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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.

Updated: 2020-07-16 by

The Affordable Care Act, also known as Obamacare, has not been struck down or repealed.

The news has been full of uncertainty about the future of the Affordable Care Act (Obamacare) as the law once again sits before the U.S. Supreme Court. However, a ruling on that case is still months away, and changes under the incoming Biden administration could end the case before the court decides it.

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. Open enrollment has ended for 2021 health care plans, but you can still get health insurance if you qualify for a special enrollment period.

In Pennsylvania, the ACA open enrollment period ended on January 15, 2020. This means that, unless you qualify for an exception, you won't be able to get health insurance through Pennsylvania's health insurance exchange, Pennie, until the 2022 open enrollment period begins in the fall of 2021.

If you’ve lost your job or significant income in the past 60 days, whether due to the COVID-19 crisis or for any other reason, you might qualify for a special enrollment period that will allow you to sign up for a new health insurance plan or to change your current plan.

To learn whether you qualify for a special enrollment period, 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. Your 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.

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.

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 years back, the Trump administration drastically cut funding for programs that provide help with health insurance enrollment. But that doesn't mean you have to fend for yourself when finding and signing up for health insurance. To connect with local support resources, see How To Sign Up for Obamacare in Pennsylvania.

 

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Pennsylvania: Law