Individual

Individual health insurance in Pennsylvania 2019

by Larissa

It’s that time of year again! Open Enrollment officially begins November 1st and ends December 15th. And in Pennsylvania, rates are going down and most counties have more options that last year. Rather than get bogged down researching all of your options on your own and possibly wasting money on the wrong plan, our team at Take Command Health has done the heavy lifting for you on our data-driven platform. We're officially open for business in Pennsylvania for the first time ever, just in time for open enrollment. Now you can spend more time researching Black Friday ads and the cheapest hotel rates for your in-laws for the holidays. You're welcome!

Nationwide, and specifically in Pennsylvania, the healthcare market is looking a little less dire this year. Marketplace insurance is healthier, evident in the low premium increases (premium decreases in some parts of Pennsylvania!) and more coverage choices. In fact, all but 10 of Pennsylvania’s counties have more than one insurer offering coverage and more insurers are joining the individual market for 2019 in 30 Pennsylvania counties.

What’s different?

  • Availability of short-term plans that can last a year. These short term, limited duration plans (STLDs) come with more restrictions, such as limits on preexisting conditions, and offer less coverage (i.e., no coverage on well-visits or maternity care), but their lower price point can be attractive to those that are relatively healthy and looking for more affordability. 
  • Individual mandate is disappearing. As a brief refresher, the Individual Mandate fines Americans who opt out of obtaining health coverage. Beginning in 2019, this mandate no longer exists. Some think that this decision to do away with the mandate could increase premium prices even further as the market adjusts for the decline in number of young people choosing to purchase health insurance. However, it might have less effect than people think because healthy young people weren’t buying plans the way families and older folks do and the markets are priced for that. Even with the individual mandate in place, healthy young people could decide to pay $200 a month for health insurance they didn’t think they needed or a $200 fee once a year.
  • Small business HRAs are becoming more popular. For small companies and startups that can’t afford traditional group plans, QSEHRAs (aka Qualified Small Employer Health Reimbursement Arrangements) offer a new way to reimburse for premiums and medical expenses tax-free. Plus, in addition to being reimbursed for plans and alleviating the financial burden of individuals buying their own health insurance, employees can choose their own plan that works best for them instead of fitting into a one-size-fits-all group plan! If you or your employer wants to learn more about this, we have a first-of-its-kind QSEHRA guide that explains everything you need to know! 
  • Cost of premiums are changing - but only slightly. The rate changes are significantly preferable to what they were last year, which were increased by an average of 30.6%. This year, the highest increase seen is 12.1% but on average throughout the state, individual plans will show a 2.3 percent rate decrease. Great news!

What’s the same?

  • Doctor networks continue to stay small: An ongoing trend since the start of Obamacare, many plans will cover an increasingly smaller percentage of doctors in a given area. That leaves the consumer with fewer choices and a greater chance of having to go out of network to get the care they need. This is a strategy used by carriers to keep costs down, but it leaves consumers financially vulnerable for shouldering those scary and sky-high out-of-network costs. Doctor networks change every year, so make sure your preferred doctors are in-network for 2019 before renewing or enrolling in your plan. 

  • Financial Aid. Insurance purchased on the federal exchange has been affordable for many individuals and families due to tax credits and other financial assistance. This financial aid will continue to be available through the exchange for health insurance in 2019.

The Pennsylvania Department of Insurance states that about four out of every five Pennsylvanians with marketplace insurance currently receive tax credits that subsidize their monthly health insurance premiums.

In 2018, these households are receiving on average $625 a month in tax credits.

  • Many Pennsylvanians will have more coverage choices. Last year, we saw a decrease in numbers of insurers in our state, but in 2019, that number is growing, and no one is exiting the market. Four of the five insurers already in the market have expanded their coverage areas and a new insurer is joining us. 

Screen Shot 2018-10-29 at 10.40.21 AMImage Credit: Pennsylvania Insurance Department

Perhaps one of the best changes is this: In 2018, 20 counties only offer one plan on the federal exchange. In 2019, this number drastically drops down to only 8 counties offering one plan. 

  • The Affordable Care Act’s consumer protections are remaining the same. These protections include coverage for pre-existing conditions (including pregnancy), free preventive care, and no lifetime or yearly dollar amount limits. 

 The full lineup for individual health insurance in Pennsylvania for 2019

Remember: on exchange means that plans are available on the ACA marketplace or exchange, and are eligible for tax credits. Off-exchange means that plans are only available through a broker or carrier directly, and not on the ACA marketplace. It's important to compare both when shopping for the best okay for you and your family, and Take Command Health's platform is an easy place to do that! 

