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What You Need To Know About Marketplace Insurance Enrollment

Pam Laye

The enrollment period for 2020 Marketplace insurance coverage is now underway. While many people view the process as complicated, there are places to turn for help. Pam Laye, supervisor of outreach and enrollment at Keystone Health, answers some frequently asked questions in today’s article.

Why is it important to have health insurance?

No one plans to get sick or hurt, but almost everyone will need medical care at some point. Health insurance covers most costs, protecting you from unexpected, high medical bills and offers many other important benefits as well. You pay less for covered in-network health care, even before you meet your deductible. Without health insurance, you are faced with paying the bills yourself and those bills could amount to a lot of money and debt which could take you years to pay off.

A three-day hospital stay could cost you as much at $30,000 if you don’t have insurance; a broken leg from skiing, bicycling or playing sports could cost you $7,500 if you don’t have insurance. The American Diabetes Association estimates that the average cost of diabetes is $13,700 in medical expenses per person per year. To help address the affordability of health insurance, tax credits and cost-sharing subsidies are available from the government that may make premiums more manageable or may help lower out of pocket expenses such as co-payments at the doctor’s office or the pharmacy.

When is the open enrollment period?

The Marketplace opened November 1, and will remain open until December 15 for coverage to begin on January 1. After the Marketplace closes, you can enroll or change plans only if you qualify for a special enrollment period. Circumstances that may qualify you for special enrollment include: marriage, a birth, adoption or fostering of a child and a change in your current insurance, income or citizenship.

What are the main options when it comes to plans?

In Franklin County the only two options are Capital Blue Cross and Highmark. Capital Blue Cross plans which are  offered are Preferred Provider Organization (PPO) plans. This means if you go to a provider who accepts Capital Blue Cross insurance, you will pay a lower cost for care. If you go out of network (to a provider who does not accept your insurance plan) the cost will be higher than in network, but still lower than full cost. Highmark is offering only Exclusive Provider Organization (EPO) plans. This means if you go out of network, insurance is not going to cover your service and you will have to pay full price.

The deductible and out of pocket cost are about the same for both options which could be as high as $15,800 and as low as $2,000 depending on your plan.

When will my coverage begin?

If you enroll or change plans by December 15, 2019, your coverage will begin January 1, 2020.

Do I need to do anything if I enrolled last year?

If you do not update your application by December 15, 2019, you will probably be re-enrolled automatically. However, it is best to review your options every year. Prices and plans change annually and there may be a new plan that is more affordable for you. If the plan you selected last year is no longer available, you will likely be enrolled in a similar plan. It is important to make sure your healthcare provider accepts the plan you are using.

If I choose to be uninsured is there a penalty?

Starting with the 2019 calendar year, it was determined that there will not be a penalty for remaining uninsured. So if you do not have health insurance when you file your taxes after January 1, 2020, there will not be a penalty.

But keep in mind: No one plans to get sick, but most people will need health insurance at some point in their life. Health insurance covers most costs, protects patients from unexpected high medical bills and offers many other important benefits. Patients pay less for covered in-network health care, even before they meet their deductible or coinsurance, and pay a small co-pay when seeing a family physician. Without health insurance, patients are faced with paying health related costs themselves, which could amount to a lot of money and debt that could take years to pay off.

How do I enroll?

There are several ways you can enroll. Most people choose to enroll online at www.healthcare.gov but you can also enroll by phone, with a paper application or with a trained helper or certified Marketplace counselor. The department I oversee, Keystone Health’s outreach and enrollment department, is one community resource that provides this service for free. Our certified enrollment navigators can meet with you and walk you through the process, and can also help you complete charity applications. You can call (717) 709-7969 for further information or to schedule a free appointment to meet with a Keystone Certified Assistance Counselor.

Marketplace agents can also help complete applications, but there is typically a fee for the use of this type of assistance. There is no cost or charge if you use a Keystone Certified Application Counselor.


Antibiotic Awareness

November 18-24 is Antibiotic Awareness Week. Antibiotics save countless lives every year, and have been one of the most significant developments in the medical field in the last century. However, using them too frequently or when not needed can have serious consequences. Dr. Raghavendra Tirupathi, Medical Director of Keystone Infectious Diseases, shares some important information about how to protect yourself by using antibiotics safely.

What are antibiotics?

Antibiotics are medicines that help to stop infections caused by bacteria by killing the bacteria or by stopping bacteria from reproducing. Many times when people are sick, they expect their medical provider to prescribe them an antibiotic. For certain types of infections, antibiotics are extremely effective. However, antibiotics can only treat bacterial infections; they do not help infections caused by viruses. If you take antibiotics when they not necessary, it can lead to antibiotic resistance.

