How it works: Choosing an Affordable Care Act plan for 2023
David BruceHow It Works is a recurring feature from the Erie Times-News that explains how government, organizations, processes, ordinances and more work. Email your questions to newsdesk@timesnews.com.
Uninsured northwestern Pennsylvanians who don't qualify for Medicare or Medicaid now have an opportunity for the 10th straight year to purchase health insurance through the federal government's Affordable Care Act, also known as Obamacare.
Erie County residents can choose from among 96 different insurance plans for coverage in 2023, while Crawford County residents can select from among 51 plans. They are offered by Highmark, UPMC and United Healthcare.
The plans are not free, but nine out of 10 people receive subsidies that have been extended through 2025 by the government's Inflation Reduction Act. Those subsidies lower the monthly cost of plans to less than $75 for 40% of Pennsylvania subscribers.
How it works:Erie County ordinances: What are they and how can the public get involved?
Am I eligible for an ACA plan?
You are eligible for health insurance through the ACA if you are a U.S. citizen, not incarcerated, and not eligible for Medicare.
People or families who are eligible for health insurance through an employer can still purchase an ACA plan, but they are not eligible for any subsidies if the coverage is considered affordable — less than 9.2% of the household income.
During the enrollment process, if you are found to be eligible for Medicaid, you will be directed to enroll in that government program instead of an ACA plan.
How do I enroll in an ACA plan?
In Pennsylvania, people can enroll in an ACA plan by visiting pennie.com. It's a website the Pennsylvania Insurance Department created in 2020 to enroll residents in ACA plans.
People can also call 844-844-8040 to talk with one of Pennie's customer service representatives.
Before starting your application, you will need the following items:
- Photo ID
- Social Security card number
- Four weeks of pay stubs
- Most recent tax return
- Immigration documents, if applicable
More:The Case for Medicare for All: Congress passes an inflation bill but is it enough?
Which health plan should I pick?
The health plan you choose depends on several factors, including the cost of the monthly premium, the out-of-pocket amounts, and the physicians, hospitals and prescription drugs that are included.
ACA plans are grouped into four basic categories:
- Platinum (highest premiums, lowest deductibles)
- Gold (higher premiums, lower deductibles)
- Silver (lower premiums, higher deductibles)
- Bronze (lowest premiums, highest deductibles)
You can compare plans without submitting your personal information, but you will have to submit it to select a plan. You should have a list of your prescription drugs and your physicians when you compare plans.
The site will give you an expense estimate of how much you could expect to pay for the year if you select that particular plan.
"We encourage consumers to research and compare plans to find coverage that best fits their needs and provides robust benefits for themselves and their families,” Pennsylvania Acting Insurance Commissioner Michael Humphreys said in a news release.
More:Biden administration to spend $99 million on navigator grants to bolster Obamacare outreach
When is the deadline for picking a plan?
The deadline for selecting an ACA plan for 2023 in Jan. 15, but if you want coverage beginning Jan. 1, you need to choose a plan by Dec. 15.
People who experience a "life qualifying event" can choose a plan at other times of the year. These events include losing your existing health coverage, getting divorced, moving, or an income change that affects the coverage for which you qualify.
Contact David Bruce at dbruce@timesnews.com. Follow him on Twitter @ETNBruce.