Health Insurance Individual Market
Individual health insurance is insurance that you buy yourself from an insurance company. Health insurance provided through your employer and health coverage provided by the government, such as Medicare, Medicaid, and TRICARE, is not considered individual insurance.
You can purchase health insurance through a few ways. The Affordable Care Act established a federally-facilitated marketplace for individual health insurance as well as the option for states to create their own state-based marketplaces. Pennsylvania currently participates through the federal marketplace available at Healthcare.gov
. You can also purchase health insurance through a license insurance agent, but if you purchase outside of the Healthcare.gov
open enrollment period, you will not be eligible for subsidies to help off-set costs. You or your child(ren) may also qualify for Medical Assistance (Medicaid) or the Children's Health Insurance Program (CHIP).
The Affordable Care Act also established an individual mandate,
so all Americans are required to obtain health insurance or face a potential
tax penalty from the IRS. You can purchase health insurance through the federal
marketplace at Healthcare.gov each year during the open enrollment period. Open
enrollment for 2016 coverage began on November 1 and will continue through
January 31. If you encounter a life change like the loss of coverage through an
employer, moving, getting married, or having a baby, you may be eligible for a
special enrollment period.
Remember, it is important to obtain health
insurance not just because it’s required, but because it provides an important
safety net for you and your family. Medical procedures can be expensive, and
under the ACA preventive services that help evaluate and maintain your health
are available at no cost if you have health insurance. If you encounter a medical issue or emergency, you need to focus on your health rather than who you will pay for care. For more information on how to select a plan that is right for you and your family, read our shopper's guide or watch our video. The video is also available en Español.
The Cost of Your Coverage
If you are concerned about the price of health insurance coverage, there are various plans and pricing options for each rating area throughout the state, and depending on your income, you may be eligible for subsidies that reduce the amount you pay for your coverage. Each summer, the Pennsylvania Insurance Dpeartment reviews changes in plan costs. You can learn more about this process and comment on proposed changes here.
If you have questions about your health insurance coverage or need to file a complaint, you may contact the department's Bureau of Consumer Services at 1-877-881-6388 or online here. If you need assistance with shopping for health insurance on the Healthcare.gov marketplace, you can find a registered navigator or licensed insurance professional in your area.