What is antibiotic resistance?

Antibiotic resistance is when bacteria change or adapt to the antibiotic, meaning the antibiotic will no longer be helpful against the virus. This is usually caused by using antibiotics too often or when they are not needed.

Using antibiotics responsibly could save your life. When bacteria become resistant to certain antibiotics, there are fewer options to treat deadly infections. Even minor infections can have fatal outcomes when effective antibiotics aren’t available. In the United States, antibiotic resistant bacterial infections lead to 23,000 deaths and more than 2 million illnesses annually.

What causes antibiotic resistance?

Some of the main causes of antibiotic resistance are: patients not taking antibiotics as prescribed or taking someone else’s antibiotics, healthcare providers prescribing antibiotics when they are not needed, patients not finishing their entire dosage of antibiotics, poor infection control in hospitals and clinics, unnecessary antibiotic use in agriculture and poor hygiene and sanitation practices.

How do I know if I need an antibiotic?

If you are ill and think an antibiotic may be necessary, always consult your healthcare provider and let them make that decision. Many common illnesses are caused by viruses, and taking antibiotics for these infections can do harm.

Some common conditions that are caused by bacteria that do require antibiotics are: strep throat, urinary tract infections and whooping cough.

Some common conditions that may require antibiotics are: sinus infections and middle ear infections.

Some common conditions that are caused by viruses and do not require antibiotics are: common colds, runny noses, bronchitis or chest colds in otherwise healthy patients, the flu and sore throats (that are not strep).

What are some ways to feel better when I don’t need antibiotics?

Some people get upset when their provider does not prescribe antibiotics, but he or she is doing that in your best interest when antibiotics will not be helpful. For viral infections, you can try over-the-counter medications (make sure you follow the directions carefully) while getting a lot of rest and drinking plenty of fluids. Upper respiratory infections (including sinus infections, ear infections, colds and bronchitis), can be soothed by using saline nasal spray or drops, avoiding smoking and secondhand smoke, breathing in steam from a hot bowl of water or shower, taking an over-the-counter pain reliever or decongestant and a warm, moist cloth over aching sinuses or ears.

For sore throats, try drinking warm beverages, gargling with salt water, using sore throat spray, and sucking on ice chips, popsicles or lozenges (for those not at risk of choking). For coughs, humidifiers or vaporizers, breathing in steam, lozenges and honey may provide some relief. (Never give honey to a child under 1 year of age.)

What can I do to protect myself from antibiotic resistance?

If your provider does prescribe you antibiotics, make sure you are closely following the directions. Finish the entire dosage, even if you are starting to feel better. Your healthcare provider should prescribe you the shortest period of antibiotics needed. Talk to your doctor if you have any questions or develop side effects to your antibiotics, including diarrhea, as it could be a sign of infection.

To combat antibiotic resistance, people should never share antibiotics, should practice good hygiene (wash your hands frequently, cover coughs, stay home when sick, etc.) and get recommended vaccinations, including the flu vaccine.

If healthcare providers and patients work together to use antibiotics responsibly, we can cut down the number of deaths from resistance and can assure these life-saving medications will be available to future generations. Please do your part in our battle against antibiotic resistance.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

Breast Cancer Prevention

 Dr. Carolyn Benenati

On average, one in eight women in the United States will develop breast cancer in their lifetime. Breast cancer is the second-most common cancer in American women with only skin cancer having more diagnosed cases each year.

When you consider these numbers, it can be scary for women to realize there is a good chance that they, or a close friend or relative, will develop the disease. The good news is there are precautions which can be taken to reduce the chance of developing breast cancer, and to catch the cancer early before it spreads.

Dr. Carolyn Benenati, OB/GYN at Keystone Women’s Care, shares some important information all women should know about breast cancer.

Breast self-exams

Adult women should be familiar with what is their “normal” breast. Breast self-awareness makes it possible to detect any changes. These changes would include pain, a lump, nipple discharge (not after stimulation of the breast) and redness of the breasts. Although not all these findings indicate a woman has a cancer, they should seek care with a health care professional if any changes are detected.

Breast self-awareness could include self-breast exams. There are no current recommendations for how often or if self-breast exams should be performed as studies indicate for average-risk women it may not reduce the risk of death associated with breast cancer. But 50% or more breast cancers are detected by women themselves. If a woman is still menstruating, the best time to examine the breast would be the week after her period.

