HEALTH INSURANCE
Choosing health insurance is one of the most important choices you can make to help protect the health and well-being of you and your family.
There are various types of health insurance and different markets. Pennsylvania’s health insurance market can be broken down into Medicaid and CHIP, Medicare, and Commercial fully-insured and self-insured. Depending on the market and type of insurance, there are different ways to obtain coverage, and there are many factors that you need to consider when deciding which path is best for you. The Pennsylvania Insurance Department is here to help with information so you can make the best decision for your situation.
ACA Remains in Place Despite Ruling
The Affordable Care Act remains in place. Plans bought during open enrollment take effect January 1, 2019. A ruling by a Federal judge in Texas that the ACA is unconstitutional remains in the court system, and does not impact health plans bought by individuals in Pennsylvania for 2019. These plans bought on healthcare.gov, or ACA-compliant plans bought elsewhere, continue to have all the consumer protections provided by the ACA, including coverage for pre-existing conditions, prescription drugs, preventive care, mental health and substance use disorder.
Make sure you pay your initial premium before
January 1 and your premiums each month to keep your coverage.
Click
here for frequently asked questions.
How do you obtain coverage?
There are various ways to obtain health insurance coverage for yourself and your family. How do you get your health insurance?
-
Healthcare.gov: Do you buy insurance on your own for you or your family? Are you looking to purchase insurance for you and your family? If so,
click here for more information on the individual insurance market and coverage purchased through the federal marketplace.
-
Employee Benefits: Do you receive health insurance coverage through your employer? If so,
click here for information on the large and small group markets.
- Young Adults: Are you making decisions about your health insurance for the first time? If so, check out advice for young adults or read Commissioner Miller's
letter to college students.
-
Older Pennsylvanians: Are you over the age of 65 and eligible for Medicare? If so,
click here to view relevant information for seniors, including information on Medicare and Medicare Supplement coverage.
-
Other Programs: Do you receive coverage through or are you interested in finding out more about one of Pennsylvania's subsidized programs administered through the
Department of Human Services?
Special Enrollment Periods
Open enrollment for individual health coverage through the Affordable Care Act runs from November 1 through December 15.
But, you can sign up during what are called Special Enrollment Periods anytime throughout the year, if you experience certain changes in your life’s circumstances.
These changes include losing health through your employer, a change in marital status, or if you have moved to a different area.
For information on ways you may qualify for a Special Enrollment Period,
click here. You can also visit www.healthcare.gov
for more information. Health Insurance Rates
Every year, the Pennsylvania Insurance Department reviews all proposed health insurance rates and changes to existing rates for plans in the individual and small group markets
. We have a number of resources available to help consumers understand this process and obtain information about requested and approved changes to their rates. For more information on the health insurance rate review process and to see a list of these resources,
click here.
Information for Employers
Are you looking to provide health insurance for your employees? Click
here for more information on providing small or large group coverage.
How does health insurance work?
The Pennsylvania Insurance Department has a number of resources to help consumers understand their health insurance.
- Are you shopping for a new health insurance plan? Do you have health insurance and want to learn more? Check out our
health insurance literacy video gallery or read our consumer guide on
How to Buy Health Insurance
(Como comprar un seguro de salud). You can also watch our video on How to Buy Health Insurance in
Spanish.
- Do you have health insurance and want to learn more about how to use it? Watch our video on how to best use your new health insurance coverage.
- Do you have health insurance and want to learn more about Mental Health and Substance Use Disorder coverage? Learn more on our Parity page.
- Do you want to appeal a decision made by your health insurance company? Read our
guide to the appeals process to understand what you need to do. The guide is also available en Español.
- Are there terms you've come across while trying to understand your insurance that you don't know? We have a glossary of health insurance terms that may be able to help.
- Do you need in-person assistance with shopping for a health insurance plan that's right for you? We can help you
find an insurance professional who can help you out.
- If you are a consumer looking for a health insurance navigator, click here.
State-Based Health Insurance Exchange
Pennsylvania's state-based exchange and reinsurance program is expected to be fully implemented for health insurance coverage that will begin January 1, 2021. To learn more, click
here.
Other questions or complaints?
You can always contact the Pennsylvania Insurance Department to ask a question or file a complaint. You can call us at 1-877-881-6388 or
click here.
Graph Sources:
Medicaid & CHIP: Pennsylvania Department of Human Services (physical health enrollment only)
Commercial Fully-Insured: PID - NAIC 2016 SHCE
Commercial Self-Insured: PID - NAIC 2016 SHCE + census data