Pennsylvania s Health Care Marketplace

Transcription

1 Pennsylvania s Health Care Marketplace Rating Areas: Insurance plans and their cost vary across the state. Pennsylvania is divided into nine rating areas. Rating areas are the geographic component used to determine plan premiums. Other components are: age, smoking status, and individual or family plan status. Rating area factors include previous health care spending, health care usage, and the cost of doing business in each area. Rating areas are state-established and approved by the Secretary of Health and Human Services. Not all insurers offer the same plans across the state; every county has at least two companies offering insurance through the marketplace. The average number of plans offered to families and individuals in each county is 45, below the national average of 53 plans, according to recent data from the U.S. Department of Health and Human Services (HHS). Plan Offerings: There are 8 organizations representing 10 companies offering plans in the Pennsylvania Marketplace: Aetna and HealthAmericaOne, both owned by Aetna, combine to cover the entire state. Aetna is offering 6 plans in 7 counties primarily in the southeast while HealthAmericaOne is offering 5 plans in the remaining 60 counties. Blue Cross of Northeastern Pennsylvania is offering 12 plans in 13 counties. Capital BlueCross and Keystone Health Plan Central, A Capital BlueCross Company offer plans in the same 21 counties. Capital BlueCross offers only 2 plans, while Keystone Health Plan Central, A Capital BlueCross Company offers 18 plans. Geisinger Health Plans offers 41 plans in 26 counties. Highmark Health Insurance Company and Highmark Health Services, both part of Highmark, operate in the same 49 counties with Highmark Health Insurance Company offering 12 plans and Highmark Health Services offering 14. UPMC Health Plan has 18 plans available in 29 western counties. 1

2 Rating Area 1: Covering eight counties in the northwestern part of the state, rating area 1 represents 536,000 Pennsylvanians under age 65, with 67,000 (13%) that are uninsured. Four insurers are offering 34 unique plans in this rating area. All counties have at least 31 plan options available. Rating Area 1 (34) $237 $119 $331 $404 $203 $563 $543 $274 $759 Bronze (7) $178 $119 $244 $304 $203 $416 $409 $274 $560 Silver (12) $219 $134 $293 $373 $228 $500 $502 $307 $673 Gold (11) $266 $169 $331 $454 $288 $563 $611 $388 $759 Platinum (1) $284 $284 $284 $484 $484 $484 $652 $652 $652 Catastrophic* (3) $138 $104 $198 $236 $177 $337 $317 $238 $454 Rating Area 2: Covering only three counties in the northern part of the state, rating area 2 represents 43,500 Pennsylvanians under age 65, 5,300 (12%) that are uninsured. This rating area is the smallest rating area by population and geography. Five insurers are offering 55 unique plans in this rating area. In Elk County, only 4 insurers offer plans, leaving uninsured residents with 31 options. Rating Area 2 (55) $221 $128 $331 $377 $218 $563 $507 $294 $759 Bronze (11) $176 $128 $244 $300 $218 $416 $404 $294 $560 Silver (20) $208 $148 $293 $354 $253 $500 $477 $340 $673 Gold (16) $248 $177 $331 $423 $302 $563 $570 $406 $759 Platinum (3) $252 $224 $284 $430 $382 $484 $578 $514 $652 Catastrophic* (5) $148 $111 $198 $252 $189 $337 $339 $254 $454 Rating Area 3: Covering 13 counties in the northeastern part of the state, rating area 3 represents 979,000 Pennsylvanians under age 65, with 129,000 (13%) that are uninsured. This rating area is geographically vast with three insurers offering 64 unique plans. Rating Area 3 (44) $222 $141 $330 $378 $240 $562 $509 $323 $757 Bronze (8) $186 $141 $226 $316 $240 $384 $426 $323 $518 Silver (16) $206 $184 $269 $350 $314 $458 $472 $423 $617 Gold (11) $238 $205 $323 $405 $349 $551 $545 $469 $742 Platinum (5) $260 $214 $330 $442 $364 $562 $595 $490 $757 Catastrophic* (4) $147 $92 $181 $251 $157 $309 $338 $211 $415 2