It is best to take your time. Inspect the breast, looking in a mirror with your hands on your hips. Check for any skin changes, change in size of the breasts and dimpling of the skin. Feel for any lumps by using the pads, not tips, of your middle three fingers. Move in small circles, applying different levels of pressure to feel just under the skin and also deeper. You should check the entire area from the collar bone to the breast bone to the armpit to the ribs under the breast.


A mammogram is an x-ray that is used as a screening test for breast cancer, and is covered by most insurance plans. This screening test is used to detect cancer early in women without symptoms to reduce risk of the disease. According to The American College of Obstetricians and Gynecologists and The National Comprehensive Cancer Network, regular mammogram screenings should begin at age 40. Other organizations recommend mammograms should begin at age 45 or 50.

As an OB/GYN, I recommend my patients have annual mammograms starting at 40. In high-risk patients, such as someone who has several family members with breast cancer or a close relative with breast cancer who is younger than 50, earlier screening with mammograms or MRI may be recommended.

Mammograms should be performed until at least age 75. Discontinuation of annual mammograms should take into account the health status and life expectancy of a woman. In healthy older women, it makes sense to continue annual screenings in order to detect any cancer early.

Reducing the risk of breast cancer

Women can also reduce their risk for breast cancer by maintaining a healthy weight (a BMI of 18.5 to 24.9), by getting regular exercise, limiting or avoiding alcohol and breastfeeding if possible.

Women who are at higher risk for breast cancer can undergo genetic testing to identify if they carry a gene that places them not only for higher risk of breast cancer but also other diseases such as ovarian cancer. These high-risk women would include those with a close relative who was diagnosed with breast cancer under age 50 or multiple relatives with cancer. This testing is available at Keystone Women’s Care and most other OB/GYN offices.

Obtaining care when uninsured

If you do not have insurance and would like to have a mammogram, there is a program through the Cumberland Valley Breast Care Alliance (CVBCA) called the MammaGift Project which provides free mammograms to those who are uninsured. For more information about this program, call 717-263-7191. The CVBCA also supports and assists women in our area diagnosed with breast cancer, with health care and other associated costs during treatment.

Breast cancer in men

Though not nearly as common, men can get breast cancer too. About 2,600 men in the United States will be diagnosed with breast cancer each year, and about 500 will die from the disease. If men notice any changes in their chest area, including the changes mentioned above, they should see their healthcare provider as soon as possible.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

Preventing Dental Problems In Kids

Dr. Nana Odoom

If you’re a parent, you likely have a lot on your calendar – doctor’s appointments, kids’ activities, school projects and more. It’s easy to put off taking your child to the dentist when they aren’t having any problems. However, helping your child get in the routine of caring for their teeth each day, including regular visits to the dentist, is a very important step for their future.

Dr. Nana Odoom, Pediatric Dentist at Keystone Dental Care, and her colleague, Dr. Victor Amarteifio, often see children who have dental conditions which could be prevented. In today’s article, she shares what parents can do to help their children have healthy teeth and avoid painful, and sometimes costly, dental problems in the future.

What conditions do pediatric dentists treat?

Pediatric dentists primarily focus on treating toddlers, adolescents and all special needs patients. After four years of dental school to treat not only growing children, but children with additional medical needs and special needs patients of all ages, we receive two to three years of extra training with a great focus on orofacial growth and development. Our training focuses on enhancing our skills to best address all forms of behavioral challenges that a child or a special needs patient may present at a dental office. Those skills include advanced behavior guidance and management techniques, and sedation and treatment in a hospital setting depending on the needs of the patient.

Some of the most common procedures we perform are routine checkups and cleanings, treating caries (cavities), abscesses and swelling. We also see patients for traumatic injuries that may sometimes include needing stitches to the mouth and face as well.

What can parents do to help prevent childhood dental problems?

The best thing you can do is to establish a dental home as early as possible – find a pediatric dentist to see your child for regular care as soon as your child has their first tooth. This dentist will be able to establish a relationship of trust with your child from an early age and get to know them and their needs.

With my patients, I try to remember their hobbies and interests so we have something to talk about when they visit. If your child feels comfortable around his or her dentist, appointments are more enjoyable and less intimidating. If an emergency situation would ever arise, children usually feel much more comfortable being treated by their regular dentist instead of someone they are meeting for the first time.

