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Pennsylvania Obamacare (Affordable Care Act) Facts 2021

What Pennsylvania Residents Need to Know About Obamacare for 2021

Essential facts about the Affordable Care Act (ACA or Obamacare) in Pennsylvania, including whether you must get health insurance, how much it will cost, and how you can save money.

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Updated: 2021-02-16 by

It's not too late! Affordable Care Act (Obamacare) enrollment will be OPEN in Pennsylvania from February 15 to May 15.

Pennsylvania has announced a special enrollment period (SEP) for health plan signups under the Affordable Care Act (Obamacare). This COVID-related enrollment period will run from February 15 to May 15. It mirrors the federal special enrollment period announced by the Biden administration, but Pennsylvania's SEP applies only to those who are currently uninsured.

This website provides information about getting health insurance under the Affordable Care Act (ACA), including:

To begin, keep in mind these key points about health insurance in Pennsylvania:

1. You can use the COVID special enrollment period to get covered under the Affordable Care Act, even though open enrollment is over.

Because of the COVID-19 pandemic, Pennie will be open for new Obamacare signups between February 15 and May 15, 2021. If you are currently uninsured, you can use this special enrollment period to get covered for 2021. To learn more about enrollment, see How To Sign Up for Obamacare in Pennsylvania.

If you already have health insurance. If you're already insured, you can change plans only if you have a "qualifying life event." Otherwise, you must wait until open enrollment for 2022 plans begins in the fall of 2021. To learn whether you qualify for a special enrollment period that will allow you to switch plans, see What Happens If I Missed the Pennsylvania Obamacare Enrollment Deadline?

2. You won’t face a tax penalty for going without health insurance in 2021—but there are big downsides to being uninsured.

Obamacare’s tax penalty went away in 2019. That means that if you didn’t have health insurance coverage in 2020, you won’t have to pay a penalty when you file your taxes this year.

However, even though there's no more tax penalty, think hard about whether it makes sense to forego health insurance. A medical crisis could knock the financial wind from your sails and do more damage than the penalty would. (A study published in 2019 showed that a lapse in health insurance coverage can double a person's chances of ending up in bankruptcy.) Even if you missed open enrollment for 2021, special circumstances may allow you to obtain coverage.

3. Pennsylvania's health insurance marketplace is located at Pennie.

In 2020, Pennsylvania rolled out its own health insurance exchange, Pennie, which is based on the HealthCare.gov platform. Running its own exchange gives the state more flexibility, including the ability to offer a longer open enrollment period.

During open enrollment, or whenever you qualify for a special enrollment period, you can use Pennie to choose your health insurance plan, apply for cost-saving tax credits, and get other help you need.

To learn more about enrollment, see How Do I Sign Up for Obamacare in Pennsylvania?

4. In Pennsylvania, there are many marketplace plans to choose from and average premiums have dropped, despite the pressures of the Covid-19 pandemic.

For 2021, eleven insurers offer coverage through Pennie. That doesn't mean everyone has eleven companies to choose from, however. Some counties have as many as four insurance providers offering plans, while a few counties must choose among plans from a single carrier. Most insurers have proposed rate decreases for 2021 premiums, though a few expect to slightly increase rates. The numbers show a proposed average decrease of 2.6% for plans offered across Pennie.

5. Premium subsidies are available to save you money.

Several forms of financial assistance can help you lower your health insurance premiums.

Federal tax credits. The federal government provides help with premium payments for those whose incomes fall between 100% and 400% of the federal poverty level. For example, for 2021 health plans, a family of four in Pennsylvania earning as much as $104,800 can qualify for subsidies, as can an individual who earns up to $51,040. Though the subsidies are tax credits, they are automatically deducted from the cost of your premiums each month, as long as you purchase your plan through Pennie.

Cost-sharing reductions. More than half of the people who purchase coverage through a health insurance exchange receive "cost-sharing reductions" (CSRs). Originally, these were payments the federal government made to insurance companies that allowed them to reduce deductibles and co-payments for lower-income Americans. In 2017, the Trump administration stopped paying for CSRs, but insurers and many state regulators found a creative way to keep the program alive—adding the costs to silver marketplace plans through a practice called “silver loading”—so CSR benefits remain available for 2020 insurance plans.

Keep in mind that cost-sharing subsidies are available only on silver plans. They will automatically reduce your premium if your income is no more than 250% of the federal poverty level. (For 2021 health plans, that means a family of four in Pennsylvania can't earn more than $65,500 and an individual not more than $25,520.) If you think you may qualify, look carefully at costs for the silver plans available at Pennie while you are shopping for coverage.

Medicaid. If your income is very low, you may qualify for free or low-cost coverage through Medical Assistance (MA) in Pennsylvania.

For more information, see Ways to Save Money on Obamacare in Pennsylvania.

6. Beware of insurance plans that don’t comply with the ACA!

In 2018, the Trump administration made it easier to purchase "short-term insurance plans" and a federal court recently upheld this move. Short term plans don’t have to cover preexisting conditions or the essential health benefits provided by Obamacare plans. In the past, short-term plans were allowed to last only three months but under new rules, you can purchase a non-ACA compliant “short term” plan that lasts as long as three years. Pennsylvania has defaulted to these new federal rules, though Pennsylvania's Insurance Commissioner has strongly spoken out against these plans.

If you’re genuinely caught without health insurance and need it for a few months to cover a new health condition, you might want to consider a true short-term plan to get you through to the next open enrollment period. Otherwise, be careful of plans that don’t meet the requirements of the Affordable Care Act and shop around to look for coverage that truly meets your needs.

Remember, if your income is very low, you may qualify for free or low-cost coverage through Medical Assistance (MA) in Pennsylvania.

7. You can get help signing up if you need it.

A couple of years back, the Trump administration drastically cut funding for programs that provide help with health insurance enrollment. But the Biden administration is expected to quickly reverse that trend, making it much easier to get the information you need to get covered. To connect with local support resources, see How To Sign Up for Obamacare in Pennsylvania.

 

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Philadelphia, PA: Law