All the time we get feedback from people that they’re surprised and relieved that a quality health plan can fit in their budget,” said Devon Trolley, the executive director of Pennie.
About 360,000 Pennsylvanians had coverage bought through Pennie in 2023.
The coverage is intended for people who would otherwise struggle to afford health insurance, but earn too much to qualify for Medicaid. The financial help is structured so people pay no more than 8.5% of their household income toward their coverage.
The plans available through Pennie are the same as many people get through their job, from major insurers including Blue Cross-Blue Shield plans. They are approved by the state insurance department and must provide ten essential benefits such as emergency care, maternity care, preventive care, prescription drugs and mental health care. The plans also cover any pre-existing conditions.
Pennie does the work in terms of looking at applicants’ income and calculating how much help they receive toward premiums, with the financial help immediately used to lower their premiums.
Still, the selection process isn’t totally automatic: Just like people who get coverage through their work, Pennie customers must evaluate and choose a plan based on factors including monthly premium, deductibles and co-pays. They should also make sure their preferred doctors and hospitals are part of the network for any plan they are considering.
The good news is that help is available: People can find abundant information including an online chat feature at pennie.com. Pennie also has a call center that offers help over the phone at 1-844-844-8040, with in-person help available as well.
The available plans vary by county, with some counties having more options than others, but all having multiple plans.
Officials on Tuesday also urged people already covered by Pennie to review the available plans to see whether their plan remains the best choice. Premiums for the upcoming year rose by about 4%. However, some premiums rose by more than that, while premiums for some went down.
They also urged existing Pennie customers to update their personal and financial information, stressing that, if their income went down, they might be eligible for more help toward their coverage. Likewise, if someone’s income rises, they should update their information. Otherwise, they might receive help that exceeds the amount they qualify, and they would have to pay a refund.
Micheal Humphreys, the state insurance commissioner, stressed that all plans sold in Pennie, including premium rates, are approved by the state.
“When you go on pennie.com, you can be confident that these plans are going to be robust,” he said.
He stressed that people who run into confusion or problems with their coverage can turn to the insurance department, which will help them understand their coverage. Further, if coverage is unfairly denied, the insurance department will contact the health insurer and lodge a challenge, which often leads to denials being reversed, Humpreys said.
