The enrollment period on the federal health care exchange began Saturday and ends Feb. 15.
During the first enrollment session from October 2013 through March, more than 317,000 Pennsylvanians signed up for coverage through a policy sold on the exchange, nearly double the target set by the federal government. The U.S. Department of Health and Human Services has not disclosed its enrollment target for the new signup period, and it has not said how many of Pennsylvanians remain on an insurance plan sold on the exchange.
Here are five things to know about the upcoming open enrollment session in Pennsylvania:
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PRICES, CHOICES AND COMPETITION
Pennsylvania residents will have more plans to choose from in the nine regions under the state’s federally run marketplace, according to health care advocates. Coverage begins as early as Jan. 1, 2015, for people enrolling by Dec. 15. In western Pennsylvania, the monthly premium for a benchmark silver plan rose by $1, while in other areas it rose by up to 8 percent, said Antoinette Kraus, executive director of the Pennsylvania Healthcare Access Network.
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NEW FOCUS
Health care advocates say they will be strengthening their focus on harder-to-reach populations this year, including those in more rural areas and immigrants.
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ASSISTANCE
Consumers can start searching for a plan at Healthcare.gov, and people who want to find counselors to help them through the sign-up process can enter their location online at https://localhelp.healthcare.gov.
The U.S. Department of Health and Human Services has distributed $2.4 million this year in grants to six groups to help enroll people in Pennsylvania. Those groups are: the Pennsylvania Association of Community Health Centers, the Pennsylvania Mental Health Consumers’ Association, the National Healthy Start Association, Penn Asian Senior Services, Young Women’s Christian Association of Pittsburgh and the Consumer Health Coalition.
The Pennsylvania Health Access Network maintains a hotline at 877-570-3642, the Pennsylvania Mental Health Consumers Association at 855-274-5626, Insure PA at 855-486-9331 and the Pennsylvania Association of Community Health Centers at 866-944-2273. The Pennsylvania Health Access Network website at pahealthaccess.org/gethelp allows people to set up an appointment. Also, Pennsylvania Association of Community Health Centers has staff deployed to at least 200 health clinics around the state where people interested in signing up can get assistance. Find out where at www.pachc.org/outreach_directory.html.
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RENEWING COVERAGE
The federal government has developed an auto-enroll option that allows those who already have coverage through the exchange to remain in their plans, but Pennsylvania health care advocates are urging residents to take another look at their options. Advocates say people may need to update their financial information or other details to ensure they’re getting the right subsidy or best plan.
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WHAT’S COVERED
Generally, benefits include coverage for things like doctor visits, prescription drugs, hospitalization, maternity and newborn care and preventive care.
Just like last year, there are five categories or metal levels of coverage including bronze, silver, gold, platinum and catastrophic. Plans in each category pay different amounts of the total costs of an average person’s care. Plans are generally divided up by region and type. Each metal plan is assigned a category (bronze, silver, gold and platinum) based on cost sharing. In general, the monthly premium for a bronze plan is lower, but the deductible is higher. Platinum premiums are higher, but the deductible is lower. According to the Department of Health and Human Services, bronze covers 60 percent of the total average costs of care, silver covers 70 percent, gold covers 80 percent and platinum covers 90 percent. You cover the rest.
If you expect a lot of doctor visits or need regular prescriptions, you may want a gold or platinum plan that have higher monthly premiums but pay more of your costs when you need care. If you don’t expect to use a lot of medical services, you may want a silver, bronze, or catastrophic plan that cost you less per month, but pay less of your costs when you need care.
Catastrophic coverage is available only to people who are under 30 years old or have a hardship exemption.
Health plans do not have to include adult vision or dental coverage, only pediatric vision and dental coverage. If your plan doesn’t include adult vision or dental coverage, you can buy stand-alone plans for an additional cost outside the exchange.
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