What Pennsylvania Residents Need to Know About Obamacare for 2022

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

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How To Sign Up for Obamacare in Pennsylvania
 
Do I Have to Get Health Insurance in Pennsylvania?

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Last Reviewed: Mon, Aug 15, 2022

In Pennsylvania, Affordable Care Act (Obamacare) open enrollment is over, but you may still qualify for 2022 coverage.

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. Pennsylvania open enrollment has ended, but you may be able to use a special enrollment period to get covered.

In Pennsylvania, open enrollment for 2022 Affordable Care Act (Obamacare) coverage has ended. This means that, unless you qualify for an exception or your income is low enough for Medicaid, you won't be able to get health insurance through Pennie until open enrollment for 2023 begins next fall.

If you’ve lost your job or significant income in the past 60 days, whether due to the COVID-19 pandemic or for any other reason, you might qualify for a special enrollment period (SEP). A SEP allows you to sign up for a new health insurance plan or change your current plan outside the open enrollment window.

In addition to job or income loss, many other qualifying events may make you eligible for a SEP. To learn more, see What Happens If I Missed the Pennsylvania Obamacare Enrollment Deadline?

2. You may qualify for new Affordable Care Act subsidies.

Last year, President Biden signed the American Rescue Plan Act (ARPA). The law provides $1.9 trillion of federal aid to Americans struggling with the COVID-19 crisis. The relief measures include additional premium subsidies for those who purchase health insurance through Pennie. People who apply for 2022 coverage under a special enrollment period can access these subsidies. (Under the Inflation Reduction Act, the additional subsidies are set to expire at the end of 2025.)

Federal tax credits. Until the passage of ARPA, the ACA provided premium subsidies only to those whose income fell between 100% and 400% of the federal poverty level. For example, the cutoff for a family of four in Pennsylvania used to be $104,800. For an individual, it was $51,040.

At least through 2022, no one will have to pay more than 8.5% of their household income for a mid-level plan purchased from Pennie. Technically, the subsidies are tax credits, but you can choose to have them automatically deducted from the cost of your monthly premiums when you purchase a plan through Pennie.

Cost-sharing subsidies. More than half of the people who purchase coverage through Pennie receive assistance in the form of cost-sharing reductions (CSRs). CSRs automatically reduce your premiums and lower your costs when you use your insurance benefits—for example, when you go to the doctor, get lab work, or have to stay in the hospital.

CSRs are available to people who make between 100% and 250% of the federal poverty level. (For 2022 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.) But they are available only on silver plans. If you think you may qualify, look carefully at costs for the silver plans available at Pennie while shopping for coverage.

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

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

3. In Pennsylvania, there are many marketplace plans to choose from and average premium costs are remaining stable.

For 2022, the number of insurers offering coverage through Pennie has grown to 13. That doesn't mean everyone has 13 companies to choose from, however. Some counties have as many as four insurance providers offering plans, while a few counties must still choose among plans from a single carrier. Overall, premium rates have risen an average of just 0.2%.

4. You won’t face a tax penalty for going without health insurance in 2022—but there are big downsides to being uninsured.

Obamacare’s tax penalty went away in 2019. That means that if you don’t have health insurance, you won’t have to pay a penalty when you file your federal income taxes. That said, 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.)

5. Watch out for 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.

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

The Biden administration is greatly increasing enrollment assistance plans, 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.

 

Jurisdictional relevance: There are versions of this article for each State.
Selected State: Pennsylvania
How To Sign Up for Obamacare in Pennsylvania
 
Do I Have to Get Health Insurance in Pennsylvania?

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