Pennsylvania insurance law and regulation
News that affects your health insurance and planning
June 2, 2019 – Status of alternative non-ACA health plans: Pennsylvania does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage, permits insurers to sell non-compliant transitional policies in the individual market and does not limit the sale of short-term coverage more strictly than the federal government.
March 29, 2019 – Small business health plans – Yesterday a federal court in the District of Columbia ruled in favor of states in striking down U.S. Treasury regulations that permitted the expansion of small business association health plans. Even before the court ruling, association health plans were not showing promise as cost-saving measures as was hoped. What this means to small businesses is that if they want a lower cost health plan then they must design it themselves independently from an insurance company. The problem is that most firms providing benefits services are primarily in the business of selling insurance rather than lowering costs. Freedom Benefits offers an affordable consultation to help small business owners design and document an alternate small business health plan without necessarily requiring the purchase of insurance.
3/19/2019 – Association Health Plans and Short term medical insurance: The commissioner of the Pennsylvania Insurance Department said the state has had a rough history with Association Health plans so they are still restricted and heavily regulated in Pennsylvania even after at the White House finalized expansion rules for these plans. Short term medical insurance plans, like those listed on this site, are more widely available in Pennsylvania.
2/25/2019 – Nearly Pennsylvania 1,000 physicians are now approved to certify patients to participate in the state’s medical marijuana program, which has also permitted 25 grower/processors in the state and 50 dispensaries. The state’s medical marijuana program became law under state Act 16 in April 2016.
12/15/2018 – The Strasburg Amish do not believe in insurance but manage their health care costs anyway.
11/30/2018 – Two thirds of Pennsylvania’s 1,500+ gun deaths each year are suicides. That’s why the state’s auditor general advocates for improved mental health care and a range of other preventative actions. Most health insurance plans have inadequate mental health coverage, so other options for care must be considered.
11/12/2018 – The Medical School at the University of Pennsylvania analyzed and commented on the Yelp review of emergency room that tend to be 5 star or one star. The study’s senior author, Raina Merchant, MD, Director of the Penn Medicine Center for Digital Health and an associate professor in Emergency Medicine, believes the Yelp reviews could fill a knowledge gap for health care consumers.
The history of health care planning in Pennsylvania (Information is outdated and links may be expired)
2/16/2017 Pennsylvanians continued protests this week about the threatened repeal of the Affordable Care Act. A town hall meeting was conducted even after Senator Toomey declined to attend. Senator Casey continues to advocate for continued health insurance coverage. For those who are eager to leave the old plans, alternatives to Obamacare are now available.
11/23/2015 The health insurance market offers few choices, higher rates for Pennsylvania’s individuals and small businesses in 2016. Prices for individual and small group health insurance plans are rising significantly for most Pennsylvanians next year. Highmark plans offered through the Health Insurance Marketplace will have the largest price increases, some as high as 26% over last year’s rates. Highmark took the majority of the state’s high risk applicants who bought subsidized coverage through the exchange and suffered large claim losses on those policies. Meanwhile, many younger healthier applicants did not buy this type of coverage and will pay a penalty tax instead. Some opted for less expensive insurance that does not meet Obamacare requirements or satisfy the requirement to avoid a penalty tax. Most individual and group health insurance plans will raise rates by less than 10%. Even at these more modest levels of price increase, health insurance remains the fastest growing expense for many individuals and small businesses in Pennsylvania. United Healthcare, also a major provider of coverage through the exchange announced that it is pulling back offering that coverage. Although it is too late to withdraw from the market for 2016, United Healthcare will not be promoting its products and so consumers may have trouble getting the support they need to enroll in these plans. Also new for 2015: many small business firms with less than 50 employees have to modify their plans to meet new IRS requirements or pay a heavy excise tax for 2015. Firms in the 50-100 employee range have a large amount of new documentation and filing requirements for tax filing this season. Freedom Benefits recommends that individuals or small businesses that do not have a strategy for dealing with these changes should arrange a health plan review as soon as possible. This service is reasonable priced, especially if handled through a remote or telephone consultation, and could save thousands over the coming months.
9/3/2015 Highmark Health will offer fewer health insurance product choices in 2016 to the residents of Pennsylvania, Delaware and West Virginia.
3/31/2015 – Last night Geisinger Health System premiered a documentary film “Reinventing American Healthcare” at the Kirby Center in Wilkes-Barre. The film documents how Geisinger evolved to a health system insuring 2.5 million Pennsylvanians and more throughout the country.
12/20/2014 Pennsylvania hospitals report that they are not seeing improvements from Obamacare. As a group, western Pennsylvania hospitals saw a 7% increase over the past year in uncompensated care provided to people without insurance or inability to pay high policy deductibles and out-of-pocket expenses. The state is planning to expand HealthyPA Medicaid program to as many as 600,000 of the lowest income residents. Middle income residents should make arrangements to pay for care not paid by insurance through supplemental insurance, HRAs or HSAs.
11/18/2014 Enrollment is open now for 2015. The most common request we get is about how to pay the expenses not covered by insurance. Many are doing it the wrong way with a non-integrated employer reimbursement that can trigger a tax penalty.
2/11/2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683.
2/9/2014 Expansion of Ehealth services – 5 agencies in Philadelphia, Bucks County, Northumberland County, Indiana County and Punxsutawney were awarded grants to expand the use of I-pads for on-site exchange of patient and care information for visiting nurses and other professionals. The program is run by PA Ehealth Partnership Authority.
7/26/2013 Affordable Smart Term Life Insurance is now available to most Pennsylvania residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.
3/11/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.