Nutritional counseling is a major part in preventing cavities from the standpoint of a pediatric dentist. We encourage discontinuing bottle-feeding at 12 months of age.  Not putting your child to sleep with a bottle with anything other than non-flavored water is also beneficial to limiting the rate at which your child can get cavities. Also, cleaning your child’s teeth after night-time feeding is highly recommended. Children should definitely not share utensils with siblings, parents and other caregivers who have had cavities before or have active cavities. Minimizing processed carbohydrate food products helps to decrease your child’s ability to get cavities. Limiting frequent snack intake as well as sugary drinks (flavored water, juice, soda, sport drinks and flavored milk products) during the day will decrease cavity formation in your child.

Cleaning your child’s teeth twice a day with a fluoride-containing toothpaste, especially at night time, will help prevent cavities from forming in their teeth.

Parents can check with their county about water fluoridation in their neighborhood and have a conversation with their dentist to determine if further fluoride supplementation is necessary for their growing child.

What dental habits should parents teach their children?

Parents should start cleaning their child’s teeth as soon as the first tooth appears. They can use a toothbrush or washcloth, or can buy a finger brush which is a small, soft brush designed to fit on the parent’s finger. Even if your baby only has one tooth, you should still clean it. Be consistent with brushing every day.

After brushing their teeth at bedtime, they should not eat anything else and should drink nothing other than water.

As your growing child becomes more independent, parents should follow up afterwards to check if the brushing has been properly done.

What should parents know about taking their child to the dentist?

Contrary to popular belief, you should not wait until your child is 2 years old for their first dental appointment. You should schedule your child’s first dental appointment when his or her first tooth appears, or no later than 12 months of age.

Don’t wait to see a dentist until problems arise. Instead, be proactive. Make caring for your child’s teeth a regular habit, and make time to see their dentist twice a year. By getting into good dental routine, many problems can be prevented.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

111 Chambers Hill Drive Opening

Starting Monday October 28, Keystone’s newest facility at 111 Chambers Hill Drive (on the corner of Norland and Fifth Avenues in Chambersburg) will be open for business!

The first floor of the building will be operational at that time. The practices on this floor are:

  • Keystone Urgent Care
  • Keystone Pediatric Therapies including Audiology and Speech (which will be renamed Keystone Pediatric Developmental Center) and
  • Keystone Infectious Diseases, HIV/STD Services, and Keystone Community Outreach (these practices will be combined into one office named Keystone Community Health Services)

In November, Keystone Administration and Keystone Pediatric Dental will move into the second floor of the building.

If you have any questions, you can contact us at 717-709-7900.

111 Chambers Hill Drive

Diabetes Health Fair!

Join us for this FREE event on November 16th, 2019!

Protect Yourself From The Flu

Join us and Keystone’s Dr. Tirupathi on October 10th for this educational presentation!

Battlefield Acupuncture

People who live with chronic pain know the impact it can have on their daily lives. Not only does it affect the quality and enjoyment of life, but it can make everyday tasks difficult or impossible. With the opioid crisis continuing to grow, many people are looking for alternative treatment methods.

Dr. Michael Gaudiose of Keystone Family Medicine has seen first-hand the improvement acupuncture, specifically Battlefield Acupuncture, has made in many people’s lives.

Dr. Gaudiose learned Battlefield Acupuncture while serving as a Family Physician at Dunham U.S. Army Clinic and received additional training at Womack Army Medical Center in Fort Bragg, NC. He answers some frequently asked questions about the subject in today’s Take Care article.

What is Battlefield Acupuncture?

Acupuncture has been around for more than 5,000 years. While researchers are still studying to find the exact way acupuncture relieves pain, we do know that all pain is processed in the brain. There is evidence that acupuncture works by suppressing pain transmission signals and by releasing endorphins into the brain to suppress the feeling of pain and disrupt the pain signals.

Battlefield Acupuncture was developed in 2001 by Dr. Richard Niemtzow while on active duty in the United States Air Force. He was looking for an effective way to be able to relieve pain on the battlefield without having to carry a lot of supplies with him. He discovered that a specific sequence of needles, when inserted into the ears, could relieve many types of pain quickly and effectively.

How does it work?

In this type of acupuncture, instead of inserting needles into the part of the body that is in pain, needles are inserted into the surface of the ear. There is scientific evidence that the regions of the ear have a connection to distant body functions, and that that pain relief can be achieved through using ear acupuncture in the correct areas.

Very small needles are inserted into five specific areas of the ear. These needles have a flat head, (similar to a very small nail head), and will stay in your ear until they fall out on their own, usually in two to five days. Pain assessments are taken before and after treatment.

How long does it take to see results?

Some people get results immediately, while others notice their results in the hours and days after treatment. Data shows that 80% of people get at least a 50% reduction in pain level.

