En español | Most Pennsylvanians can buy health insurance through Pennie, the state’s Affordable Care Act (ACA) marketplace, during open enrollment, which begins on Nov. 1, 2023, for 2024 health insurance coverage.
If you experience a qualifying life event — such as the birth of a child, a move, a marriage, a divorce or the loss of your employer-provided health insurance — you may be able to enroll or change your coverage outside of open enrollment.
Most people enrolled in ACA marketplace plans have seen their premiums go down because the 2021 American Rescue Plan Act (ARPA) increased tax credits for insurance premiums and expanded the number of households that qualify for them. Every household that pays more than 8.5 percent of its household income now qualifies for federal tax credits to help them afford health insurance. These enhanced subsidies are available through 2025.
Before the 2021 law, such tax credits were only available to people earning less than a certain salary ($54,360 for one person). Most Americans with a marketplace plan can save an average of about $800 per year, according to the federal government.
maternity and newborn care and emergency services at hospitals and
medical centers throughout the state.
Who is eligible?
- Most Pennsylvanians are eligible to buy health insurance through Pennie, regardless of whether they are currently insured. Some non-U.S. citizens may also be eligible.
- Low-income people and families may also qualify for free or low-cost health insurance through Medicaid. You can fill out a questionnaire through the state’s COMPASS benefits portal to see if you’re eligible. If you start a Pennie application and realize you’re eligible for Medicaid, you’ll be redirected to COMPASS and won’t need to re-enter your information.
- The Children’s Health Insurance Program offers health insurance for children and teens in families with incomes too high to qualify for Medicaid but who still may struggle to find affordable coverage. You can apply for the program through the COMPASS benefits portal or by calling 800-986-5437. If you start a Pennie application and realize your children are eligible for the program, you’ll be redirected to COMPASS and won’t need to re-enter your information.
When can I enroll?
- Pennie’s open enrollment for 2023 health insurance coverage has closed. Open enrollment for 2024 coverage starts Nov. 1, 2023, and runs through Jan. 15, 2024.
- If you experience a qualifying life event, you can enroll during a special enrollment period. Qualifying events include certain moves, births and adoptions, loss of employer-provided coverage, marriage, divorce and other special circumstances. You only have 60 days from that event to enroll.
- If your household income is no more than 150 percent of the federal poverty level, you automatically qualify for a special enrollment period. For example, a two-person household earning $26,130 or less may enroll at any time.
- You can also enroll anytime if you qualify for Medicaid, if your children qualify for CHIP or if you’re a member of a recognized American Indian tribe.
How do I sign up?
First, use the Pennie Plan Comparison Tool or contact a certified enrollment assister to estimate costs and sort through various plan options. Once you’re ready to sign up, you can apply online, over the phone or through an assister or insurance broker, in person or by phone. Once you’re approved for a plan, you’ll need to pay your first monthly premium for your coverage to begin.
To apply and enroll:
- Online: Go to Pennie’s website and click “Get Covered.” You’ll need to create an account and, if you have them, provide your Social Security number and proof of household income, such as recent pay stubs or federal or state tax returns.
- By phone: You can enroll over the phone by calling Pennie’s service center at 844-844-8040.
- Through an assister or broker: Both offer free help with creating an account and selecting a plan, but only brokers can offer advice about what’s best for you. Pennie’s website lets you search for assisters and brokers by zip code. You may be able to meet with an expert in person or virtually.
You can also call Pennie’s service center (844-844-8040) to ask questions and to help determine if you qualify for financial assistance.
What is covered, and how much will it cost?
Coverage and cost depend on where you live, the type of plan you choose, your estimated household income, and the age and disability status of you and your family.
If you qualify for Medicaid, you will be able to get free or low-cost coverage and may not need to worry about premiums or copays, depending on your level of income.
All Pennie plans cover 10 “essential” benefits, including:
- Emergency services and hospitalization
- Pregnancy, maternity and newborn care
- Mental health services (including counseling)
- Chronic disease management and preventive care
- Prescription drugs
Insurance companies cannot deny coverage because of pre-existing conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family.
All Pennie plans cover basic dental services for children, including cleanings and exams. But adults who want dental coverage must add it to their policy or get a separate plan. Deductibles and out-of-pocket costs vary between plans.
What about federal assistance for premiums?
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income qualifies for federal tax credits for insurance premiums through 2025.
According to Megan O’Reilly, AARP vice president of government affairs for health and family, subsidy recipients ages 50 to 64 have already seen average annual savings of over $950.
Is there any other financial assistance available?
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help you pay for such out-of-pocket expenses as deductibles and copays. You must enroll in a Silver-level plan to get this assistance.
What plans are available?
Pennie’s plans are organized into four categories:
- Bronze plans have the lowest monthly premiums and the highest deductibles and copays. They cover roughly 60 percent of care costs. They’re designed to help you in case of serious illness or injury.
- Silver plans have moderate monthly premiums, deductibles and copays. They cover roughly 70 percent of costs. They’re the only plans eligible for cost-sharing subsidies.
- Gold plans have higher monthly premiums and lower deductibles and copays, and they cover roughly 80 percent of care costs.
- Platinum plans have the highest monthly premiums and the lowest deductibles and copays. They cover roughly 90 percent of care costs. These are for people who have significant health care needs and are willing to pay the highest premiums.
The Pennie Plan Comparison Tool helps you estimate costs and benefits of various plans and check whether you might qualify for financial assistance. Pennsylvanians 29 and younger can also apply for a catastrophic plan offering low premiums but with high deductibles.
What if I already have health insurance?
If you already have coverage through your employer or directly through an insurance provider but are eligible for lower premiums, you can switch to Pennie. But you may not qualify for tax credits if you opt out of your employer’s plan — unless those premiums exceed a certain portion of your household income. The premiums would need to be more than 9.12 percent of your household income for individual coverage to qualify for the tax credits.
If you lose coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you may be able to sign up for a Pennie plan during a 60-day special enrollment window. Try to apply and select your plan before your COBRA coverage ends to make sure there's no gap in coverage. If you’re not sure about whether making this switch makes sense for you, you can ask for free advice from a certified insurance broker or assister.Will I need to get a new doctor?
That depends. Major insurance providers, including Capital Blue Cross, Highmark and UPMC, offer Pennie plans, but not all doctors accept them. You can talk to your primary care physician to see whether he or she accepts a particular marketplace plan.
Will my family members qualify for the same health plan that I do?
It depends. You can enroll as a family. But in some cases, some family members may also be eligible for subsidies or other programs such as Medicare, Medicaid or the state’s Children’s Health Insurance Program, depending on age, income and disability or caregiver status. Such families may choose to enroll separately. They may still be able to see the same doctor or go to the same medical practice, depending on the types of insurance plans accepted.
This guide was updated on Feb. 1, 2023, with new information about open enrollment.