Does it feel like you’re stuck between paying too much or not having health insurance at all?  Millions of Pennsylvanians are being confronted with unbelievable premiums and deductibles that make it impossible to afford healthcare.  Many are paying several hundreds of dollars in premiums each month, only to find that they have up to $6,000 in deductibles before their insurance even pays out.  If you’re between 30 and 64 and are in good health, you are probably paying too much for health insurance, and there’s a reason.

A brief history

Before the Affordable Care Act (ACA), or “Obamacare”, health insurance companies had diverse “pools” of insured individuals who ranged from very healthy to very sick.  These people would each pay a premium, effectively absorbing the cost of each other's health care. Insurance companies usually set different levels of eligibility based on health, in order to keep the premium for all their members within an acceptable price range.  

Under the Affordable Care Act, health insurance companies are required to provide plans to every individual, regardless of preconditions.  That means that no matter how costly a chronically ill individual’s healthcare bills are, they are being absorbed by the “pool” of people paying into it.  That means if you’re a healthy person, you’re paying more than you normally would if you were grouped into a pool of mostly healthy people. So a chronically sick person ends up paying much less for their healthcare while the healthy people shoulder the burden by paying often outrageous premiums and deductibles.  

How does this affect you?

If you're a healthy individual purchasing insurance through the Markeplace and you're paying full price (not getting exemptions or subsidies) then you're probably paying too much for your coverage. 

The marketplace guarantees coverage for all individuals, regardless of their health. That means that healthy people pay the same as someone with a chronic condition. Healthy people end up paying part of the coverage of unhealthy people, therefore the rates have to be higher to cover everybody. 

So what can you do? If you’re someone with a chronic illness, your best option is purchasing insurance through the Marketplace (Obamacare). But if you’re a healthy individual who only goes to the doctor once or twice a year and only needs coverage on bloodwork and major medical expenses, you may be eligible for lower cost options than what you'll find in the Marketplace.  These plans provide necessary healthcare coverages and will exempt you from paying the individual mandate penalty, a fee incurred by those not insured (which averages around $2,000 per family).

A note about the Individual Mandate Penalty:  While the new tax reform bill signed by President Trump did remove the Individual Mandate, it won’t take effect until 2019.  That means if you’re not insured for 2018, you will incur a penalty for each member of your family not insured.

This is why you’re paying more

Obamacare requires health insurance plans to cover things that many people may never need, such as mammograms, pregnancy, pap smears, rectal exams, prostate screenings, mental health, and inpatient/outpatient services.  This large suite of services raises your premium and deductible. Cheaper exempt insurance plans only provide coverage for services that a healthy individual will need. Exempt plans can cut premiums by 75% with no deductible and still provide coverage for important procedures, prescriptions, doctor’s visits, and hospitalization!  By the time you needed a service such as a prostate screening or a mammogram, if you were insured under an Obamacare plan, you would have paid several times more than the cost of the procedure in premiums and deductibles than if you had just paid for it outright.  

Open enrollment is the short period where you're allowed to make changes to your healthcare plan without penalty. However, this only applies to healthcare plans under Obamacare (the Affordable Care Act).  In Pennsylvania, the open enrollment period for 2019 coverage is November 1 to December 15, 2018.

If you need help making sense of Healthcare and finding the right plan, it's best to first talk with a trusted advisor.  Susan My Insurance Lady is a licensed insurance broker in Pennsylvania who will help you pick the right plan and it won’t cost you a dime!  This is an entirely free service to you.

As a licensed Insurance Broker, Susan represents multiple companies, allowing her to work for you without favoritism.  Susan will help you shop the marketplace and find a plan that suits you best, hopefully saving you hundreds a month on health insurance.  Many people don't know they can find plans within or outside of the health insurance marketplace (Obamacare).  Susan will recommend matching plans based on your specific needs.

Read on to see how Susan has helped local residents avoid huge medical expenses or avoiding overpaying for insurance coverage that won’t help them.
*The names and images in these stories have been changed for the protection of our clients.