‘Tis the season — when many people’s thoughts turn to open enrollment for their health insurance.
For some young adults, making decisions about obtaining their own health insurance coverage may not be top of mind — yet. The Affordable Care Act allows them to receive health insurance coverage through their parents’ plan, up to age 26.
Once young adults hit that age, however, they will need to obtain health coverage on their own, in most cases. They may be faced with questions as they prepare to search for their own health insurance — what are the options, what’s the process, where can they look for information?
According to information on the Pennsylvania Insurance Department website, it’s important for young adults to understand their health insurance options early so they’re ready to make a decision when the time comes.
“No one plans to get sick or hurt, but most people will need medical care at some point,” the insurance department’s website states. “Health insurance covers essential health benefits, medical care for illness and accidents and protects you from unexpected, high medical costs.”
Not having insurance can result in large medical bills or avoiding necessary medical care.
A flyer from Pennie, Pennsylvania’s health insurance marketplace, with information for young adults seeking health care. (PHOTO COURTESY OF PENNIE)
Where to start?
For those Pennsylvania residents looking for their own insurance for the first time, Pennie is the state’s one-stop shop for affordable health and dental insurance plans, according to Executive Director Zachary Sherman.
Pennie is Pennsylvania’s official health insurance marketplace and provides individuals and families with the ability to shop for health care plans and apply for financial assistance, according to the insurance department.
Established as a state-affiliated entity within Pennsylvania through Act 42 of 2019, Pennie was signed into law by Gov. Tom Wolf on July 2, 2019, after passing unanimously through both chambers of the General Assembly.
As of Aug. 16, 2022, nearly 375,000 Pennsylvanians had signed up for coverage with Pennie.
What does Pennie provide?
Pennie provides quality, affordable health insurance plans through trusted insurers.
“All health plans sold through Pennie meet requirements of the Affordable Care Act (ACA), including covering the 10 essential health benefits. Pennie is also the only place for Pennsylvanians to receive financial savings to help lower the cost of coverage and care,” Sherman said in an emailed response to questions.
He added that nine out of 10 Pennie customers, ages 19-34, qualify for financial assistance to reduce the monthly cost of health insurance.
Among the health benefits included in Pennie are regular doctor visits; emergency services and hospitalizations; maternity and newborn care; prescription drug coverage; and preventive services, according to Pennsylvania Insurance Commissioner Michael Humphreys.
Pennie also offers stand-alone dental plans for those that might have medical coverage through an employer but not dental coverage.
When should you start the process?
There are a couple of scenarios related to timing, according to Sherman:
• A young adult who has coverage through their parents’ employer and is losing coverage due to turning 26 — most likely at the end of the month they turn 26 — will qualify for a special enrollment period through Pennie and can contact Pennie or apply up to 60 days prior to their loss of coverage or 60 days after their loss of coverage.
• If a young adult is enrolled through Pennie and on their parents’ plan, they will not lose coverage until the end of the plan year in which they turn 26. They just won’t be renewed for coverage under their parents plan and can apply separately.
• A person under 26 who doesn’t have coverage through their parents can enroll regardless, if they qualify.
Special enrollment periods allow applicants to sign up any time if they experience certain changes in life’s circumstances, according to the insurance department website.
In addition to young adults required to come off their parents’ insurance, the changes include losing health care insurance through an employer, a change in marital status, or a change in residence. View the full list of Pennie’s qualifying life events for more information.
Open enrollment for Pennie is Nov. 1 through Jan. 15. All Pennsylvania residents who are citizens, U.S. nationals, or have a qualified immigration status can apply and enroll in health coverage through Pennie.
What is the process?
Sherman said Pennie makes the process of enrolling in health coverage easy, and offers online tools and tips, as well as local, personalized professionals who can guide applicants through the process.
Pennsylvania residents can shop for health care plans through Pennie, Pennsylvania’s health insurance marketplace. (PHOTO COURTESY OF PENNIE)
To get things going, applicants can visit pennie.com, fill out an application to see the financial assistance for which they’re eligible, easily filter plans to shop around, and finally enroll in the best health and/or dental plan for them, Sherman added.
Pennie-certified assisters and brokers can help answer questions and guide customers through the entire process. Assistance can be found at pennie.com/connect or by calling Pennie customer service at 1-844-844-8040.
Applicants can also use Pennie’s plan comparison tool to see how much health coverage may cost through Pennie, according to Sherman.
“Also, because of Pennie’s no-wrong-door policy, starting at Pennie means you’ll receive the coverage that is right for you and your situation,” Sherman and Humphreys said in the emailed response.
If an applicant is deemed eligible for medical assistance (Pennsylvania’s Medicade Program), Pennie will transfer the account to finish the enrollment there.