Pennsylvania residents have the right to buy health insurance that will help pay for any hospital stays they may need.
Pennsylvania residents have access to health insurance either through their employer or individual plans that they may purchase. The Pennsylvania Insurance Department regulates insurance companies in the state and answers consumers' questions on its website and through a toll-free number (877-881-6388). The state follows federal insurance laws as well as enforcing some of its own.
Can Anyone Buy Individual Insurance?
In Pennsylvania, all residents have the right to buy individual insurance plans through Blue Cross and Blue Shield on a guaranteed-issue basis. Certain factors such as pre-existing conditions may limit your choice of plans, and force you to wait through an exclusion period. Residents who are eligible for coverage through HIPAA, the Health Insurance Portability and Accountability Act, would not have to wait through an exclusion period.
What Factors Help You Avoid the Waiting Period?
You may buy individual coverage from Blue Cross and Blue Shield with no waiting period for pre-existing conditions if you had 18 months of continuous coverage with no break of 63 days or longer, and during which at least the last day was under a group health plan. You also must have used up your COBRA continuation coverage, not be eligible for Medicare, Medicaid or any group health plan, and have no other health insurance.
What Are State Laws Regarding Pre-Existing Conditions?
If you change jobs and get coverage through a group plan with your new employer, your new insurance company may impose no more than one 12-month waiting period for any pre-existing condition for which you have received a diagnosis and treatment in the previous six months. The new insurance company must credit your prior insurance coverage toward the waiting period if you maintained continuous coverage with a break of no more than 63 days. That means if you had group coverage for a year with a break of no more than 63 days, the new insurance company may impose no exclusion period.
What Is A Self-Funded Group Plan?
The majority of employers buy group health plans through private insurance companies and pass along costs to employees. However, some employers may use company funds to pay employees' health-care expenses. The federal government regulates self-funded plans, while the Pennsylvania government regulates private insurance plans. Self-funded plans might not offer the same benefits as private plans.
Who is Eligible for Medicaid?
Pennsylvania residents are eligible for Medicaid if they meet certain requirements that relate to finances and status. Residents are eligible if they meet the income and resource thresholds and are age 65 and older, blind or disabled; have kids under age 21; or have other qualifying factors such as a temporary disability. Income and resources may not exceed a certain level depending on your eligibility category. For example, families with an infant may not have income that exceeds 185 percent of the federal poverty level. Families with children between ages 1 and 6 may not have income that exceeds 133 percent of the federal poverty level.
What are Other State-Subsizidied Insurance Programs?
CHIP, or the Children's Health Insurance Program, is a way for kids in Pennsylvania who have not yet turned 19 to have access to health insurance if their families' income is too high to qualify for Medicaid but too low to afford a policy through a private company. Another program, adultBasic, is for adults between the ages of 19 and 64 who meet income and other eligibility requirements.
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