Here's what we know so far: 

  • Capital Advantage Assurance will be available on and off the exchange with a 20.8% decrease in rates approved for 2019.
  • Capital Advantage Insurance Company is available off the exchange only with a 43.2% decrease in rates approved for 2019.
  • Keystone Health Plan Central is available off exchange only with a 7.3% decrease in rates approved for 2019.
  • First Priority Health HMO will be available on and off the exchange with a 1.1% in rates approved for 2019.
  • Highmark Inc.will be available on and off the exchange with a 6.3% increase in rates approved for 2019. Highmark and UPMC Health Plan are the only insurers offering ACA plans in Western Pennsylvania next year. Highmark Inc. is offering two lower-cost bronze plans with more limited coverage, three mid-range silver plans and one gold plan on the marketplace. Highmark’s HMO plans will be offered in Allegheny, Washington and Westmoreland counties, and similar planswill be available in Beaver, Butler, Armstrong, Erie, Crawford and Warren counties. One of the Highmark silver plans, my Direct Blue HMO Silver 0, carries no deductible.
  • Highmark Choice Company will be available on and off the exchange with a 4.0% increase in rates approved for 2019.
  • Highmark Health Insurance Company will be available on and off the exchange with a 6.8% decrease in rates approved for 2019.
  • Geisinger Quality Options will be available on and off the exchange with a 0.4% decrease in rates approved for 2019.
  • Keystone Health Plan East will be available on and off the exchange with a 1.7% decrease in rates approved for 2019.
  • QCC Insurance Company will be available on and off the exchange with a 6.4% decrease in rates approved for 2019.
  • UPMC Health Coverage Inc. will be available off the exchange only with a 12.1% increase in rates approved for 2019. UPMC Health Plan and Highmark are the only insurers offering ACA plans in Western Pennsylvania next year. UPMC, already the dominant ACA player in the Pittsburgh region, will extend its presence in the marketplace from 32 to 47 counties in 2019 as it expands into the central part of the state. In Allegheny County, the insurer is offering its mid-range Partner Network Silver plan in for $327 a month premium*, with a $25 co-payment and $3,500 yearly deductible for a 40-year-old enrollee. The Select Network plan in Beaver, Butler, Washington and Westmoreland counties has a $346 monthly premium, with a $25 copayment and $3,500 yearly deductible. *Premiums on any individual’s specific plan may vary based on factors such as age and status as a smoker.
  • UPMC Health Options Inc. will be available on and off the exchange with a 2.03% increase in rates approved for 2019.
  • PA Health and Wellness is new to Pennsylvania this year, so no rate changes are applicable. It will be available on and off the exchange.

Affordable Alternatives You Should Know About

Major medical plans may not be the best choice for everyone. If that’s the case for you, or even if you’re simply looking for more affordable options, check out some of these alternatives to traditional insurance.

Pivot short term plans: Pivot provides short term medical insurance solutions until a qualified major medical health plan is chosen. Pivot plans are renewable 90-day plans which, in most states, can be automatically renewed 4 times without additional medical screening to provide up to 12 months of continuous coverage. This is a great option for those who plan on obtaining health insurance in the near future- through a new job, change in marriage status, or some other form of a life change.

Faith-based: Medi-Share is a Faith-based program that has a state-wide PPO network available in 2019 managed by PHCS (Private Healthcare Systems, now owned by Multiplan). It may be smaller than some of the PPO networks in the past, but it does provide flexibility to see your doctors and will cover out-of-network expenses as long as it meets Medi-Share’s faith-based guidelines. Medi-Share won’t be for everyone but is a good option if it happens to fit your personal convictions and lifestyle. Make sure to check out our Medi-Share review and compare it to other major medical plans on our website before you enroll. 

A new way to shop

Take Command Health is officially open for business in Pennsylvania, just in time for open enrollment. We are a health technology startup aimed at bringing awareness, advocacy, and transparency to the confusing world of health insurance for small businesses and individuals, two groups that often get left behind with the deals and breaks that larger corporations enjoy.

In the healthcare industry today, rising costs, shifting policy changes, lack of consumer awareness, and lack of carrier and provider transparency all mean one thing: there’s room for improvement. And that starts with empowering consumers to be savvy, well-informed, and well-equipped to make smart decisions.

While more choices are a welcome change, hunting down and comparing all of these options can feel overwhelming. However, at TakeCommandHealth.com we help you compare all of your options side-by-side including off-exchange plans, marketplace plans, and faith-based options. You can use our award-winning tools to search for your doctors, check your prescriptions, and even simulate conditions and health needs to make sure you get the most of for your money.

We also offer a membership with added perks like the ability to call a doctor 24/7 for $0, enjoy medical bill negotiation support, a personal health advocate, dental, vision, and pharmacy discounts, etc. These really help save money with some of the higher deductible plans. 

Take Command Health is here to help

Our team (real people, not robots!) is at the ready to help answer any questions you may have. You can get started by chatting with one of our licensed professionals on our website or emailing us at support@takecommandhealth.com. 

Once open enrollment begins, you can visit our website and we'll walk you through your options. Our goal is to help you get the most out of your money and find the plan that really works for you and your family. 

Remember you have until Dec 15th to select a plan that starts Jan 1st, 2019. 

Picture of Larissa

Hi, I'm Larissa! I wrote this blog because I love helping people understand healthcare. After graduating with a degree in Public Relations, I decided to start my journey in healthcare management and stayed in the industry for 9 years. Currently, I'm pursuing my masters in counseling while still keeping my hand in the healthcare field with Take Command Health. Most importantly, I'm a single mom to a three-year-old whose goal is to experience all of the emotions every hour of every day. Learn more about me and connect with me on our about us page. Thanks!