On July 2nd, 2019 the Pennsylvania Senate passed Act 42, paving the way for Pennsylvania to take back control of its healthcare from the federal exchanges. When Obamacare, the ACA, was initially introduced in 2010 it gave each state a choice to lean into Healthcare.gov or create their own exchange. To opt-out of healthcare.gov, a state needed to apply for a waiver and show that it can reduce the costs to the fed and provide a better solution. Like many states, PA has waited for markets to stabilize before they felt confident to evaluate what is working and what isn’t in our state. The truth is moving to a state-based exchange has major implications for the 700,000 people enrolled in Medicaid and the over 400,000 people enrolled in Qualified Health Insurance on healthcare.gov. But we think we’re ready.
What are the changes?
Open Enrollment Timeline: For the past several years Open Enrollment for the marketplace has been November 1st – December 15th with a January 1st effective date for all enrollments. This year Pennie will add an additional timeline, above the initial period, December 16th – January 15th with a February 1st effective date. So, while you have more time to pick a plan for 2021, be mindful that enrollments after December 15th could leave you uncovered for January. Alternatively, your prior coverage may continue for the month of January at a new rate you have not physically signed up for.
New Website: For all individuals looking for 2021 coverage, you will need to transition from Healthcare.gov to setting up a new login on Pennie.com. Don’t be scared of moving to a new system. One benefit of Pennsylvania waiting to go to a state-based exchange is that behind the face of Pennie.com is software by the company GetInsured. GetInsured works with state-based exchanges and already partners with California, Idaho, Washington, Minnesota, and Nevada to manage their exchanges. Unlike the rocky start of the first few years of healthcare.gov, GetInsured has got this process down to ease your transition to Pennie.com. In addition, Healthcare.gov is migrating all of your data over to Pennie so that you don’t have to start from scratch. If you are working with a broker, assume no real changes other than the logo’s on your notices. If you go it alone, you will have to set up a new login at pennie.com to see plans and enroll.
Plan Rates: On the Pennsylvania Insurance Departments website we are already seeing some benefits of Pennie. Insurers have chimed in with the impact of the exchange, and they are pleased. On 8/4/2020 PA released proposed rate changes for the 2021 plan year. Capital Blue Cross is asking for between a 14.3% and 15.5% reduction in last year's premiums. Highmark, the prior years' lowest cost option is looking for between .70% and 15.6% reductions. Finally, Geisinger is asking for between 11.28% and 13.57% reductions. This bodes well for consumers looking to find affordable options this year.
What stays the same?
Plan Selection: Can it be too easy? GetInsured promises to make Pennie.com an easy system to get in, pick a plan, and enroll. The trouble is, when processes are too watered down, unique scenarios like not qualifying for tax credits, foreign nationals, and low-income planning can be more difficult. In addition, just because it is easy to see a plan doesn’t mean understanding which plans work with which providers is easy.
Incomplete Data: Much like the Healthcare.gov platform, GetInsured relies on the data.healthcare.gov data to give you a clear picture of which providers and drugs are in-network. The problem is these datasets can be off.
Don’t go it alone: Health Insurance Brokers are certified to help you find a plan. They spend all year keeping abreast of regulatory changes and they tend to be more in tune with local politics to ensure you aren’t enrolling in a plan that doesn’t account for your providers. Also, common mistakes while enrolling can be thwarted when the broker you are working with has access to advanced support teams and contacts at both the state and federal levels to correct issues.
All advice isn’t created equally: Community Based Navigators and Assisters are primed and ready to help the most vulnerable low-income populations get setup and ready to go with Medicaid, CHIP, and Subsidized Healthcare. If you’re in this category or have relatively simple inputs (one w2 and healthy) these resources are a great start. For those with more complex scenarios like specialists in multiple health networks, several different income changes, foreign national status, employer HRA compensation, self-employed income, alternate claiming dependents with an ex-spouse, etc., lean on a Broker with a wide product shelf to ensure you are getting a full picture of plan options and having your situation compared thoroughly.
The Conclusion?
Yes, we are moving from Healthcare.gov to Pennie.com. But, we are moving from an established system to an established system that will reduce overall costs to consumers. If you are overwhelmed, using a Broker, Assistor or Navigator will help to ease that burden. They can be a resource year-round to answer questions and solve problems that are out of your depth. Finally, your key dates are Nov 1 – Dec 15 for Jan 1 coverage or Dec 16 – Jan 15 for Feb 1 coverage. As we always say, you have until mid-December, but don’t wait. If your broker has 300 meetings in 31 business days, be sure you have a slot.