The enrollment period for 2025 state-based insurance coverage is now underway. Previously known as federal marketplace insurance, Pennsylvania is using a state-based insurance program known as Pennie for 2025 coverage. Pam Laye, supervisor of Outreach and Enrollment at Keystone Health, answers some frequently asked questions about insurance enrollment below.
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 a fall, a car accident or playing sports could cost you $7,500 if you are uninsured. 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 and when will coverage begin?
Pennie opened November 1 and will remain open until January 15 for coverage to begin on February 1. If you enroll before December 15 your coverage will begin January 1.
After January 15, 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.
Who is eligible to apply for Pennie insurance?
Anyone living legally in Pennsylvania is eligible to apply for insurance through Pennie.
Where can I learn more about Pennie?
To learn more about this program, visit www.pennie.com or call 1-844-844-8040. During the open enrollment period, this number is staffed from 8:00 A.M.-7:00 P.M. Monday-Friday, and Saturdays 8:00 A.M.-1:00 P.M. After the open enrollment period ends, phone lines are staffed Monday-Friday 8:00 A.M.-6:00 P.M.
What are the main options when it comes to plans?
In Franklin County there are three options for 2025: Capital Blue Cross, Highmark and Geisinger. All three companies offer Preferred Provider Organization (PPO) plans, which means if you go to a provider who accepts your 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 also offering an Exclusive Provider Organization (EPO) plan. This means if you go out-of-network, insurance is not going to cover your service, and you will have to pay full price.
Geisinger is offering a Health Maintenance Organization (HMO) plan in addition to the PPO option. HMO plans limit coverage to providers who work with that plan, and you must have a primary care provider assigned in order for the HMO plan to cover your services.
The deductible and out-of-pocket cost are about the same for all plan options which could be as high as $15,800 and as low as $2,000 depending on your plan.
What about dental and vision insurance?
Vision and dental options are included in some plans. In addition, dental plans can be purchased without purchasing a medical plan.
Do I need to do anything if I enrolled last year?
If you were enrolled in a Pennie plan last year, you will be auto-enrolled unless you make a change. It’s always a wise decision to look at what is available for the coming year.
If I choose to be uninsured is there a penalty?
There is no longer a penalty for being uninsured, but keep in mind what was said above. No one plans to get sick or hurt, but an unexpected medical expense could put you in a lot of debt. Many times, these debts take years to pay off. Having health insurance is a way to protect yourself and your family from the burden of this possible outcome and gives you more peace of mind about finances if you do have a medical emergency.
How do I enroll?
There are several ways you can enroll. Most people choose to enroll online at www.pennie.com but you can also enroll by phone or with a trained helper or Certified Application 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 Application Counselor.
Brokers and agents can also help complete applications, but there is typically a fee for this type of assistance. There is no cost or charge if you use a certified counselor at Keystone.
