Alyssa Lane
If you live in Philadelphia, Pennsylvania, there are several options for getting medical insurance. Firstly, you can apply for Medicaid, also known as Medical Assistance (MA), which provides health care services for eligible individuals based on their income, disability status, or need for long-term care. Alternatively, Pennie, Pennsylvania's official health and dental insurance marketplace, offers low-cost or no-cost health coverage options with open enrollment from November to January annually. Special enrollment periods may also be available if you experience certain life changes, such as losing your employer-provided insurance or a change in marital status. Additionally, if you have children, the Children's Health Insurance Program (CHIP) provides free or low-cost health coverage.
| Characteristics | Values |
|---|---|
| Pennsylvania's insurance marketplace | Pennie |
| Pennie's open enrollment period | November to January |
| Pennie's insurance coverage | Health and dental |
| Pennie's insurance cost | Low or no cost |
| Pennie's insurance application process | Online, in-person, on the phone, or through the mail |
| Pennie's insurance qualification criteria | Income |
| Special enrollment period | Qualifying life events such as losing employer health insurance, change in marital status, the birth of a baby, or moving to a different area |
| Medicare | Federal health insurance for people 65 or older |
| Medicare Initial Enrollment Period | Begins three months before a person turns 65 and ends three months after |
| General Enrollment Period | January 1 to March 31 |
| Medicare Supplement Insurance | Private insurance that fills in the gaps left by Medicare |
| Medicaid | Also known as Medical Assistance (MA); provides health care services for eligible individuals |
| Children's Health Insurance Program (CHIP) | Provides free or low-cost health insurance to Pennsylvania children |
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What You'll Learn
Pennie: Pennsylvania's health and dental insurance marketplace
Pennie is Pennsylvania's official health and dental insurance marketplace. It provides individuals and families with the ability to shop for and compare high-quality health plans and easily apply for financial assistance. Pennie's open enrollment runs from November through January every year, but depending on your personal situation, you may qualify for a special enrollment period. For instance, if you experience certain life changes such as losing your employer health insurance, a change in marital status, the birth of a baby, or if you have moved to a different area, you can sign up for health coverage outside of the open enrollment period.
All Pennsylvania residents who are citizens, U.S. nationals, or have a qualified immigration status can apply and enroll in health coverage through Pennie during an eligible enrollment period. Pennie offers quality health plan options for low or no cost. Nine out of ten Pennie customers qualify for financial savings. You can apply online, in-person, on the phone, or through the mail.
If you are not eligible for Pennie, you may still be able to get health insurance through other programs. For example, if you are 65 or older, certain younger people with disabilities, or people with end-stage renal disease, you may be eligible for Medicare, the federal health insurance program. Depending on your income, you may also qualify for free or low-cost health insurance through Medicaid (also known as Medical Assistance) or the Children's Health Insurance Program (CHIP). Enrollment in these programs is open year-round.
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Medicaid: health care for eligible individuals
Medicaid, also known as Medical Assistance (MA) in Pennsylvania, is a healthcare program that provides health care services for eligible individuals. It helps Pennsylvanians access physical and behavioural healthcare and supportive services essential to living a healthy life.
Medicaid covers a broad range of physical and behavioural health services, including doctor visits, preventive care, health screenings, vaccines, hospital stays, prescription medications, and mental health and substance use disorder care. It also provides access to timely and quality medical care through Pennsylvania's managed care programs, such as HealthChoices. HealthChoices connects people who receive Medicaid benefits with mental health, drug and alcohol services, and community-based support.
To apply for Medicaid, individuals can apply online via COMPASS, in person at a County Assistance Office, by phone, or by mail. When applying, individuals may need to provide proof of household income, information on resources, and their Social Security Number (SSN). It is important to note that Medicaid is available to all Pennsylvania residents, regardless of how long they have been residents.
For those who are not eligible for Medicaid or have lost their coverage, Pennsylvania's official health and dental insurance marketplace, Pennie, offers low-cost or no-cost health coverage options. Pennie's open enrollment typically runs from November through January, but special enrollment periods may be available depending on an individual's circumstances.
