Pennsylvania Health Insurance

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Health Insurance for the Well Informed

Celtic Insurance Company

Uninsured Pennsylvanians

With the rising cost of health insurance, 10% of Pennsylvania does not have health insurance. This is a 5% better rate than the national average, but it still means that 1,263,460 Pennsylvanians are without health insurance according tothe Henry J. Kaiser Family Foundation. Lower rates of employer-sponsored health insurance have drastically hurt the uninsured rate. According to www.rxforpa.com, 71% of uninsured Pennsylvanians ARE employed.

Individual Health Insurance

The percent of Pennsylvanians buying individual health insurance increased by 0.7% in 2004, and is still on the rise today. As a result, Pennsylvanians need to be more informed about their health insurance options, and Health Plan One can help.

Many health insurance companies offer individual health coverage to people who either are self-employed or work for a business that does not offer health insurance. In Pennsylvania, medical underwriting is allowed without restriction. Medical underwriting is the process that an insurance company uses to decide, based on your medical history, whether or not to take your application for insurance, whether or not to add a waiting period for pre-existing conditions and how much to charge you for that insurance. There is a 60 month look back and 36 month exclusionary period for preexisting conditions for those without prior health insurance.

Pennsylvania does not have a high risk pool; however, BCBS does offer health coverage for the otherwise medically uninsurable on a guaranteed issue basis.

Family Health Insurance

According to Governor Rendell’s Prescription for Pennsylvania Plan, the average cost of family health insurance premiums increased by 75.6% between 2000 and 2006. At the same time, the increase in median wages was only 13.3%.

For more on "Prescription for Pennsylvania" See Below. (Pennsylvania Health Insurance in the News)

If you work for a company that offers a group health insurance plan, or even a choice of plans to its employees, obtaining health insurance may not be a problem. In Pennsylvania, medical underwriting is allowed with a variance of up to 300% of the base rate. There is a 6 month look back and 12 month exclusionary period limit for preexisting conditions for those without prior healthcare.

Pennsylvania offers COBRA, the Consolidate Omnibus Budget Reconciliation Act of 1985. COBRA allows the person (and their dependents) enrolled in a group policy the right to continue in the group coverage on a temporary basis after the departure from an employer with 20 or more employees. COBRA does not apply if the employer terminated the plan. Also, if the employer goes out of business and cancels the plan or fails to pay the premium, the coverage stops and COBRA does not apply. Again, COBRA only applies when the group policy remains in force.

Medicaid is a joint state and federal program for public assistance to eligible people, regardless of age, whose income and resources are insufficient to pay for health care.

Income requirements

Children (ages 1-5)-133% of the Federal Poverty Level
Children (Ages 6-19)-100% of the Federal Poverty Level

Pregnant Women and Infants

Pregnant Women-185% of the Federal Poverty Level
Infants (ages 0-1)-185% of the Federal Poverty Level

Parents at 33% of the Federal Poverty Level

Other populations

Medically Needy Individual- 59% of the Federal Poverty Level

Medically Needy Couple- 46% of the Federal Poverty Level

Supplemental Security Income Recipients- 74% of the Federal Poverty Level

Aged, blind, and disabled- 100% of the Federal Poverty Level

Covered Services

Inpatient and outpatient hospital care, rural health clinic services, laboratory and x-rays, physicians’ services, early periodic screening diagnosis and treatment, family planning, chiropractic services, podiatry, optometry, home health services, substance abuse treatment, psychiatric services, ambulatory surgical centers, school-based clinics, renal dialysis care, dental services, prescription drugs, prosthetics and orthotics, vision care, hearing services, nurse midwife services, ambulance services, federally qualified health centers, and case management.

There are no co-payments.

You may learn more about Pennsylvania Medicaid at http://www.dpw.state.pa.us/OMAP/.

Pennsylvania offers the CHIP program for children under the age of 19 whose family income is up to 235% of the Federal Poverty Level. The children must be residents of Pennsylvania, be a U.S. citizen or legal resident, and not be eligible for Medicaid. Please visit the CHIP website for more detailed information at http://www.ins.state.pa.us/ins/cwp/view.asp?a=1279&q=527075&insNav=|.

AdultBasic is administered by the Pennsylvania Insurance Department and offers basic benefits for adults ages 19-64 and are within income guidelines and eligibility requirements. More information about AdultBasic can be obtained by calling 1-800-GO-BASIC.

"Governor Rendell Announces Another Record Growth Month for Expanded CHIP Program"

"Governor Rendell Unveils Historic "Prescription for Pennsylvania" to Provide Access to Affordable, Quality Health Care for all Pennsylvanians."