Pennsylvania opens its own health exchange in November. What does that mean for us?

By ANNEMARIE SCHUETZ
Posted 9/30/20

HONESDALE, PA — If you’re one of the 331,825 people in Pennsylvania who buy health insurance on the exchange, get ready. Here comes Pennie.

That’s what the state has dubbed its …

This item is available in full to subscribers.

Please log in to continue

Log in

Pennsylvania opens its own health exchange in November. What does that mean for us?

Posted

HONESDALE, PA — If you’re one of the 331,825 people in Pennsylvania who buy health insurance on the exchange, get ready. Here comes Pennie.

That’s what the state has dubbed its new health insurance exchange, replacing the federal one that helped people buy Affordable Care Act insurance.

Pennie still gets you ACA insurance, but the change means that the consumer benefits, said Gov. Tom Wolf in a statement last July. He called it a “huge step toward making health insurance affordable and effective for all Pennsylvanians.”

At the time, he predicted that everyone would pay less and it looks like, for most people, that’s true. Insurance commissioner Jessica Altman is calling for an average rate decrease for exchange plans in 2021.

Where could I go in Wayne County?

If you want insurance, the place to start is Wayne Health’s Outreach and Enrollment Office.

Enrollment begins on Sunday, November 1, but the Outreach office is currently open. They’ll help you navigate Pennie, apply for Medical Assistance (expanded Medicaid) and learn more about the sliding fee scale available for local dental, primary care, and surgical, neurology, Women’s Health and Behavioral Health services.

Co-coordinators Laura Resti and Rebecca Mead explain people’s health care options. They’re getting ready now for a busy enrollment season. Once open enrollment starts, “People should call for an appointment,” Resti said. “Or we can meet virtually.”

Because, of course, COVID-19.

And this is important, says Resti. “All our services are free.”

The details

Program details are still being hammered out, and enrollment doesn’t begin for another month. But here’s what we do know:

  • Pre-existing conditions are still covered, as are other regulations the Affordable Care Act ushered in to protect consumers, especially the ill and otherwise vulnerable. This is still ACA insurance, just delivered by a state marketplace.
  • Open enrollment will last until Friday, January 15. “That is spectacular,” Laura Resti said, recounting how incredibly busy their office can get. More time means more people can sign up and receive health care.
  • Interested in getting insurance but think you can’t afford it? There’s financial assistance available if you qualify. Contact Wayne Health Outreach at the numbers below.
  • The state has said we’re saving money and premiums are expected to be lower. Here’s why:

Pennsylvania has used the federal exchange since 2010. Insurers pay a fee to the government to cover costs—about $88 million in the state in 2020. But now with the state creating its own more-efficient exchange, Gov. Tom Wolf’s office said that a program could cost $30 million to run (www.bit.ly/RRwolfstatement40). At least some of those savings would result in lower premiums. But an even bigger factor is…

  • Reinsurance. This is key to reducing premiums. A Pennsylvania reinsurance program will start in 2021. Under reinsurance, if an insurer’s claims go over a certain amount, a third party (like the state or federal government) can take over payment.

Too many patients with high medical bills can bankrupt an insurer. So, companies try to mitigate this by increasing premiums across the board, but with a reinsurance program in place, that doesn’t need to happen. “Reinsurance is a way to stabilize an insurance market and make coverage more available and affordable,” says www.healthcare.gov.

“The combined savings and anticipated federal government reinsurance contribution will save Pennsylvanian consumers up to $250 million in annual health insurance premiums,” Wolf’s office said.

  • If you already buy your insurance on the exchange, your details will be moved to Pennie automatically, Resti said. That means less work once open enrollment starts.

If you want to learn more about health care options, especially once Pennie opens on November 1, call Wayne Health’s Outreach and Enrollment at 570/251-6554 or 570/251-6569. The office is located at 630 Park St. in Honesdale.

You can also go to www.pennie.com and read all about it.

Comments

No comments on this story | Please log in to comment by clicking here
Please log in or register to add your comment