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Medicare: federal insurance for people 65+
If you are 65 or older, Medicare is the federal health insurance programme for you. Administered by the federal Department of Health and Human Services, it provides coverage at four different levels, either directly or through private health insurance companies. The four levels are:
- Medicare Initial Enrollment Period: This begins three months before you turn 65 and ends three months after. Enrolling during this period will likely give you the best rates. Enrolling after your initial eligibility may result in higher costs for late enrolment.
- General Enrollment Period: This takes place from January 1 to March 31.
Medicare Supplement Insurance is private insurance that fills in the gaps left by Medicare. For example, when you have a hospital or doctor bill, Medicare pays its approved amount first, then the supplemental insurance pays other costs, such as deductibles and copays.
If you are not eligible for Medicare, you may be able to get low-cost or free health coverage through Pennie, Pennsylvania's official health and dental insurance marketplace. Pennie connects you with financial assistance and helps you shop for, compare, and buy health insurance. Nine out of 10 Pennie customers qualify for financial savings. You can apply online, in-person, on the phone, or through the mail. Pennie's open enrolment runs from November through January every year, but depending on your personal situation, you may qualify for a special enrolment period.
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CHIP: free/low-cost insurance for children
If you are a resident of Philadelphia, Pennsylvania, with a child or children, you may be able to benefit from the Children's Health Insurance Program (CHIP). CHIP is a state- and federally-funded health insurance program that provides health insurance coverage to all children who meet the eligibility guidelines. CHIP is administered by Keystone Health Plan East, Inc. (Keystone Health Plan East) through its Keystone HMO product, which is available to children in Bucks, Chester, Delaware, Montgomery, and Philadelphia counties.
CHIP provides free, low-cost, or full-cost health insurance to children in Pennsylvania who are not eligible for, or enrolled in, Medical Assistance (Medicaid). The child's age, family size, and household income will determine the level of coverage. To be eligible, the child must be a resident of Pennsylvania and meet the eligibility guidelines. CHIP provides medical, dental, vision, hearing, and prescription drug coverage to help your child grow healthy and strong.
You can apply for CHIP through Pennie, Pennsylvania's official health and dental insurance marketplace. Pennie offers quality health plan options for low or no cost. Depending on your personal situation, you may be able to qualify for a special enrollment period outside of the usual open enrollment period, which runs from November through January every year. You can apply online, in-person, on the phone, or through the mail.
If you are already enrolled in CHIP, you must renew your coverage each year to maintain your benefits. It is important to keep your information, such as your address and employment status, up to date to ensure that you can keep your coverage.
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Short-term health insurance plans
Short-term health plans in Philadelphia, PA, do not cover all medical needs and may not cover pre-existing conditions. They often exclude maternity care, prescription drugs, and mental healthcare. They also impose dollar limits on the amount payable. It is important to carefully review the plan's details and consult with licensed agents to find the best plan for your needs and budget.
To qualify for a short-term plan, you will need to complete a health questionnaire from the insurance provider, which assesses your medical history and any recent symptoms or treatments for conditions like cancer, heart disease, or emphysema.
If you are considering a short-term health insurance plan in Philadelphia, it is important to check the specific rules and regulations in Pennsylvania and understand the limitations of these plans.
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Frequently asked questions
You can get medical insurance in Philadelphia, PA through Pennie, Pennsylvania's official health and dental insurance marketplace. You can apply online, in-person, on the phone, or through the mail.
Pennie is Pennsylvania's insurance marketplace and provides individuals and families with the ability to shop for high-quality health plans and easily apply for financial assistance.
All PA residents who are citizens, U.S. nationals, or have a qualified immigration status can apply and enrol in health coverage through Pennie during an eligible enrolment period.
Pennie's open enrolment period runs from November through January every year. However, depending on your personal situation, you may qualify for a special enrolment period outside of this time frame.
Some other options include Medicaid (also known as Medical Assistance), Medicare, and short-term health insurance plans.
