‘Tis the season – when many people’s thoughts turn to open enrollment for their health insurance.
For some young adults, making decisions about getting their own health insurance coverage may not be on their minds yet. The Affordable Care Act allows them to get health insurance coverage through their parents’ plan until age 26.
However, once young people reach that age, in most cases, they will have to get health coverage on their own. They may face questions as they prepare to apply for their health insurance – what are the options, what is the process, where can they look for information?
According to information on the Pennsylvania Department of Insurance website, it’s important for young people 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 attention at some point,” the insurance department’s website states. “Health insurance covers essential health benefits, medical care for illnesses and accidents, and protects you from unexpected and high medical costs.”
Lack of insurance can result in large medical bills or avoidance of necessary medical care.
Where to start?
For those Pennsylvanians looking for their insurance for the first time, Pennie’s 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 offers individuals and families the opportunity to purchase health care plans and apply for financial assistance, according to the insurance department.
Established as a state-related entity within Pennsylvania through Act 42 of 2019, Pennie was signed into law by Governor Tom Wolf on July 2, 2019, after passing unanimously in both houses of the General Assembly.
As of August 16, 2022, nearly 375,000 Pennsylvanians had signed up for coverage with Pennie.
What does Pennie offer?
Pennie offers quality and affordable health insurance plans through trusted insurers.
“All health plans sold through Pennie meet the requirements of the Affordable Care Act (ACA), including coverage of 10 essential health benefits. Pennie is also the only place Pennsylvanians 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’s customers, ages 19-34, qualify for financial assistance to lower 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 who may have medical coverage through an employer but not dental coverage.
When should you start the process?
There are several scenarios related to timing, according to Sherman:
• A young adult who has coverage through their parents’ employer and is losing coverage because they turn 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 before losing coverage or 60 days after losing coverage.
• If a young person is enrolled through Pennie and in their parents’ plan, they will not lose coverage until the end of the plan year in which they turn 26. They simply won’t be renewed for coverage under their parents’ plan and can apply separately.
• A person under 26 who does not have coverage through their parents can enroll regardless of eligibility.
Special enrollment periods allow applicants to enroll at any time if they experience certain changes in life circumstances, according to the insurance department’s website.
In addition to young adults being required to drop their parents’ insurance, changes include losing health care insurance through an employer, a change in marital status, or a change in residence. See the full list of Pennie’s qualifying life events for more information.
Open registration for Pennie is from November 1st to January 15th. All Pennsylvania residents who are citizens, US citizens or have 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 advice, as well as local, personalized professionals who can guide applicants through the process.
To get things started, applicants can visit pennie.com, fill out an application to see the financial aid they’re eligible for, easily filter plans to shop, and finally enroll in the best plan health and/or dental for them. Sherman added.
Pennie Certified Assistants and Agents can help answer questions and guide customers through the process. Help 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 through Pennie might cost, according to Sherman.
“Also, because of Pennie’s no-faulty-door policy, starting with Pennie you’ll get the coverage that’s right for you and your situation,” Sherman and Humphreys said in the emailed response.
If an applicant is deemed eligible for Medicaid (Pennsylvania’s Medicaid Program), Pennie will transfer the account to complete enrollment there.