Editor's note: This story was originally posted Oct. 24, 2019. The deadline for 2020 open enrollment is Sunday, Dec. 15.
Next year’s plans for Lancaster County residents who buy their own health insurance have been finalized, and it’s a mixed bag.
There will be a lot of new options when enrollment begins Nov. 1. Some will be cheaper than 2019 offerings, but those will generally exclude some area health systems.
Federal premium subsidies will be down a bit. People who want plans that include all area health systems may have to pay more for them. And, depending on age and income, some people may still be able to get plans with $0 premiums but big deductibles.
As always, experts say people may save hundreds or thousands of dollars by shopping around — and suggest starting early and getting help if needed.
“We often hear from consumers who don’t think they would receive financial assistance, only to find out that they do,” said Pennsylvania Insurance Commissioner Jessica Altman.
Here’s what you need to know about the 2020 open enrollment period, which will run from Nov. 1 to Dec. 15.
Start looking now
The state site is currently providing quick online estimates without registration, after just a few questions on things like ZIP code, age and expected household income. The federal site will offer similar “window-shopping” shortly before Nov. 1.
Both sites can also check for coverage of certain medications or doctors, although experts advise confirming network status with providers.
Financial assistance that often amounts to hundreds of dollars a month is available only through the federal site. However, that site doesn’t include qualifying plans offered directly by insurers, which may be cheaper for those who make too much to get financial help.
The state site, by contrast, shows all qualifying plans. Plans not listed on the state site do not meet Affordable Care Act coverage requirements.
There are a lot more plans to choose from — 26 on healthcare.gov for most people, up from 18 this year. That’s not counting “catastrophic plans,” which are only for those who are under 30 years old or have a hardship exemption.
The increase comes from Highmark doubling its offerings.
Metal descriptors are used to classify plans; bronze generally has the lowest premiums and highest deductibles, with gold having the highest premiums and lowest deductibles, and silver in between.
But Joshua Brooker, CEO of Lancaster-based health insurance agency PA Health Advocates LLC, noted that in some cases, subsidies may result a gold plan having a lower deductible and net premium than silver ones do.
Plan networks and changes
The four major health systems that Lancaster County residents use are Penn Medicine Lancaster General Health, Penn State Health (including Hershey Medical Center), UPMC Pinnacle and WellSpan Health.
Here’s an overview of networks and changes for 2020.
- Capital BlueCross: All four systems are in-network. It’s making biofeedback therapy an option for certain chronic pain conditions and as an alternative to opioids, adding it to current offerings of acupuncture and spinal manipulation therapies.
- Geisinger: All four systems are in-network for Lancaster County (but UPMC Pinnacle is not in-network for commercial members in Dauphin County). It’s making minimal cost share changes.
- Highmark: In the immediate area, only Lancaster General and Penn State are in-network for Direct Blue plans, but Blue Access plans let people use all four health systems. It’s strengthening preventive care coverage, with some plans offering a few primary care or mental health visits, telemedicine visits and certain prescription drugs at no cost.
- UPMC: In the immediate area, only Lancaster General and UPMC Pinnacle are in network. It's expanding a no-cost wellness program for members who have diabetes or diabetes risk factors.
EPO, HMO, POS & PPO
The below 2-minute video from Pennsylvania Department of Health explains the differences between these types of plans. Healthcare.gov has an explanation too.
Two types of federal assistance are offered, advance premium tax credits and cost-sharing reductions. Some people can get both. See graphic.
It’s important to note that the tax credits, which are also called premium subsidies, are based on estimated income, then reconciled at tax time. Earning just $1 more can require paying back hundreds or thousands of dollars, so it’s important to be accurate — and using IRA contributions to keep taxable household income below the subsidy cap can be helpful.
Where to get help
The national call center for people seeking over-the-phone assistance enrolling is 1-800-318-2596.
Some area nonprofits, agents and brokers also offer help enrolling. Localhelp.healthcare.gov/#/ has a list.
Pennsylvania Health Access Network has a free helpline at 877-570-3642. And Lancaster Health Center has three counselors who can help people apply, with appointments available by calling 717-299-6371.
In the midst of an awful lot going on in the country, health insurance open enrollment under the ACA starts in a week on November 1. We have dozens and dozens of FAQs to help.https://t.co/PKpsUPjZtu— Larry Levitt (@larry_levitt) October 24, 2019