Medical Insurance Options – Pennsylvania « Health Insurance Advisory

Welcome to the New Healthcare Law Center and State News

new healthcare reform lawThe new healthcare law, called the Patient Protection and Affordable Care Act (PPACA), represents comprehensive healthcare reform legislation signed into law on March 23, 2010. It contains numerous provisions designed to protect consumers and promote low cost medical insurance, including many new taxes to pay for the cost.

In this section of the site, you can also obtain the following information specific to your state: available medical insurance options, efforts to regulate medical insurance premiums, healthcare, the individual medical insurance marketplace and the new healthcare law.

Our objective is to help Americans make sense of the new healthcare law by explaining key provisions in plain English and assisting individuals, families and the self-employed in using this information to find and secure affordable medical insurance.

Medical Insurance Options – Pennsylvania

Author: Administrator | Mar 01 2011 | New Healthcare Law, Pennsylvania
 Medical Insurance Options   Pennsylvania

Pennsylvania - Find Medical Insurance

Having adequate, affordable medical insurance is essential because it helps ensure access to quality healthcare and helps pay for the high cost of medical services, supplies, surgery and hospitalization. You and your dependents may be eligible for one or more of the following alternatives in Pennsylvania:

Medical insurance for young adults less than age 26 – Pennsylvania

Under the new healthcare law, called the Patient Protection and Affordable Care Act (PPACA), effective September 2010, young adults covered their parent’s medical insurance are eligible to remain covered up to age 26. Previously, most young adults “aged off” their parent’s medical insurance when they turned 19 or graduated from college. The young adult is not required to live with their parents to be eligible. They can even be married. Find more details regarding medical coverage for adults less than age 26 by visiting our healthcare reform blog.

Guaranteed health insurance for children less than age 19 – Pennsylvania

Also under PPACA, effective September 2010, medical insurance companies and health plans must provide coverage to children less than age 19, regardless of their health status. Previously, all applicants regardless of age could be denied individual medical insurance or have restrictions put on their medical insurance (Exclusionary Endorsements or Elimination Riders) that exclude pre-existing medical conditions from being covered. For more information regarding guaranteed health insurance for children less than age 19, visit our healthcare reform blog.

COBRA continuation coverage –
Pennsylvania

Passed by Congress in 1985, the Consolidated Omnibus Budget Reconciliation Act requires health insurance continuation coverage be offered to employees, their spouses, their former spouses and their dependent children when group health coverage would otherwise be lost due to specific events. Continuation coverage must be made available for 18, 29, or 36 months. Although generally expensive, COBRA can be an excellent alternative for individuals who cannot obtain an individual or self-employed medical insurance policy due to pre-existing health conditions. For COBRA eligibility rules and other details, visit our research center.

Conversion policy

For individuals currently covered under an employer (group) health insurance plan that are leaving the employer, it might be possible to convert the job-based health insurance plan to an individual medical insurance policy. This is called “conversion” coverage. It is not the same COBRA continuation coverage because benefits are usually reduced or limited. Contact your employer or employer (group) health insurance carrier for information.

HIPAA coverage – Pennsylvania

The Health Insurance Portability and Accountability Act (HIPAA) guarantees the right to purchase private major medical insurance to “HIPPA eligible individuals,” regardless of their health status. HIPAA also prohibits medical insurance companies from excluding or restricting coverage for pre-existing conditions. This is important because most private health insurance is currently medically underwritten, except for children less than age 19 as explained above. Consequently, individuals 18 and older with medical conditions may not qualify.

A “HIPAA Eligible Individual” is someone who has/ is:

  1. Had continuous (no break in coverage for 63 days or longer) credible medical insurance coverage for at least eighteen months with the most recent coverage being under a group health plan,
  2. Lost group coverage due to circumstances other than fraud or non-payment of premium (whether you quit your job, were fired or laid off does not matter),
  3. Elected and exhausted COBRA continuation coverage, if eligible (employers less than 20 employees are not subject to COBRA),
  4. Not be eligible for coverage under another group health plan, Medicare or Medicaid, and
  5. Not currently covered under a medical insurance plan

In Pennsylvania, “HIPAA eligible individuals” may purchase individual medical insurance directly from Blue Cross Blue Shield.  They are required of offer individual major medical regardless of a person’s health status. For more details regarding HIPAA visit our research center.

Medicaid – Pennsylvania

Medicaid offers healthcare coverage to certain people with limited income that meet Pennsylvania’s Medicaid eligibility requirements. Generally, children and parents, pregnant women, people with disabilities, and seniors are included. Medicaid programs are run by states with a mix of state and federal funding. There are certain core rules all states must follow, but some Medicaid rules vary by state.

Since most states are currently facing severe budget deficits, Medicaid eligibility rules and benefits provided under the program may have recently changed. Please visit Pennsylvania’s Medicaid program for current information and details.

State Children’s Health Insurance Plan – Pennsylvania

If you are seeking health insurance for your children, President Obama signed the Children’s Health Insurance Bill on February 4, 2009. It enables millions of children to receive health insurance. The eligibility rules for the Children’s Health Insurance Plan are unique because every state has its own program and rules. Generally, uninsured children 18 years old and younger whose families earn up to $44,500 a year (for a family of four) are eligible for free or low-cost health insurance that pays for doctor visits, dental care, prescription medicines and hospitalization.

Since most states are currently facing severe budget deficits, eligibility rules and benefits provided under Pennsylvania’s Childrens Health Insurance Plan may have recently changed. Please visit Pennsylvania’s State Childrens Health Insurance Plan for current information and details.

Pre-Existing Condition Insurance and High Risk Pool Plans (PCIP) – Pennsylvania

The PCIP is a new program offered in every state under the new healthcare law. It can be administered by either states or the Federal government. The PCIP may be able to help you if are unable to qualify for individual major medical insurance. You may qualify if you have been:

  1. Uninsured for at least six months
  2. Have a pre-existing medical condition(s), and
  3. Have been denied coverage (or offered insurance without coverage of the pre-existing condition) by a private health insurance company.

PCIP covers major-medical and prescription drug expenses. You’re responsible for paying premium, deductible, copayments, and coinsurance amounts. PCIP will not cost you more just because of your health condition. PCIP is not based on income eligibility like Medicaid.

Visit Pennsylvania’s Pre-Existing Condition Insurance Plan for details.

Guaranteed Health Insurance

Guaranteed Health Insurance, also called Mini-Med, Limited Benefit or Pre-Existing Condition Medical Insurance is another option if you are unable to qualify for individual major medical insurance. Since most Guaranteed Health Insurance Plans are not medically underwritten acceptance is guaranteed.

While considered supplemental medical insurance, not major medical insurance, these plans typically pay a fixed dollar amount for covered healthcare expenses, such as physician office visits, diagnostic services, lab, x-ray, surgery, inpatient confinement and wellness.

Individuals purchase Guaranteed Health Insurance because they:

  • Cannot qualify or afford individual major medical insurance
  • Want to save money on healthcare expenses by paying reduced fees (discounts with participating healthcare providers can range from 10 to 25% and eliminate balance billing- owing the healthcare provider the difference between their retail charge and the rate negotiated by the preferred provider network)
  • Want an ID Card to gain access to the healthcare system in the event that unexpected medical care is needed.
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