How long do the results last?

While some patients receive long-term relief after just one treatment, many require repeat treatments. Most patients will have several days of relief after the first treatment, and after multiple treatments their relief period often becomes longer. Most people report having pain relief for a few days to a month after treatment.

Is it painful?

The needles are so small that pain is not an issue for most patients. You may feel a slight pinch or minor discomfort, but this feeling goes away quickly.

When you leave the office the needles are usually not bothersome, but can become uncomfortable during certain activities such as talking on the phone or sleeping on your side. If they are causing discomfort you can remove them with tweezers or your fingernails.

What have patients said about their experience?

Some patients say they feel better than they have in years, and some have been able to reduce the amount of opioids they take.

I witnessed one patient who walked into the office bent over because of back pain, leaving the office walking upright due to the relief of acupuncture. It is important to note that this treatment does not work for everyone. A small number of people experience no relief after treatment. But in my experience about 90% of patients get at least some results from Battlefield Acupuncture.

Who is a good candidate for Battlefield Acupuncture?

If you experience any type of chronic pain, including migraines, you may benefit from it. People who are pregnant (or might be pregnant), or have a fear of needles are not recommended to undergo this treatment. If you have a bleeding disorder you should discuss this with your provider before deciding to try Battlefield Acupuncture. People who are on active military special mission programs (such as Flight Status) may have restrictions as well.

This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

October is Breast Cancer Awareness Month

Arthritis Of The Foot And Ankle

Dr. David Pagnanelli Jr.

Having arthritis can result in a great deal of pain and can affect the quality of life for those who have the disease. When arthritis is in the feet and ankles it can present a variety of challenges during day-to-day life, including an impact on mobility. The good news is that treatment is available.

Dr. David Pagnanelli Jr. of Keystone Foot and Ankle Center shares some information about how podiatrists can help patients with arthritis, and why seeing a doctor sooner rather than later is so important.

What is arthritis and what causes it?

Arthritis refers to a group of diseases that causes joint pain and swelling. There are more than 100 types of arthritis, but the most common form is Degenerative Arthritis, also known as Osteoarthritis. This arthritis comes into play when your cartilage, which should be smooth and slick to help your joints glide, becomes worn down.

A variety of factors affect one’s risk for developing arthritis and these factors include age, excessive weight, previous injuries and a family history.

How does arthritis affect the feet and ankles?

Everyone wants to walk, but arthritis can make walking difficult. All of your weight is transferred through the bones and joints of your ankles and feet. The excessive strain on these small joints can cause the cartilage to break down and can result in pain with every step you take. The bone on either side of the joint then starts to rub together, causing pain, swelling, stiffness and spurring.

How is arthritis in the feet and ankles treated?

Different types of arthritis are treated in various ways. Early treatment for osteoarthritis of the foot or ankle joints consists of specialized custom orthotics (shoe inserts). These hold your joints in an upright, aligned position during each step to reduce excess pressure and weight in one location on the joint surface. This helps create a more normal and functional walking pattern. We also use NSAIDS (pain relievers) and steroid injections to reduce inflammation and pain as well as bracing and taping to help stabilize the joint.

Surgical intervention is also an option for end-stage arthritis. Depending on the severity of the arthritis, we surgically treat these joints by either simply cleaning up the arthritic spurring, or completely fusing the joint. By completely fusing the joint you eliminate the micro-motion and the sliding of the bone on bone and therefore eliminate the pain. We also can place joint implants for certain joints like the toe joints and the ankle joint. These can only be placed in certain patients who qualify for them.

When is surgery recommended?

When the pain becomes constant and non-invasive treatments have not been sufficient, and/or when there is no more cartilage left in the joint and you begin to create large bone spurs as a result, surgery may be recommended.

Is it important to keep your joints moving when you have arthritis of the foot or ankle?

Although arthritic pain is caused by moving your joints, if you completely stop moving you will add to the stiffness and you will get muscle fatigue and atrophy (loss of muscle mass and strength). It is good to have an exercise program to keep your joints moving but not to the excess that it produces pain. Most patients find that aquatic exercises are the best to alleviate pain and keep joints moving.

What are some tips for living with arthritis of the foot or ankle?

Know your limits and don’t overstress your joints. Try and find a healthy balance of exercise and rest. Also, it’s important that you don’t wait to see a doctor until your pain gets so bad that it hurts with every step. If treated early, your doctor may be able to help you manage your symptoms before they become severe. If you wait until your pain becomes constant, it might be too late for non-invasive treatments and surgery could be needed.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.