10/14/2012 Pennsylvania Insurance Department reports that is will not be ready to expand Medicaid to low income residents through an insurance exchange by this time next year as required by federal health reform law. Despite receiving a $33.8 million grant from the federal government for the project, the state has not made much progress in developing its online health insurance exchange.
9/27/2012 Freedom Benefits principal Tony Novak attended a health insurance rally at the state capital building in Harrisburg PA but found little sympathy for the protestors. They were struggling with health care but these Pennsylvanians are apparently managing better than many of the people we hear from in states where insurance is more highly regulated like New York and New Jersey.
8/27/2012 Four Pennsylvania health care organizations will spend another $6 million on eHealth projects to improve exchange of patient health records as part of a $17 million project to develop a health information exchange. HealthShare of Southeastern PA, Inc., Philadelphia; Highmark HIE, LLC., Pittsburgh; Lehigh Valley Hospital, Inc., Allentown; and St. Luke’s Hospital, Bethlehem will be allocated $1.5 million each. Consumer groups are increasingly critical of public funds being spent to for what is typically viewed as a technology that could otherwise be handled more effectively and at a lower cost by private sector firms. For more information, visit the PA eHealth Collaborative website at www.paehealthcollab.com.
2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 Highmark Health Insurance, Aetna and Independence Blue Cross are the state’s largest health insurance providers and as such, earn the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.
11/7/2011 Pennsylvania opened its Children’s Health Insurance Program (CHIP) to the kids of low-income and part-time state employees, an option that was prohibited until the passage of the 2010 health-care law. The program is jointly financed by the state and the federal government to provide coverage to the uninsured children of families who earn too much to qualify for Medicaid but cannot afford private insurance.
8/19/2011 Maternal and Child Health Consortium of Chester County received a federal grant in the amount of $875,814 to help the uninsured children of immigrants living in the Delaware Valley enroll in government-paid health insurance.
7/10/2011 The U.S. Center for Consumer Information and Insurance Oversight announced that Pennsylvania lacks proper resources or authority in the small-group market to effectively review large rate increases as required by federal law. The federal government will temporarily take over the task of reviewing small business health insurance rate increases that are more than 10%.
5/4/2011 The AdultBasic helpline will remain open until May 31 at 1-800-GO-BASIC. Former enrollees with questions should call before that date. It is currently staffed Monday through Friday, 7 a.m. to 7 p.m., and Saturday, 9 a.m. to 3 p.m. After May 31, former enrollees will continue to be able to access insurance contractors and OnlineNavigator support for help and information. AdultBasic was a state-sponsored program that closed leaving up to 42,000 without health insurance. The Universal Health Insurance Blog discusses the issues and coverage options in more detail.
2/12/2011 With dozens of health plans choices available online offering a wide range of pricing and benefits, how do you find the best combination of price and benefits? Celtic Insurance realizes that the choices can be overwhelming; the company offers more than 40 possible health plan designs in many parts of the United States. A new feature called “Help Me Choose” lets users easily and quickly select the benefits they value most and narrows the list down to a few of the best choices. No personal information is required other than zip code and date of birth.
1/24/1011 Adult Basic, PA Fair Care or Special Care? Subsidized insurance for low income residents will become more complicated (and more expensive) as the Adult Basic health plan comes to an end next month. The Universal Health Insurance Blog discusses some of the lowest priced commercial insurance supplements and alternatives available regardless of income.
12/16/2010 Pennsylvania Department of Insurance officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.
In its initial federal grant request for the insurance exchange project, Pennsylvania said that it would: 1) Address Information Technology (IT) needs; including altering their various IT benefit systems (Medicaid, Food Stamps, Exchange) so they have the ability to “talk to each other,” and designing a web-portal that offers a common entry point for consumers, 2) Produce a comprehensive report on the insurance market, uninsured populations, various Exchange models, and a cost analysis of program integration, 3) Analysis of the steps necessary to integrate public programs and private insurance processes and a cost analysis of such integration, and 4) Identification of financial, information technology and business operations processes required for implementation of a successful.
The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.
8/4/2010 PA High Risk Health Insurance Online enrollment for Pennsylvania’s high risk health insurance plan begins today and personal enrollment support is available through OnlineAdviser. The cost of this insurance is primarily paid by the federal government so that the cost to individuals is less than $400 per month. The plan is administered by Highmark in Pittsburg. See www.pafaircare.com for more information.
6/28/2010 High Risk Health Insurance: Up to 5,600 Pennsylvania residents with significant ongoing medical expenses ineligible for other coverage will soon be eligible to purchase health insurance under the federal health insurance reform program. Individual open enrollment health insurance is offered regardless of previous medical conditions except that those currently confined to a health care facility due to chronic illness or permanent injury are not eligible. Premium rates are currently $629 per month for basic adult coverage but the cost may be reduced by federal health insurance reform funds available until 2014. The subsidy funds from the federal government are expected to total more than $29,000 per participant in the high risk health plan over the next three years for each expected participant in the plan. Coverage may be limited for pre-existing conditions for the first 12 months if the applicant is currently uninsured or there is a gap in previous recent coverage greater than 63 days. Otherwise, a three month waiting period applies to pre-existing medical conditions. The plan administrator has not been announced so quotes and enrollment forms are not yet available.
5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in Pennsylvania is now available at Freedom Benefits.
5/10/2010 Diabetes Coverage: Diabetes Coverage: A new resource to help find health insurance for diabetics in Pennsylvania is now available at Freedom Benefits.
3/23/2010 Pennsylvania and ten other states including Alabama, Florida, Michigan, Nebraska, North Dakota, South Carolina, South Dakota, Texas, Utah and Washington will make a joint legal challenge to the federal health reform bill on the basis that it improperly usurps state sovereignty over health insurance and that requiring health insurance is an illegal and improper government action.