It’s the time for many of us to select a health insurance plan for the coming year, and the Pennsylvania Insurance Department is armed with resources to help you decipher terminology, prices, and coverage options and pick the best plan for your health care.
“Having health insurance coverage is really about protecting yourself and your family because you never know what your health care needs may be in a given year,” Insurance Commissioner Jessica Altman said.
If you buy health insurance through healthcare.gov or a licensed insurance agent, your open enrollment period runs from Nov. 1 to Dec. 15. If you receive coverage through your employer, check when your open enrollment period is scheduled.
Altman said a new insurer has entered the marketplace, another expanded into 14 new counties, and she approved an average statewide rate increase of just 4%, which all adds up to a consumer-friendly marketplace.
“Some health insurance products in the state are going down in price, and there are more choices than before,” she said. “It’s exciting, and consumers should take time to shop around every year. More and new options could be better or more affordable than what you have now.”
But she emphasized that consumers should not consider monthly premium price alone.
“People always look at the sticker price. The lower the premium, the more affordable the price looks, but it’s more important to focus on what costs you might face in the coming year when choosing,” she said. “It’s also important to make sure the services you need are covered.”
Affordable Care Act (ACA) plans are designated with medal levels—bronze, silver and gold—corresponding to how generous they are in coverage, Altman said. She advised consumers to investigate other costs such as copayments, deductibles, and coinsurance. It’s also important to check which prescription drugs are covered and at what rate, whether your favorite doctors are in the health care network, and whether referrals are needed for specialized health care.
Altman warned that short-term insurance plans, which often are marketed as a more affordable option, are not ACA compliant and not allowed on the marketplace. ACA plans must cover essential health benefits such as annual physicals, certain cancer screenings, and vaccinations at no cost to the consumer. Short-term plans often provide limited coverage with higher out-of-pocket costs.
“They can discriminate against anyone with preexisting conditions, deny coverage altogether, and not cover things like drugs, maternity care, and mental health and substance abuse,” Altman said. “You have to make sure you really understand what you’re buying.”
The Insurance Department offers a number of resources online to help sort out all of the information, including more than a dozen videos that explain important concepts and offer tips on how to choose a plan. Its Consumer Checkbook lets you see what’s available in your area and compare plans without having to go through the application process.
Additionally, there’s help available through a number of organizations in the form of “exchange assisters.” The Insurance Department provides an online list of organizations that are available to assist consumers.
For further questions, you can call the department’s Customer Service Line at (877) 881-6388 (TTY/TDD: (717) 783-3898).