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Why Are People in Pennsylvania Paying $1,200+ a Month for Health Insurance?
Every January we hear the same thing from Pennsylvanians: "My premium is $1,200 and I never go to the doctor." Here's why that happens.
Reason 1: you're above the subsidy line
Marketplace plans are built around the premium tax credit. If you earn too much to get it, you're paying the sticker price designed to be subsidized. Nobody tells you that's what happened.
Reason 2: guaranteed issue has a cost
Pennie plans must accept everyone regardless of health, and can only price on age, location and tobacco. A healthy 45-year-old and a 45-year-old with multiple chronic conditions pay the same. The healthy person is subsidizing the pool.
Reason 3: Pennsylvania's market
Pennsylvania runs its own marketplace, Pennie, and hospital systems like UPMC and Jefferson are so central that many buyers choose a plan around their doctors — which is exactly what a PPO network question looks like. Pennsylvania has no state individual mandate.
The option most people were never shown
Private shared-network plans — PPOs on the Cigna, Aetna and PHCS PPO networks — price on your health instead of your income. For a healthy person they are often $400–$700 a month less than full-price marketplace coverage, with a national network. They aren't for everyone: there's a health questionnaire, and serious pre-existing conditions can be declined. But if you're healthy and over the subsidy cliff, you're exactly who they were built for.
If you're paying $1,200 a month, you deserve to see the alternative. Check your options — it takes 60 seconds.