3 Rating Area 4: Covering 10 counties in the southwestern part of the state, rating area 4 represents 2 million Pennsylvanians under age 65, with 223,000 (11%) that are uninsured. This rating area, including Pittsburgh, has four insurers offering 38 unique plans. Rating Area 4 (38) $236 $119 $322 $402 $203 $549 $541 $274 $740 Bronze (8) $180 $119 $238 $306 $203 $405 $412 $274 $546 Silver (13) $216 $134 $286 $367 $228 $487 $495 $307 $656 Gold (12) $263 $169 $322 $449 $288 $549 $605 $388 $740 Platinum (1) $284 $284 $284 $484 $484 $484 $652 $652 $652 Catastrophic* (4) $143 $104 $193 $244 $177 $329 $328 $238 $443 Rating Area 5: Covering 7 counties in the southern part of the state, rating area 5 represents 445,000 Pennsylvanians under age 65, with 58,000 (13%) that are uninsured. This largely rural rating area has 5 insurers offering 55 unique plans. Rating Area 5 (55) $221 $128 $332 $377 $218 $567 $507 $294 $763 Bronze (11) $177 $128 $245 $302 $218 $418 $407 $294 $563 Silver (20) $208 $148 $295 $354 $253 $503 $476 $340 $677 Gold (16) $247 $177 $332 $421 $302 $567 $567 $406 $763 Platinum (3) $252 $229 $284 $429 $391 $484 $578 $526 $652 Catastrophic* (5) $151 $111 $199 $258 $190 $339 $347 $256 $457 Rating Area 6: Covering 10 counties in the middle-eastern part of the state, rating area 6 represents 1 million Pennsylvanians under age 65, with 125,000 (12%) that are uninsured. This rating area has the most options in the state with 8 insurers offering 86 unique plans. Rating Area 6 (86) $235 $133 $383 $400 $226 $653 $538 $305 $880 Bronze (15) $198 $133 $281 $338 $226 $478 $455 $305 $644 Silver (34) $224 $155 $329 $382 $264 $560 $514 $355 $755 Gold (24) $260 $188 $383 $443 $320 $653 $596 $430 $880 Platinum (4) $256 $214 $304 $436 $365 $519 $587 $492 $699 Catastrophic* (9) $148 $103 $182 $212 $0 $310 $339 $237 $417 3

4 Rating Area 7: Covering 4 counties in the south central part of the state, rating area 7 represents 1.2 million Pennsylvanians under age 65, with 156,000 (13%) that are uninsured. This rating area has 6 insurers offering 64 plans. However, only 55 options are available in each county. Rating Area 7 (64) $258 $139 $414 $440 $236 $706 $593 $318 $951 Bronze (13) $209 $139 $291 $355 $236 $496 $478 $318 $668 Silver (26) $243 $159 $355 $414 $271 $606 $558 $365 $815 Gold (16) $282 $192 $414 $480 $327 $706 $646 $441 $951 Platinum (3) $300 $293 $304 $511 $499 $519 $688 $671 $699 Catastrophic* (6) $162 $103 $220 $235 $0 $375 $371 $236 $505 Rating Area 8: Covering 5 counties in the southeastern part of the state, rating area 8 represents 3.4 million Pennsylvanians under age 65, with 405,500 (12%) that are uninsured. This rating area includes Philadelphia and its suburbs and has the fewest plan offerings in the state. Rating area 8 has only 2 insurers offering 27 plans. However, only 55 options are available in each county. Rating Area 8 (27) $287 $195 $357 $488 $332 $608 $658 $447 $819 Bronze (9) $229 $195 $251 $390 $332 $427 $525 $447 $575 Silver (7) $260 $210 $291 $443 $358 $496 $596 $482 $667 Gold (6) $316 $250 $348 $538 $426 $592 $725 $574 $798 Platinum (2) $342 $326 $357 $582 $556 $608 $784 $749 $819 Catastrophic* (3) $176 $171 $184 $301 $291 $314 $405 $391 $423 Rating Area 9: Covering 7 counties in the south central part of the state, rating area 9 represents 718,500 Pennsylvanians under age 65, with 87,500 (12%) that are uninsured. Rating area 9 has 6 insurers offering 70 unique plans. Only 31 options are available in Franklin County with options available in the remaining 6 counties. Rating Area 9 (70) $234 $130 $390 $398 $222 $665 $536 $299 $895 Bronze (13) $190 $130 $258 $325 $222 $439 $437 $299 $592 Silver (29) $223 $152 $335 $379 $259 $570 $511 $348 $768 Gold (18) $258 $184 $390 $440 $314 $665 $593 $422 $895 Platinum (4) $263 $221 $299 $448 $376 $509 $604 $506 $685 Catastrophic* (6) $142 $112 $187 $201 $0 $319 $327 $256 $429 *Catastrophic coverage is not included in average, minimum and maximum calculations due to eligibility requirements and limited benefits not comparable to essential health benefits provided in metal level plans. 4

5 Number of Plans Available by County and Medal Level County Bronze Silver Gold Plat. Cata. Total County Bronze Silver Gold Plat. Cata. Total Adams Lackawanna Allegheny Lancaster Armstrong Lawrence Beaver Lebanon Bedford Lehigh Berks Luzerne Blair Lycoming Bradford Mc Kean Bucks Mercer Butler Mifflin Cambria Monroe Cameron Montgomery Carbon Montour Centre Northampton Chester Northumberland Clarion Perry Clearfield Philadelphia Clinton Pike Columbia Potter Crawford Schuylkill Cumberland Snyder Dauphin Somerset Delaware Sullivan Elk Susquehanna Erie Tioga Fayette Union Forest Venango Franklin Warren Fulton Washington Greene Wayne Huntingdon Westmoreland Indiana Wyoming Jefferson York Juniata