Pennie can help consumers save dollars
State’s Affordable Care Act marketplace shoudn’t be overlooked
For people under age 65 who are shopping for health insurance, Pennsylvania’s online Affordable Care Act marketplace may be the bargain bin.
Even with an average monthly premium increase of 5.5% starting in January, savings on health insurance through government subsidies can only be found on the state’s online marketplace, called
Pennie. Sign-up for Pennie plans begins Nov. 1 and continues through Jan. 15.
“It’s the only deal for people under 65 if you don’t have a group plan,” said Terri A. Simon, principal at Terri A. Simon Insurance in Forest Hills, who has been selling health insurance since 1996. “You’re getting so much more than they offered before.”
Enhanced subsidies that hold down monthly premiums and trim co-pays and deductibles, which drove the uninsured rate nationally to a record low of 8% this year, continue through 2025, thanks to the Inflation Reduction Act, which was signed into law in August.
Premium tax credits — otherwise known as insurance premium subsidies — on average reduced this year’s premiums by 50% or by $67 per consumer per month, according to the Centers for Medicare and Medicaid Services.
Those savings, along with income-dependent subsidies for co -pays and deductibles, continue through 2025.
“Go to Pennie every year and shop,” said Antoinette Kraus, founding executive director of Pennsylvania Health Access Network, a nonprofit Philadelphia education and advocacy group. “It’s all based on taxable income.”
Pennsylvania residents can choose from 296 plans in the marketplace, with maximum
out-of-pocket expenses of $9,100 for an individual and $18,000 for a family, depending on the monthly premium. Highmark and UPMC are the dominant ACA insurers in Western Pennsylvania.
In previous years, income eligibility for subsidies was capped at 400% of the federal poverty level, or $54,360 for an individual and $111,000 for a family of four. But through 2025, premium subsidies are available above that level if they’re needed to keep the cost of the benchmark plan at no more than 8.5% of household income, doing away with the “subsidy cliff” of previous years.
For example, a 50-yearold Allegheny County resident making $60,000 a year would be eligible for a monthly premium subsidy of $36, leaving a monthly payment of $425 for a silver plan, according to a Kaiser Family Foundation calculator. A bronze plan for the same person would cost $275 a month.
Buying silver plan coverage for a family of three, two adults and a 12-year-old child with the same household income, would cost $247 a month, which includes a monthly premium tax credit of $411.
PHAN’s Ms. Kraus offers a caveat to shopping on Pennie: Keep your marketplace profile up to date, adding information about job changes or loss that affect your income and therefore the health insurance subsidies you receive.
“We’ve seen folks get caught in this,” she said.
Buying health insurance can be a confusing ordeal, Pennie Executive Director Zachery Sherman said, which the marketplace tries to limit.
“It is very complicated and could be overwhelming,” he said. “And that’s why Pennie is here. We’re ready to help people navigate that confusion.”