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Benefit Plans

The plans offered through the Health Insurance Marketplace will be in four different categories: Bronze, Silver, Gold and Platinum. In general, as you move from bronze up to platinum, the monthly premium increases while at the same time, the out-of-pocket expense (deductible, coinsurance or copay) decreases. So it is important for one to decide if your situation dictates seeking a plan with lower monthly premium costs but higher out-of-pocket expenses, or if the opposite is true. Regardless of the plan that is selected, the 10 Essential Health Benefits will be included as part of the coverage. There will also be a "catastrophic" plan available that provides limited coverage and no opportunity for advanced tax credits or lower out-of-pocket expenses. This plan is available in limited cases and only for those under the age of 30 or those having met a financial hardship determination (For more information on this catastrophic plan, visit https://www.healthcare.gov/glossary/catastrophic-health-plan)

It is important to note that the plans purchased through the Health Insurance Marketplace are not applied retroactively to prior services. Coverage under the plan selected begins either the first of the month after selection or the month after that (depending on if the selection was made before or after the 15th of the month), and the receipt of the first monthly premium payment is required. This means that patients who arrive at a hospital for an emergent service with no insurance will not be able to have the selected plan applied for coverage of this visit. Patients in this circumstance may enroll in coverage for future services, but will be responsible for the prior services (there still remains the opportunity to apply for Medical Assistance through the Commonwealth of Pennsylvania to seek coverage for these visits.)

Those who enroll in the Health Insurance Marketplace will be required to provide information regarding anticipated annual income for the year of coverage (2014 in this open enrollment period). It will be important to provide an accurate estimate and update your application if this amount changes, as there is the potential for the IRS to require repayment of advance tax credits should your income not be within range of your estimated amount entered on your application.

Last Updated: 9/30/2013